How Point of Care Ultrasound Can Impact Access and Care

By Matt Phillion

The demand for high-quality, accessible care is at an all-time high due to an aging population and shrinking healthcare workforce. This is acutely urgent in the area of reliable, prompt diagnoses, as highlighted in the 2023 Survey Report: Unlocking Point of Care Ultrasound.

The report looks at the emerging use of handheld ultrasound as a method of expanding access to care and diagnostics not only in the hospital setting, but in remote or rural locations or even at home. Surveying over 150 caregivers, the report finds:

• Over 90% of respondents cited “more confident diagnosis” and “speed to diagnosis and treatment” as key benefits to point of care ultrasound (POCUS).
• 50% believe POCUS will become commonplace in the primary care setting in the next five years.
• 72% believe POCUS can increase care access for underserved populations.
• 77% responded they would be willing to invest in AI as an add-on to POCUS.

“To me, this report actually codifies a lot of anecdotal stuff we’ve been seeing,” says Sandeep Akkaraju, CEO and co-founder of Exo.

One of the focal points Exo has been looking at is adoption rates for POCUS and what pain points need to be addressed.

“What we found are there are some key infrastructure challenges,” says Akkaraju. “There are a lot of devices out there that have poor image quality and poor integration into the physician workflow, so getting that image data into the EHR can be a challenge.”

A vast number of exams conducted are not being recorded, Akkaraju notes, which indicates a core disconnect in documentation.

“The other issue we’ve seen is just a lack of revenue capture,” he says. “Over a third of exams are simply not being documented. That comes from a lack of infrastructure.”

Opening the doors to access

While there is some trepidation, Akkaraju says, POCUS has the opportunity to open up diagnostics in underserved communities and healthcare deserts where access to imaging can be limited.

“There’s some hesitation on the technical competency and medical legal side, but that’s partly an infrastructure issue,” says Akkaraju. “Who gets to do these exams, how do you track quality, are you running a compliant POCUS program?”

Some of those issues, Akkaraju notes, can be resolved by leaning on AI to assist care providers.

“Close to 80% of respondents were genuinely positive to AI. It would positively impact the adoption and use of POCUS—more than 60% said it would streamline their image interpretation process,” he says. “AI for us is about operator dependence and ease of scanning. Ultrasound is a higher operator-dependent modality, and reproducibility is an important aspect of that. We want to deliver more accurate, verifiable findings and help in standardization of care.”

There’s been a rise in satellite imaging, but there’s leakage between the satellite locations and the imaging centers, Akkaraju says.

“In terms of hub to spoke, you’ve got to have the necessary competency at the spoke otherwise you get leakage back to the hub,” he says.

This is where reducing operator dependency and using AI to help create more checks to improve standardization come into play, Akkaraju notes.

“From a workflow standpoint, the challenge of documentation and infrastructure is ensuring the information being captured in the spokes is associated with the patient and travels back to the hubs. You’ve got siloed data in locations that don’t necessarily have imaging capabilities,” says Akkaraju.

The intent of combining POCUS with AI is to simplify the process to remove some of these inconsistencies.

“One of the things we’ve been working on is making it very simple to get the view of the right organ. How are you making sure you’re reliably getting the right view, and how can you automate that even further?” he says. “That’s a key part of what we see in improvement of competency and getting to those reproducible answers.”

Akkaraju relates the concept to a blood pressure cuff: highly reproducible results regardless of who is operating the instrument.

“There’s a reason everyone uses blood pressure cuffs,” he says.

The starting point of diagnosis

The intent of POCUS isn’t to entirely replace other forms of diagnostics but open the door for more options at the bedside, Akkaraju explains.

“We need to make it easy to obtain images—that’s a starting point. An image is a starting point to getting to diagnosis,” he says.

The simplicity of a POCUS device—essentially a hand-held wand—could be used in common situations like hip dysplasia in infants.

“Two in every 100 children have hip dysplasia. If it’s caught early, the child would never even know it happened,” says Akkaraju. “If not, it results in a lifetime of pain. The current standard of care is palpating the newborn’s legs. We’re now moving into national trials for hip dysplasia; we have an instrument with better sensitivity and specificity than the current technique.”

That number, essentially 4% of infants, shows how great a need there is for technology that offers simple, reproducible results, Akkaraju notes.

“There’s 6.5 million Americans with heart failure. How many of them are being monitored on a regular basis?” he says. “There’s somewhere around 20,000 echocardiographers serving that entire population. It doesn’t add up. If you can de-skill and re-skill a different set of people to monitor and screen, that’s where change can happen.”

Adding simplicity and automation also offers an avenue to keep professionals practicing at the top of their license, Akkaraju says.

“If you look at the prevalence rates of some of these disease states—heart failure is going up, and if one in four of these patients is bouncing back into the hospital within 30 days, that leads to CMS penalties. Combine this with staffing shortages, and you need people practicing at the top of their license. Point-of-care ultrasound gives you that instant window inside the human body,” he says.

The industry is well aware of the risks staffing shortages can entail. Technology like POCUS can provide that start to diagnosis in key settings fast to open the door to better care.

“The number one reason people go to the emergency room or urgent care is a stomachache. Being able to instantly get an answer as to whether it’s gall stones or kidney stones or something else, being able to quickly rule things in and out. This is a tool that can do that,” says Akkaraju. “It enables care providers to separate something out as very serious very quickly.”

Another example: pneumonia is the number one cause of death for children under five, and the country sees 140 million cases of pneumonia every year.

“A child dies every five seconds because of it. Today, diagnosis depends on ionizing radiation, and nobody wants to subject their child to x-rays,” says Akkaraju. “POCUS is a tool that can immediately tell you if there is consolidation in the lung. It’s getting that instant answer instead of in more traditional ways.”

Speaking of non-traditional: stats show that more than 20% of acute care is moving to the home. Portable, on-site imaging that can be done from an outpatient setting without bringing the patient all the way into a brick-and-mortar setting can help support that sea change.

Perhaps an obvious opportunity lies in trauma care, Akkaraju notes.

“A recent statistic showed that 40% of trauma patients’ lives could be saved through standardized care—if you get that standardized care within the first hour of trauma,” he says. “If you can start doing that level of diagnosis in the field, that can save lives.”

All these case studies and opportunities add up to a chance to make the patient experience better while improving access to imaging for providers and patients alike, wherever they are.

It’s one of the things we’ve been focusing on providing: a full ecosystem that flows from imaging all the way up the workflow, through billing and documentation. Imagine a device you can place on the patient, sweep over an organ, and get actionable insights,” says Akkaraju. “With AI that helps with positioning and assessment, doctors can make those instant decisions, with the information flowing into the health record. It sounds simple, but it requires incredible technology to be able to do this.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.