Point-of-Care Echo Studies Improve Workflows

By Matt Phillion

A new AI-powered point-of-care ultrasound software platform will now enable providers outside the hospital setting to bring improved care to underserved communities in South Florida.

AISAP has designed a form of point-of-care assistive diagnosis designed to empower clinicians to provide fast efficient diagnoses from the bedside. The organization is partnering with Amavita Heart and Vascular Health to deploy the software in screenings for aortic stenosis and other valvular diseases in its clinics, local skilled nursing facilities, and via mobile screening units in underserved communities with large minority populations.

Initial screenings through the community health program has enabled Amavita to detect significant valvular pathologies in more than 28% of the roughly 60 patients screened to date. Of note:

• Aortic stenosis was detected in 10.3% of scans
• Mitral valve regurgitation was detected in 17.9% of scans
• Tricuspid valve regurgitation was detected in 12.8% of scans
• Aortic valve regurgitation was detected in 2.6% of scans

“The initial pain point we wanted to address is the global problem of access to imaging,” says Roni Attali, US-GM and CSO of AISAP. “We want to improve access to echocardiograms and improve equity of care within communities. And we want that imaging to be at the bedside and not require moving the patient from place to place.”

This challenge is particularly prevalent in underserved communities where it’s possible to have cardiac indications and yet take a week or two to have a proper diagnosis due to access to imaging technology and the skilled personnel needed to use it.

“There are way too many patients and not enough tech or cardiologists,” says Attali. “And this is a much bigger challenge in rural communities.”

“Say you come to see me at the office. You’re 35 years old. I need to order an echocardiogram,” says Dr. Pedro Martinez-Clark, founder and medical director with Amavita. “You go to be checked out, and the next opening for an echo is a month away. You come back a month later and have that echo done.”

The delay in assessment is one challenge, Martinez-Clark says. But add on top of this what the healthcare provider or organization needs to do to maintain the ability to do so in the first place. The machine might be 5 or 6 feet tall, cost $100,000, and require an expensive serviced agreement. When the machine stops working the organization needs to replace it while stuck with a now-obsolete machine.

“In addition, I also have to have a sonographer, someone who specializes in obtaining the right images so that the information acquired is accurate,” Martinez-Clark says. “The study takes about 40 minutes. The sonographer fills out the primary report. Your doctor reads the study and then let’s say your follow-up appointment is three weeks after that. You’ve gone a month-and-a-half waiting on this diagnosis. It’s a huge investment of time and resources and there are many inefficiencies in this process.”

The average wait for an echocardiogram in a clinic is six weeks, Martinez-Clark notes. By comparison, using AISAP, a seven-to-10-minute study can be run during that very first appointment.

“I would rather not give the impression it replaces the big tests, but it modifies that workflow,” Martinez-Clark says. “If I do my AISAP assessment and find that your results are normal, you’re done. But if I identify something that worries me on the AISAP test, I know right away and I don’t have to wait a month-and-a-half to tell you something is abnormal, and you need another study. I could see you right now and know that one of the chambers in your heart is dilated or something else is functioning incorrectly, and I can then say, ‘I need you to have a more sophisticated echo.’ I want the big machine, I want the sonographer, I want the lab to be productive and to be used for people who are sick. I don’t want 100 patients who are not at risk taking up spots from patients who are really sick.”

Faster preliminary diagnoses

Beyond just freeing up spots so that labs can focus on higher risk patients, a faster turnaround time for preliminary tests can be life savers, Attali notes.

“We’re seeing things that could’ve been missed,” she says. “The measures we’re getting from skilled nursing facilities are showing something near 10% to 15% of valvular pathologies they wouldn’t have known about—severe pathologies, and if these are missed, those undiagnosed patients could have died. And even moderate or mild conditions could be managed better. It’s why we’re talking about this initiative and how we want it to go out into the community and scan these patients who wouldn’t otherwise have access to imaging.”

The workflow improvements bring peace of mind as well as operational efficiencies, Attali notes.

“Why wait for a weekend because there’s no one in the echo lab? If it’s a non-emergency, you can send the patient home and if they need to come back for further care, they can, but this way they’re not risking getting sick at the hospital,” she says.

“The impact of this technique and innovation is very powerful and affects many aspects of cardiovascular healthcare delivery, particularly in emergencies and in rural communities,” says Martinez-Clark. “Now that it’s incorporated into my workflow, I can’t see myself practicing without it.”

The platform also offers a way to alleviate some of the stress and burnout the industry is seeing due to staffing shortages and lack of specialists.

“The whole point of AISAP CARDIO is it increases access to imaging,” says Attali. “There’s not enough cardiologists right now. This device offers a way to enable non-specialized physicians, nurse practitioners, physicians’ assistants, or other providers to fill the gap. It’s a very educational tool, not just a diagnostic tool.”

Not a replacement for human expertise

The tool doesn’t replace the specialized knowledge of a cardiologist but rather helps with enabling others to do that initial, efficient scan to keep the patient journey moving in the right direction.

“There’s always a bit of resistance, but this isn’t going to replace a cardiologist with thirty years of experience,” says Martinez-Clark. “But it offers a chance to build operational efficiencies with a tangible way to improve workflows. Half of the counties in the U.S. don’t have a cardiologist, but cardiovascular disease is the leading cause of mortality.”

With a device and platform like AISAP CARDIO and the high accuracy of its AI, trained and credentialed physicians can get the images they need without always having to wait for a cardiologist to access the findings, Attali notes.

“How we do that education is important,” she says. “And because we’re SaaS, we can monitor everything and give them education dashboards to identify when things are not being done as well as they could be.”

The AI component can see some pushback, but Martinez-Clark explains it’s an assistive tool, not an end-all be-all diagnostic option.

“The AI component is wonderful and impacts the workflows positively, but medicine involves a lot of judgment, and AI hasn’t gotten to the point where it can replace that,” says Martinez-Clark.

The patient reaction has been mostly positive, Attali notes. While there is some reflexive pushback about how data is being used, when they see it in action at the bedside, the satisfaction levels are high.

“The immediacy of it is critical,” says Martinez-Clark. “You come in, interact with the physician, and you get more out of the visit.”

The wait time for an initial diagnosis, even if further follow up is needed based on the results of the AISAP test, has been an improvement as well.

“You don’t have people waiting six weeks for that first test,” Martinez-Clark says.

Martinez-Clark would like to see the device used in more sophisticated functions.

“It’s extremely useful now but there’s room for innovation outside the cardiac equation,” he says. “You could replicate this scenario with pretty much a whole-body ultrasound.”

Attali says that with the success AISAP has seen in echocardiograms, the organization would like to submit for FDA clearance on other uses as well, such as abdomen and lungs.

“We’re all nerds here. We really want to be able to create something that acts as a tricorder,” a handheld sensor seen on the old Star Trek TV show, Attali says. “That’s the future.”

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