Ultrasounds are among the most used imaging in healthcare. But some in the health IT industry see an alternative way of conducting ultrasounds that they say can help with issues from staffing shortages to health equity.

Dr. John Martin is chief medical officer at Butterfly Network, an ultrasound platform vendor. He sees point-of-care ultrasound (POCUS) devices as the future of this school of imaging.

We interviewed Martin to discuss the future of POCUS, the role artificial intelligence can play with POCUS, and its use to address health equity.

Q. You suggest that in a couple of years, POCUS will be widespread across healthcare organizations as an affordable, scalable way to improve and speed up diagnostics. How do they work, and what factors do you see driving the adoption of these devices?

A. In many care scenarios, the ability to reduce the time it takes to make a better clinical decision is critical. In the past, healthcare providers followed the path of "history, physical, pause," and thereafter, a clinician decided whether a patient should get imaging.

This involves long periods of waiting, sometimes weeks at a time, leading to patient anxiety and frustration. If a clinician is contemplating what is wrong, approximately 80% of the time, simple imaging can answer the question.

With a POCUS device in hand, care teams can now transition to "history, physical, POCUS exam," moving imaging to the left of the care continuum to provide the right information, make better decisions and provide rapid care.

Traditional cart-based ultrasound and first-generation point-of-care ultrasound have been around for some time, but newer semiconductor chip-based, stapler-sized, less costly probes make clinical assessment imaging not only possible, but highly practical.

The newer devices are portable, affordable, durable, and through the support of AI and software are highly usable in addition to being easily integrated within existing clinical systems and workflows.

As we continue to show the impact of thinking differently with better information earlier in care, the interest for ultrasound information to enable more informed clinical decisions will grow and, in time, will change the paradigm of care delivery.

Especially as hospitals and health systems continue to face staffing shortages, as value-based care models gain ground and as home-based care becomes more ever-present. Caregiver access to convenient, intelligent, ready-to-use imaging at the bedside will become that much more important to optimize resources and eliminate waste while simultaneously improving outcomes.

Also, such simple, affordable imaging can meaningfully advance health equity across geographies, specifically in rural areas where access to radiologists is limited and can result in significant inconvenience to patients, let alone delays in care.

Q. AI is growing in use to help bridge the gap created by the staffing shortages in healthcare. In your experience, how is AI enabling staff with less training to do more?

A. Cross-setting and cross-specialty use of ultrasound information not only improves and speeds diagnostic decision-making at the point of care, but also addresses growing burdens on the radiology field. The reality is that the demand for imaging has risen at much faster rates relative to other health services in recent years, all while the pool of radiologists has steadily dwindled.

AI-powered imaging that draws from a deep repository of data and provides robust guidance delivers the framework needed to expand healthcare's view of where, how and who can use diagnostic imaging. For example, paramedics have effectively introduced handheld ultrasound into cardiac assessment without disrupting resuscitation protocol.

Other care teams are using handheld ultrasound to determine heart failure without the need to order and await the results of a chest X-ray. And notably, a recent study conducted by UNC Health found that nurse midwives using handheld ultrasound probes could perform at the level of trained sonographers when trying to obtain measures such as fetal age.

By rethinking "the way it has always been done," a wide variety of specialties are poised to overcome the limits of too few machines and professionals. Not to mention to only call upon radiating testing for patients when absolutely necessary.

Q. How can POCUS devices address health equity concerns?

A. Across the United States, the more portable, affordable and usable ultrasound probes hold tremendous promise for growing scarcity of radiology resources in rural areas. And, in the two-thirds of the world where medical imaging is absent altogether, use of handheld ultrasound can introduce a care modality that otherwise does not exist.

Ultrasound information at the point of care closes information gaps faster, improves the accuracy of timely diagnostics and, simply put, can save lives. This is true in low-mid income nations and in parts of higher-income countries.

It's one reason the Gates Foundation recently provided a $5 million grant to Butterfly to bring 1,000 handheld ultrasound devices to Sub-Saharan Africa to improve community access to medical imaging. This is a crucial step toward enhancing care using innovative technology in some of the most remote settings around the world.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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