Primary Care Reports – Advances in Point of Care Ultrasound Technology – GE Healthcare

SPECIAL REPORT

Advances in Point of Care Ultrasound Technology The Benefits of Ultrasound Use in Primary Care Rising to the Challenge: Handheld Diagnostics and the Future of the NHS Point of Care Ultrasound: Improving Technologies and Changing Demand Buying Guide: Choosing the Best Portable Ultrasound Scanner The Future of Point of Care Ultrasound

Published by Global Business Media

‘SPECIAL REPORT: ADVANCES IN POINT OF CARE ULTRASOUND TECHNOLOGY

SPECIAL REPORT

Advances in Point of Care Ultrasound Technology The Benefits of Ultrasound Use in Primary Care Rising to the Challenge: Handheld Diagnostics and the Future of the NHS

Contents

Point of Care Ultrasound: Improving Technologies and Changing Demand Buying Guide: Choosing the Best Portable Ultrasound Scanner The Future of Point of Care Ultrasound

Foreword

2

Tom Cropper, Editor

The Benefits of Ultrasound Use in Primary Care

3

GE Healthcare

Published by Global Business Media

Published by Global Business Media Global Business Media Limited 62 The Street Ashtead Surrey KT21 1AT United Kingdom Switchboard: +44 (0)1737 850 939 Fax: +44 (0)1737 851 952 Email: info@globalbusinessmedia.org Website: www.globalbusinessmedia.org Publisher Kevin Bell Business Development Director Marie-Anne Brooks Editor Tom Cropper Senior Project Manager Steve Banks Advertising Executives Michael McCarthy Abigail Coombes Production Manager Paul Davies For further information visit: www.globalbusinessmedia.org

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Introduction The Benefits Versatility First-Line Diagnosis Clinical Studies Training Funding Conclusion

Rising to the Challenge: Handheld Diagnostics 8 and the Future of the NHS Tom Cropper, Editor

The NHS Funding Crisis Improving Diagnosis Cost Considerations

Point of Care Ultrasound: Improving Technologies and Changing Demand

10

Jo Roth, Staff Writer

Image Quality Point of Care Obstacles How Demand is Changing Technology Goes Small

Buying Guide: Choosing the Best Portable Ultrasound Scanner

12

James Butler, Staff Writer

Assessing the Cost Real World Performance New versus Used Choosing a Supplier Researching the Market

The Future of Point of Care Ultrasound

14

Tom Cropper, Editor

A Growing Market The Latest Technology What the Future Holds

References 16

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SPECIAL REPORT: ADVANCES IN POINT OF CARE ULTRASOUND TECHNOLOGY

Foreword

W

HEN PEOPLE think of an ultrasound

to more timely and accurate diagnosis and help the

machine they still revert to the traditional

NHS meet their key targets. The big question is cost.

image of bulky apparatus which requires a

However, there is a choice available and they offer

specialist to operate. Increasingly, though, pocket-

sustained operational savings.

sized devices which bear a greater resemblance to

Jo Roth then looks at the evolving market. Portable

smartphones are making their presence felt and, as

ultrasound is not an entirely new concept, but

they do, they are revolutionising the way hospitals

advances in technology promise to take it onto a new

provide care.

level. He looks at how the technology is changing and

Our opening article comes from GE Healthcare. In

how demands are evolving.

2010, they revolutionised the market with the Vscan,

With such a growing market, choosing between the

a high tech mobile ultrasound scanning device. This

options on offer can be challenging. James Butler

year they released an update – the Vscan ExtendTM,

offers a short buying guide to help managers choose

which adds improved performance, mobility and

the best solution for their needs.

connectivity. They explain how it works and why they

Finally, we’ll look at the features on offer with the

see it as breaking new ground in the way healthcare

latest technology and how they are sparking rapid

is delivered.

change. The technology has enormous potential,

We then look at some of the challenges facing the healthcare sector. A shortage of staff, withering

but just how much can it do? This is what we’ll try to answer in this Report.

finances, and rising demand call for innovative solutions. Handheld ultrasound scans offer an answer to all those issues – they can improve productivity, lead

Tom Cropper Editor

Tom Cropper has produced articles and reports on various aspects of global business over the past 15 years. He has also worked as a copywriter for some of the largest corporations in the world, including ING, KPMG, and Zurich Insurance.

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SPECIAL REPORT: ADVANCES IN POINT OF CARE ULTRASOUND TECHNOLOGY

The Benefits of Ultrasound Use in Primary Care GE Healthcare

Many GPs refer patients for ultrasound for suspected gallstones or deep vein thrombosis whereas, with training, Introduction Handheld ultrasound devices are set to transform the primary care environment. Some are now pocket-sized and their increased convenience and powerful visualisation enhance the physical examination by providing immediate information that can help determine the optimised course of diagnosis and treatment for your patients.

