POINT OF CARE ULTRASOUND, THE NEW PHYSICAL EXAMINATION
Ilan Kedan, M.D., Cedars Sinai Heart Institute, Los Angeles, CA, USA
Background: Ultrasound technology has become a central part of modern day healthcare. Its use as a clinical tool will continue to expand as the technology becomes more portable.
Hypothesis: Point-of-care (POC) ultrasound will ultimately replace the prior medical paradigm of a physical examination centric approach to patient evaluation.
Limitations: 1. Cost of equipment 2. Access to devices 3. Reimbursement model for use of technology 4. Learning curve and scarcity of master clinician ultrasound educators 5. Legal barriers and potential regulatory barriers.
Methods for adoption: 1. Change reimbursement model to deliver population based care to include bundling of reimbursement 2. Engage new device delivery models that allow access to equipment with a lower cost of entry 3. Build in ultrasound curricula to all levels of medical and clinical training 4. Expand the Emergency Department model of standardized examinations (FAST scan) into focused systems based examinations for point-of-care hypothesis testing.
Possible initial strategies: 1. Start with specific actionable evidence based imaging (IVC, gall bladder, pleural effusions) 2. Enlist medical training programs to incorporate POC ultrasound into all facets of curricula 3. Expand users of POC ultrasound to health care extenders and ancillary health care professionals to acquire actionable imaging data for physicians remotely.