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After the Match

After the Match

What's in Your Pocket?

Cook, Thomas MD

Author Information
Emergency Medicine News: May 2016 - Volume 38 - Issue 5 - p 12
doi: 10.1097/01.EEM.0000483178.50727.b1

    Anyone remember the Palm Pilot? It was one of the first personal digital assistants (PDA) on the market in the 1990s. PDAs were the precursors of smartphones, and the Palm Pilot was a huge hit that enriched the company that produced it when their initial public offering in 2000 hit a high of $95. Its parent company even had its name on the San Francisco 49er's football stadium. (Anyone remember 3Com Park?) The stock plunged to under $7 within a year, however, and the company was defunct by 2010.

    It's laughable by today's standards, but I loved my Palm Pilot because it allowed me to keep addresses nearby and to jot down notes. I began traveling a lot during this time to teach about another hot technology, bedside ultrasound. Part of my presentation then was to hold up my Palm Pilot and tell listeners that in the future this would be their ultrasound machine. My thinking was that technological synergies would eventually shrink ultrasound devices to fit in your lab coat while giving you a better image than systems currently available. They would also seamlessly upload image data wirelessly for patient records, education, and research. That was 20 years ago, and today everyone in the ultrasound industry knows a product like this will revolutionize medical imaging and create a monumental financial opportunity.

    Consider how all medical imaging has been done for the past 60 years: big machines that require a lot of space, highly-trained personnel, a very high cost per machine, and in a lot of cases, radiation. These characteristics have only been challenged in the past two decades when ultrasound went to the bedside with smaller units and user-friendly interfaces. An ultrasound system that produces high-quality images right now will have three to four transducers on a cart-based platform and will set you back $50,000 to $80,000. Cost alone makes this purchase a hospital-based decision. Simply put, no physicians will pony up this much cash.

    But what if the price were only $4,000? This is somewhat comparable with a high-end computer that most physicians already turn over every few years. Suddenly the power to decide what and when to buy lies not with the hospital but the user. Now the business model goes from selling a specialized product to something closer to a commodity, and it becomes a personal medical device as ubiquitous as your stethoscope.

    How Close Are We?

    We may not get there completely for another decade, but things are moving faster and faster. The first handheld ultrasound systems were first sold about 15 years ago, and most of the large vendors tried to market something small. So far, however, none has been able to put together the combination of high-quality imaging, simplicity of use, small size, low cost, and seamless integration into electronic medical records. But a couple of new products are pushing these boundaries.

    SonoSite released iViz last fall. Pocket-sized with multiple transducers, it has a highly intuitive interface akin to a notepad, but still needs a hard wire to move data from the probe to the screen. The cost is much higher than physicians will pay, too.

    Philips Lumify is also pocket-sized, but it has a fresh and unique approach. The system is completely housed in the transducer, it connects by a cable into an Android phone or notepad, and you rent the device rather than own. The cost is relatively low at roughly $200 per month per transducer ($2,400 per year), and you can return the device at any time if it does not meet your needs.

    But the Holy Grail of bedside ultrasound still must overcome two difficult challenges. The first is to get rid of the wire connecting the probe to the screen. This will allow any screen to be used that can wirelessly receive imaging data from a probe-only device. These data will be processed on your smart device or even Google Glasses. Then you will have one less thing to carry around.

    The second is the integration into medical records. This is not complicated on the surface, but the age of HIPAA has hospital attorneys paranoid about every scintilla of data that can be perceived as patient information. Ask any former (and some current) employees of companies managing bedside ultrasound data (e.g., Q-path and UltraLinq), and they will tell you the hardest part of selling their product is permission to move patient data outside of the hospital's internal data system.

    Today's EM residents will begin seeing the impact of these dramatic changes over the next few years, and their pocket devices will hold a capability only dreamed about a couple of decades ago. Obstacles remain, but what they will eventually bring to the bedside will be amazing.

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