The Vscan Extend TM, launched by GE Healthcare earlier this year, is one such pocketsized, app-based device available with a sector probe or a dual probe that includes both sector and linear transducers. The probe connects to a hand-held console that has wireless connectivity to hospitals’ DICOM® systems* and cloud-based archiving solutions. In this way, secure, seamless and standard communication is ensured between different healthcare providers. * Valid for systems with Wi-Fi and DICOM configurations.

The Benefits General Practitioners and other primary care professionals are showing increased interest in handheld ultrasound as it’s ideal for opportunistic scans for acute problems as well as for routine booked consultations. The potential benefits of using ultrasound in primary care settings are numerous:

•F or your patient’s peace of mind and understanding of their condition • For confident referral decisions on the spot •A voids unnecessary referrals to secondary care • Reduces time by enhancing your productivity •R educes patient wait times through quicker consultations •Q uick and non-invasive for your patients • Can help you improve patient outcomes •C an provide important information that the physical examination can miss •T he Vscan ExtendTM enhances your workflow with wireless image export and DICOMTM* connectivity • Customisable to your needs and care areas

this could be better managed in general practice

* Valid for systems with W-iFi and DICOM configurations.

Taking a closer look at the Vscan ExtendTM, you will see that it is surprisingly capable. The Vscan ExtendTM is: SIMPLE: Enabling you to streamline patient evaluations and make diagnostic decisions with confidence • Easy to use, intuitive touchscreen interface you can operate with just your thumb • Rapid access to pertinent clinical data WWW.PRIMARYCAREREPORTS.CO.UK | 3

SPECIAL REPORT: ADVANCES IN POINT OF CARE ULTRASOUND TECHNOLOGY

General Practitioners

• Automated suggestion of caliper placements for bladder volume • Automated preset selection, image annotation, and structured reporting for thorax evaluation • Convenient presets • Quick and easy to clean

• Leverages on Vscan’sTM proven image quality • Enables decisive action in critical moments • Supports appropriate referrals • Helps you optimise course of treatment •M ay help you improve patient outcomes and reduce cost of care

FAST: Allowing you to expedite workflow and make quick, informed assessments and treatment decisions on the spot

With sophisticated pocket-sized ultrasound devices such as Vscan Extend now readily available, this technology is more accessible to primary care providers than ever before.

•G ives immediate access to important information •T wo transducers in one saves time when switching between deep and shallow examinations • Rapid power-on from standby •S eamless image storage and data transfer* to quickly communicate vital information and refer for a second opinion •A utoCycle to capture a colour cine clip of the blood flow in a single heartbeat PRECISE: Providing the critical information required to determine the origin of a complaint

*Valid for systems with Wi-Fi configurations

Versatility The sector probe (a phased array for deep scanning) and the dual probe (combining a linear array for shallow scanning and a phased array for deep scanning) of the Vscan ExtendTM enable a broad range of applications for the primary care provider. These range from basic abdominal examinations, urological complaints, chest pain, vascular issues and basic antenatal examinations.

and other primary care professionals are showing increased interest in handheld ultrasound as it’s ideal for opportunistic scans for acute problems as well as for routine booked consultations

SECTOR PROBE FOR DEEP SCANNING AND LINEAR PROBE FOR SHALLOW SCANNING

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SPECIAL REPORT: ADVANCES IN POINT OF CARE ULTRASOUND TECHNOLOGY

The VscanTM is supported by far more published clinical papers than any other pocket-sized* ultrasound device. In addition, these papers provide evidence of its effectiveness across a range of clinical settings. However, with the gradual shift of certain diagnostics away from the hospital environment and in to General Practice surgeries and the patient’s home** the role of pocket-sized ultrasound is becoming ever more important. This is because this level of versatility and portability is also driving its successful adoption by the Emergency Services and the military.

Portable ultrasound is increasing access to healthcare for the young through to the very old in urban, rural and even remote areas.

With an ageing population and an increasingly overburdened health service, being able to treat and monitor a patient at the point of care is becoming ever more important. * Compact enough device that fits in a lab white coat pocket ** C onsult the user manual for the appropriate environmental conditions for the product that you are using.

First-Line Diagnosis Many GPs refer patients for ultrasound for suspected gallstones or deep vein thrombosis whereas, with training, this could be better managed in general practice. More basic antenatal screening could also be performed in the community with the Vscan ExtendTM. Fundamental concerns of ascertaining the position of the baby in the final trimester can easily be accomplished using pocket-sized ultrasound devices. To be able to offer this service at local clinics or at the patient’s home*, provides obvious convenience for pregnant women.

* The device has been verified for limited use outside of professional healthcare facilities including during transport.

Use is restricted to environmental properties described in the user manual. Please contact your GE Healthcare sales representative for detailed information.

Further emphasising its important role in firstline diagnosis, pocket-sized ultrasound is being increasingly used as a complement to the stethoscope. At the end of 2015, Kings College University became the first University Medical School in the country to pilot the use of pocket-sized ultrasound as an aide to medical education. The Vscan with Dual ProbeTM was used alongside the traditional stethoscope when teaching medical students in the clinical environment.

Until then, doctors had used the stethoscope to make an initial judgement, often using other tests, such as x-rays and CT scans to confirm a diagnosis. This may increase the time it takes to treat patients, and could expose them to unnecessary radiation.

Dr Mamoun Abu-Habsa, Consultant in Emergency Medicine at King’s College Hospital, who led the pilot said, “Portable ultrasound is the diagnostic tool of the future. When a patient is very unwell, being able to see as well as hear what’s happening aids a physician’s ability to make an accurate and speedy diagnosis.

Evidence shows the earlier you can diagnose and administer treatment, the better the outcome for the patient.”

He added, “The stethoscope is a valuable tool to a physician. Although it won’t become entirely redundant, we need to combine its use with emerging technology so we are using the most efficient tools, fit for modern-day medicine.

It’s easy to appreciate the diverse applications and benefits of ultrasound in primary care, but, in addition, pocket-sized ultrasound devices boot-up rapidly and are realistically priced for primary care settings

36 WEEK FOETAL SCAN

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SPECIAL REPORT: ADVANCES IN POINT OF CARE ULTRASOUND TECHNOLOGY

COGORA AND GE HEALTHCARE’S PRIMARY CARE TRIAGE ACADEMY

Portable ultrasound is increasing access to healthcare for the young through to the very old in urban, rural and even remote areas

When teaching the next generation of doctors, it’s vital that we embed innovative diagnostic skills right from the start so they can be developed over the course of a doctor’s training and utilised throughout their career.”a It’s easy to appreciate the diverse applications and benefits of ultrasound in primary care, but, in addition, pocket-sized ultrasound devices bootup rapidly and are realistically priced for primary care settings.

Clinical Studies With increased awareness and usage of ultrasound in primary care settings, relevant clinical studies are also increasing in number.

For example, Colli & Casazzab found that after a simple and short training course, a pocketsized ultrasound device examination can be used in addition to a physical examination to improve the answer to ten common clinical questions concerning in- and outpatients, and can reduce the need for further testing. Mbuyita & Mbaruku c concluded that it is possible to train health providers to conduct some routine scanning using the VscanTM at primary health facility level and to produce quality scans and correct diagnosis similar to that of an expert sonologist.

Training Training is of course a key precursor for using ultrasound. Students at the University of Leeds became the first in the UK to be given ultrasound training during their five year medical degrees. This early introduction of ultrasound can enhance current anatomy teaching, improve clinical skills teaching and teach core skills essential for practice as a foundation year doctor and beyond.

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So, whilst the future looks bright for increased ultrasound usage in primary care with this emerging new generation of healthcare practitioners, this does not mean that more established practitioners are being left behind.

There is good adoption of a variety of training solutions by primary care practitioners of all experience levels.

There are a number of accredited training programmes on the market to suit all learning styles from live workshops to online courses.

For example, the largest online medical platform for learning ultrasound and echocardiology is 123sonography.com from the Medical University of Vienna. The course is CME accredited with over 20,000 clients from over 200 countries.

The Primary Care Triage Academy is another option offering online resources and ultrasound workshops for GPs and GP commissioners.

Free-of-charge and run in a partnership between Cogora and GE Healthcare, it proved to be a popular programme in 2017 and further courses are planned for the future.

Funding Pocket-sized ultrasound devices also mean ultrasound is now within reach of typical primary care budgets. The Vscan ExtendTM, depending on specification and configuration, retails between £6000 and £7000. Total cost of ownership is mitigated with a 3 year warranty and initial installation training to ensure that you can achieve the most from your investment.

Financing options are also available such as three or five year leases, rental or rent-to-buy.

Whilst more studies in primary care settings, as opposed to secondary care, are needed to better quantify cost savings, primary care

SPECIAL REPORT: ADVANCES IN POINT OF CARE ULTRASOUND TECHNOLOGY

users of ultrasound have little doubt concerning the economic benefits that portable ultrasound can deliver.

There is good adoption of a variety of training

Conclusion

solutions by primary

With a steady increase to now 8% of GP practices in the UK using Ultrasoundd, all indications are that this growth trend will continue. In light of the numerous benefits of ultrasound use in primary care settings, the last word should be left to James White a recent delegate of the Primary Care Triage Academy, he said “I’ve thought about ultrasound in Primary Care for quite a long time…. It’s going to come whether people like it or not.”

care practitioners of all experience levels

References: Kings College Hospital Press Release. Karen Welsh. 30 Dec 2015

(a)

Colli A, Prati D, Fraquelli M, Segato S, Vescovi PP, Colombo F, et al. (2015) The Use of a Pocket-

(b)

Sized Ultrasound Device Improves Physical Examination: Results of an In- and Outpatient Cohort Study. PLoS ONE 10(3): e0122181. doi:10.1371/ journal.pone.0122181 Mbuyita S, Tillya R, Godfrey R, Janeen U, Mukherji K, et al. (2014) Uptake of Training on Vscan

(c)

by Midlevel Providers Working in Rural Health Facilities in Tanzania: Implications for Reliability.

J Biosafety Health Educ 2: 123.doi:10.4172/2332-0893.1000123 Cogora & GE Healthcare Triage Academy Website and Cogora UK data on file 2016

(d)

This early introduction of ultrasound can enhance current anatomy teaching, improve clinical skills teaching and teach core skills essential for practice as a foundation year doctor and beyond

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SPECIAL REPORT: ADVANCES IN POINT OF CARE ULTRASOUND TECHNOLOGY

Rising to the Challenge: Handheld Diagnostics and the Future of the NHS Tom Cropper, Editor How handheld ultrasound devices can help hospitals meet some of their key operational challenges.

A The population is aging.

People are living longer and with more complex and long lasting chronic conditions

S THE UK entered a snap election, one of the key battlegrounds quickly became the running of the NHS. With money tight, experts were predicting catastrophe unless the government found more money.

Unfortunately, none of the main party manifestos offered the level of funding needed, which means managers must look to innovative solutions to manage the conflicting goals of improving performance while cutting costs. One possible option lies in the growth of point of care solutions.

The NHS Funding Crisis Budgets are under strain. The Conservative Manifesto promised more than £8bn additional spending between now and 20201. However, it was vague about where this was coming from and when it would be implemented. The Government admitted it would not be new spending, prompting many to question whether this funding would ever appear. Even if it did, the Nuffield Trust pointed out that spending as a percentage of national income on the NHS would continue to fall2.

The population is aging. People are living longer and with more complex and long lasting chronic conditions. A report found that 70% of the NHS budget is spent on people with long term conditions3 and who need ongoing care.

Unless the NHS found a way to care for long term conditions more effectively, the report warned, the NHS in the form we know it could become unsustainable. The next ten years will see a continuing rise in life expectancy as medical technologies improve which, in turn, will see long term conditions become an even bigger issue.

Patient expectations are also changing. The Health Secretary, Jeremy Hunt, has been relentless in his drive to provide greater choice and wider flexibility for patients, which includes 8 | WWW.PRIMARYCAREREPORTS.CO.UK

access to medical records and seven-day opening for GP practices. They receive a high standard of personalised service in their day to day lives and are used to receiving flexible services which make use of the very latest technology. They live busy lives and are looking for options which fit in with their daily routines.

Improving Diagnosis The NHS faces major challenges in relation to improving the accuracy and speed of diagnosis and enhancing patient experience while in hospital. The traditional diagnostics approach can leave much to be desired. Doctors will make an initial determination – as they have done for decades – with a simple stethoscope. While this has proved its value for more than a hundred years, it has obvious limitations in that it can only deliver sound and relies on the judgement of that doctor at that time. For more detailed assessments, patients will need to be taken for an ultrasound scan – and that can be disruptive, time consuming and stressful.

Improved point of care treatment can solve this.

Tests and diagnostics which can be carried out at a patient’s bedside allow medical professionals to get results back in the shortest possible time.

It means patients will not have to be disturbed and, more importantly, doctors see the results much more quickly. Being able to see results in real-time helps patients to become more informed and involved in the treatment process.

The market for point of care treatment is growing rapidly. It is expected to reach $36.96bn by 2021 growing at a CAGR of 9.8%, according to a report from MarketsandMarkets4. Growth is spurred by rising demand and also the increasing sophistication of the technology available.

Portable systems are being developed which offer time saving opportunities in a range of fields from glucose monitoring to urinalysis, cholesterols, drugs use and ultrasound.

SPECIAL REPORT: ADVANCES IN POINT OF CARE ULTRASOUND TECHNOLOGY

Handheld ultrasound products can do a huge amount to improve performance. Doctors now have much more than their traditional stethoscopes to help them with a diagnosis. They can use a scanner to get detailed images, which can help diagnose issues such as fluid in the chest, heart conditions and much more right at the bedsides. Some of the latest devices can be used by people in the home and the emergency services, improving assessments for the people who need them most.

Cost Considerations The big barrier to the rise of handheld ultrasound equipment is the cost. Devices can retail for several thousand pounds apiece. Managers balancing tight budgets will naturally be reluctant to shoulder such a large initial investment.

However, against those costs managers should measure the savings.

By streamlining the diagnostics process, handheld devices reduce the amount of time that it takes to get results. Turnaround times improve as does the accuracy of the initial diagnosis, which reduces uncertainty and the risk of mistakes leading to complications. Being

able to use the system in real time and involve the patient in the process also helps hospitals meet their goals of meeting patient expectations.

This is a system which continues to save money the longer it is used and helps hospitals meet their key targets. There is a clear return on investment if a manager can overcome the initial investment. Some NHS Trusts, such as the Royal Surrey County Hospital, have placed handheld ultrasound scanners in their wish-lists for charitable funding5. However, the benefits are so clear that, despite the cost, this is something managers should be looking at.

The challenges facing the NHS are very real: budgets are falling, staff numbers are in decline, demand for services is growing and more people are living with long term and complex medical conditions. Managers can react in two ways: they can cut costs where they can and avoid buying complex new machinery or they can use their budgets by buying smartly in other words, bringing in new technologies which are shown to improve performance and reduce operating times. These represent the best way for Trusts to meet their demanding longterm funding challenges.

The NHS faces major challenges in relation to improving the accuracy and speed of diagnosis and enhancing patient experience while in hospital

By streamlining the diagnostics process, handheld devices reduce the amount of time that it takes to get results

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SPECIAL REPORT: ADVANCES IN POINT OF CARE ULTRASOUND TECHNOLOGY

Point of Care Ultrasound: Improving Technologies and Changing Demand Jo Roth, Staff Writer Ultrasound technology is becoming smaller and more mobile. How far can it go?

T Image quality is improving rapidly with leading manufacturers capable of producing crystal clear images in high resolution and bright colour quality

HE FUTURE is bright for ultrasound technologies. With demand for portable point of care technology rising, the global ultrasound market is set for substantial growth over the next few years. Growth is being triggered by a number of factors, not least of which is the changing way healthcare professionals use ultrasound technologies and the greater capacity of the latest systems. They offer a new approach which improves image clarity, diagnosis speeds and accuracy. In this article, we’ll look at the key technological developments which are shaping the portable ultrasound market.

Image Quality Image quality is improving rapidly with leading manufacturers capable of producing crystal clear images in high resolution and bright colour quality. Vendors are focusing on improved image technology with some of the leading names pushing beyond 2D and into 3D and even 4D ultrasound technologies. The development of cutting-edge imaging technology is pushing the boundaries of quality forward with some of the leading providers claiming to offer near CT-quality clarity. Others have been moving into areas which would traditionally have been difficult for ultrasound, such as the profusion of slow-flow vessels. 4D imaging technology introduces motion into the scan and make it easier to deliver repeatedly consistent results from multiple scans.

Point of Care Improved ergonomic designs enable ultrasound systems to respond to the growing demand for devices which can go beyond the laboratory, into the field and the patient’s bedside. To achieve this, vendors have condensed technology into small handheld devices which can be used anywhere. The introduction of lighter casings 10 | WWW.PRIMARYCAREREPORTS.CO.UK

reduces weight, while touchscreens cut out the need for cumbersome keyboards, as well as offering an intuitive method of operation similar to smartphones. All the time, screen resolution is increasing with small handheld devices being capable of rendering high quality scans to doctors and operators wherever they are.

A number of vendors have introduced ultrasound Apps which can transform an ordinary smartphone into a handheld ultrasound device.

It’s a major step forward and one which, not only improves the mobility of ultrasound technology, but also drives down the cost.

Other handheld devices are going beyond improved image quality and delivering data that can communicate with other systems. For example, they could automatically update a patient’s electrical medical record with an ultrasound scan.

Obstacles For all these advances, though, vendors still have a challenging time promoting widespread adoption. If legacy systems have been seen to perform adequately, managers and individual staff will be reluctant to make a change, particularly if that change represents an increased cost. At a time when budgets are tight buyers become intrinsically cautious. That’s not to say they will not make a purchase, but they do need to see a tangible return on investment.

A key advance is the ability to reduce operator variability. Many current models will deliver a different result depending on the location of the scan. Operators need to run repeated scans in order to achieve a reliable result. Devices which can produce reliable and repeatable results will be central to the future.

How Demand is Changing Requirements for ultrasound imaging are certainly changing. Doctors want improved imaging

SPECIAL REPORT: ADVANCES IN POINT OF CARE ULTRASOUND TECHNOLOGY

technologies, greater portability, and more compact and ergonomic design. Vendors are responding with a new generation of highly advanced imaging technologies which deliver a major step forward on traditional options.

However, their greatest quality is also their biggest weakness. These are innovative and ground-breaking systems but, while the technology is excellent, vendors face a challenging time communicating those advantages to the users. Buyers will need to be propelled by the limitations of traditional 2D options as well as the improved quality of future systems.

Sellers are countering those arguments with several strategies. The first is to raise awareness – to show exactly where new technology can spark improvements and how it may contribute to lower overall operational costs. The more it is used in the real world, the more solid examples they have at their disposal to demonstrate.

At the same time, they are refining the technology to reduce the cost obstacle.

Advances in the transducer design, more efficient manufacturing techniques and reliability improvements reduce the total cost of ownership, as well as the upfront costs. As this is achieved, so the sums being calculated by potential buyers become increasingly favourable. Work is being carried out, also, to make the devices more accessible and intuitive so they could be used by non-certified staff which, in turn, improves overall performance.

Technology Goes Small Miniaturisation is a key feature of modern technology and it’s no different here. Ultrasound is moving beyond simple portability, to hand held, pocket sized devices which can go anywhere. They enable people to go to a patient’s bedside and perform quite detailed scans,

to provide a more accurate initial assessment.

Sometimes this will highlight an issue which may prompt a more detailed scan but, at others, it is enough to replace the need for a new scan entirely.

Paramedics are adopting the latest models as they allow them to perform instant scans on patients at the site of an accident. By improving that first assessment, therefore, they have the potential to significantly increase survival rates. They change the way people receive care with people being able to receive a more comprehensive initial assessment at the early stages.

Obstacles remain. NHS Trusts can be slow to change and managers will have different opinions about how they see and quantify the value on offer. As things stand, many feel they cannot justify the upfront cost which means the challenge for sellers is to overcome that objection. How do they do that? They can try several approaches. Promoting the long-term cost advantages of a new solution can do some of the work, but managers may still feel the short-term cost is too high. There is a huge reservoir of untapped potential custom available – trusts which want a handheld device but can’t afford one. The expense is front-loaded while the return on investment is delayed.

Overcoming such an objection is difficult and may require flexible payment options, which allow users to spread the costs in a more affordable way.

The gains are there for both buyers and sellers.

Vendors want to tap the full potential of market growth while buyers need to find new ways to make the NHS more cost effective. Smart, efficient technology is a good way to do that and, as it improves, the return on investment is becoming more compelling all the time.

It has the potential to be transformative if it can overcome some of these short-term barriers.

Requirements for ultrasound imaging are certainly changing.

Doctors want improved imaging technologies, greater portability, and more compact and ergonomic design

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SPECIAL REPORT: ADVANCES IN POINT OF CARE ULTRASOUND TECHNOLOGY

Buying Guide: Choosing the Best Portable Ultrasound Scanner James Butler, Staff Writer An ultrasound scanner can work wonders, but how do you ensure you’ve got the right device and are working with the best supplier?

I Start by determining what the machine will be used for. Try writing down various tasks as a proportion of their regular use

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N A relatively short time, portable ultrasound technology has had a profound impact on healthcare in the UK and around the world.

With technology continuously developing and devices becoming more accessible and affordable, the outlook is extremely promising. Even so, factors such as the cost of systems and a lack of awareness among buyers continue to hold it back. If you are considering buying a device, but aren’t certain, here are a few factors you might consider.

Assessing the Cost A portable ultrasound device is not cheap.

A single unit can cost thousands of pounds and in overstretched units that can seem unsustainable. The benefits are clear, but managers will need to assess whether this represents the best use of their money. To do so, they need to clearly evaluate the benefits against the cost.

Evaluating the cost effectiveness of point of care solutions is difficult because of limited studies. We can start with what we do know. A 2009 study into the effect of handheld devices in healthcare found that they had considerable advantages for physicians, especially in those areas in which time was of the essence6. More recently, in 2015, a study found that the “use of portable US in the pre-hospital setting has a positive impact on aspects of the patient care process, including aiding in diagnosis, patient triage, and treatment decisions with no apparent evidence of harm.7” However, elsewhere it was inconclusive and called for further evidence.

Technology has moved on in recent years – we’ve seen the emergence of pocket sized devices offering high quality images and utilising the latest smartphone technology. As it does so, it heightens the return on investment and changes the way doctors work.

Fundamentally, this is seen as creating a dramatically more efficient version of the stethoscope. Studies in the US have seen the emergence of sono-first protocols and statistically significant and clinically relevant reductions in the number of CT scans being used. This results in sizable reductions in operating costs as Lawrence Melniker, MD, writes: “while the marginal cost or operating cost of CT scan is estimated to be £50-$60, charges average $1500 to $2000 depending on the setting, compared to $10-$20 operating cost for PoCUS and $100 to $200 in charges8.”

As technology evolves, it is becoming more affordable and accessible. The obstacles to adoption are falling at a time when the return on investment is growing.

Real World Performance The benefits have been well publicised, but how it performs in the real world will depend on a number of factors such as how well-trained staff are and whether buyers select the right devices for individual tasks.

The market has shown enormous growth in the last few years and the technology has improved greatly, which complicates the buying process.

Start by determining what the machine will be used for. Try writing down various tasks as a proportion of their regular use. For example, will it be predominantly used for cardiovascular diagnosis, work on the abdomen or for cardio echo? This will help you match the right device to your requirements.

Look at the various options and assess the features. Will you need all of them? For example, will you need colour images? Doppler or stress echo? How extensive are your needs and will you be using all the features on the device?

This allows you to optimise cost and purchase a piece of equipment which does enough, but not too much.

SPECIAL REPORT: ADVANCES IN POINT OF CARE ULTRASOUND TECHNOLOGY

New versus Used You might also think about new versus used equipment. Used devices may potentially save money while providing the functionality you need. Against that, the technology is evolving rapidly and new models are delivering greater accessibility and higher performance. The cost is falling, making them more accessible.

To make the call, you will need to research the market and understand exactly what each device can and can’t do. In a competitive marketplace, manufacturers will make ambitious claims in their marketing material, but you’ll want to find supporting evidence to back up those claims. Customer feedback is essential – you may be able to see case studies about how certain hospitals have made use of the technology and where it has helped. You can also take to the internet and discussion forums to find out about the experiences other medical professionals have had – both good and bad.

You need to know as much as possible about how it performs in the real world.

Choosing a Supplier Your choice of vendor may also be as important as your choice of machine. You need a supplier who has real experience in the sector. Getting independent verification about a machine – perhaps through word of mouth or personal recommendation – is a good way to see how it truly performs, but there are indicators which may suggest whether a seller has the expertise they claim. Many companies use content which is generic and sales-led. A true expert will deliver more detailed information and encourage you to do your own research

and find out about a product. True experts are confident in the quality of what they are selling so it is in their interests to help you find out as much as possible.

Find out what expertise they have onsite – if they don’t have any it begs the followup question: how can they be certain which products are the most effective if they don’t have access to expertise?

Ask as many questions as possible. Find out what evidence a seller can provide about performance and what aftersales support they have on offer. These can be complicated devices and the value you extract may depend on how expertly you and your team use them. Ongoing support can be crucial with little details such as exporting images to a DVD or hard disk drive, sharing images and interpreting them. Some may not provide this, others may charge for it.

When choosing your new system, you need to know what happens if you need support.

Ask as many questions as possible. Find out what evidence a seller can provide about performance and what aftersales support they have on offer

Researching the Market Complexity should not be an impediment.

There is a huge amount of information available about all the competing devices; if you do your research it should be straightforward to find a device perfectly aligned with your requirements.

But that’s not where the process ends. People will need to be trained and this entails an additional expense. The better the training is, the more valuable a product will turn out to be.

The market is moving forward quickly, so this is an issue buyers will have to stay on top of. A technology which is cutting-edge today may well be obsolete tomorrow with new devices being more detailed and much more sophisticated.

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SPECIAL REPORT: ADVANCES IN POINT OF CARE ULTRASOUND TECHNOLOGY

The Future of Point of Care Ultrasound Tom Cropper, Editor Point of Care Ultrasound technologies have enormous potential. The latest devices put increasing amounts of functionality at the disposal of clinicians, but how transformative can they be?

I The Vscan ExtendTM weighs roughly a pound and connects to a smartphone-like screen, which fits snugly into a pocket

T’S OFTEN talked about as a brand-new technology but portable ultrasound devices have been with us for many years. However, for one reason or another, the market has been relatively slow to respond. Now, though, projections for growth are increasing, and the technology is making great strides. The question now is just how big an impact could this have?

A Growing Market Ultrasound as a whole is set to see rapid growth and pick-up over the next decade. Markets and Markets expects the global market to reach $6.86bn by 2021, a compound annual growth rate of just over 5.2%9. However, it is the portable sector which is creating the most excitement.

A separate report found that the portable ultrasound market was worth $1.39bn in revenue in 2015 and will grow at nearly 9% CAGR over the next five years10. Devices are becoming smaller, and the handheld market, which sees pocket size devices resembling smartphones, is expected to grow at 13%CAGR until 2022. The market will be dominated by Europe, but the fastest growth will be in Asia as healthcare organisations rapidly adopt the latest technologies.

Such a positive outlook has seen an increase in the number of participants with new products becoming available both from established players and new start-ups. This innovation echoes the development of mobile technology in the consumer space with developers striving to outdo themselves in terms of sophistication.

The Latest Technology One of the leading manufacturers, GE Healthcare, is stepping up new product development to maintain a position at the cutting edge of the market. In 2010, it produced a revolutionary new product in the Vscan handheld device – a tiny piece of technology in comparison to other products on the market at the time. It was only 14 | WWW.PRIMARYCAREREPORTS.CO.UK

three inches wide and 5.3 inches long11. It featured voice annotation, an intuitive touchscreen interface and the ability to quickly upload images to PC or tablet. It made it easier than ever to produce clear images at patients’ bedsides.

Technology, though, moves forward quickly.

Earlier this year they produced another pocket-sized device capable of giving clearer images and to swiftly share images. The Vscan ExtendTM weighs roughly a pound and connects to a smartphone-like screen, which fits snugly into a pocket. The innovative addition with this new model is DICOM integration, which allows it to connect to a hospital’s PACS (Picture Archiving and Communications System) and upload the data seamlessly to be kept on record. The device is small and agile enough to be used by clinicians in the field. Like many pieces of technology, then, it is becoming more easily integrated and connected to other digital systems.

Reviews from doctors have been extremely positive.

“Vscan ExtendTM completely changes the game in how we are able to use ultrasound both inside and outside hospitals,” says Dr. Guy Lloyd, Clinical Cardiologist and Lead for Echocardiography at Barts Heart Centre in London. “For the first time on handheld ultrasounds, we can pre-populate the device with images thanks to the DICOM integration, which then cascades the images through PACS, enabling seamless collaboration with colleagues in our hospital system. As a result, we are able to provide rapid diagnostics to patients, increase efficiency, and save on cost.”

The technology is moving progressively further into the field. Doctors are taking it to the bedside where it improves the patient experience. They do not need to be disturbed to be taken elsewhere for a scan - they can have it then and there; also, they can see the images taken. This doesn’t necessarily replace the full ultrasound scan, which takes an hour, uses specially trained personnel, and is

SPECIAL REPORT: ADVANCES IN POINT OF CARE ULTRASOUND TECHNOLOGY

much more involved. However, it can pick up some problems more quickly and may alert doctors to the need to conduct further scans.

Writing on his blog, one Canadian MD argues that it could represent a breakthrough on the scale of the stethoscope and first ultrasounds. The most common question he is asked, he says, is ‘why doesn’t everyone have one of these?’12 Many patients are surprised to hear that a piece of technology which has been around for more than five years hasn’t made greater inroads. Part of the reason, he suggests, is a lack of marketing from the main producers and a lack of awareness among doctors, as well as the question of the expensive purchase price and the need to train staff in its use.

As the technology develops, though, it is pushing further out into the field. GE’s Vscan ExtendTM is intended to be used by emergency services, allowing them to make faster and more accurate medical assessments on the spot. By doing so, it is hoped, the device can save lives and dramatically improve treatment at the location of an accident.

What the Future Holds It is difficult to predict the future at the best of times. The fortunes of handheld ultrasound

scanning depend on many factors, such as how fast the technology develops, how quickly awareness grows, healthcare budgets and awareness among hospital staff. However, all the ingredients are in place for rapid adoption.

Budgets may be constrained, but as evidence of their benefits builds up, more and more managers are making the transition. Many hospital departments would like to have a device if they can afford one. Many NHS Trusts in the UK have only been able to afford a device because they have been donated one by a charity. As the technology becomes more affordable and accessible cost-based barriers will become easier to overcome.

The question is not whether handheld ultrasound scanners can make an impact, but how far will that impact extend? Will it, as its proponents suggest, be the next great revolution to hit the healthcare profession or will it just be a nice to have? Where will it take care – to the bedside, to the home and to the scene of accidents?

Just how extensive can portable examinations become? The answers will depend on how the technology of the future evolves, how staff are trained and whether managers feel the long-term benefits justify short term costs.

The fortunes of handheld ultrasound scanning depend on many factors, such as how fast the technology develops, how quickly awareness grows, healthcare budgets and awareness among hospital staff

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SPECIAL REPORT: ADVANCES IN POINT OF CARE ULTRASOUND TECHNOLOGY

References: 1

Tories Pledge £8bn Rise in Healthcare Spending:

http://www.telegraph.co.uk/news/2017/05/18/conservative-manifesto-tories-pledge8bn-rise-nhs-spending/ 2

Our Response to the Conservative Manifesto: https://www.nuffieldtrust.org.uk/news-item/our-response-to-the-conservative-manifesto

3

NHS Could be Overwhelmed: https://www.theguardian.com/society/2014/jan/03/nhs-overwhelmed-long-term-medical-conditions

4

Point of Care Market Grows: http://www.marketsandmarkets.com/PressReleases/point-of-care-diagnostic.asp

5

Royal Surrey County Hospital Wishlist: http://www.royalsurrey.nhs.uk/wp-content/uploads/2015/09/Final-wish-list-2016.pdf

6

The Impact of Mobile Handheld Technology: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002124/

7

Portable Ultrasound in the Pre-Hospital Setting: https://www.ncbi.nlm.nih.gov/books/NBK349868/

8

Ask the experts: How do you See the Economics of Point of Care Ultrasound: https://www.acep.org/Content.aspx?id=102325

9

Ultrasound Market to Reach $6.68bn by 2021: http://www.marketsandmarkets.com/PressReleases/ultrasound-devices.asp

10

Portable Handheld Ultrasound Market: http://www.auntminnie.com/index.aspx?sec=ser&sub=def&pag=dis&ItemID=114223

11

Handheld V-Scan: https://www.medgadget.com/2010/02/ges_vscan_worlds_smallest_portable_ultrasound_now_available_worldwide.html

12

Why Doesn’t Everyone Have a Pocket Ultrasound Machine? http://www.kevinmd.com/blog/2014/05/pocket-ultrasound-machine.html

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