Best tech for pediatrics 2015

In October 2014, I presented a workshop on office technology at the American Academy of Pediatrics (AAP) National Conference and Exhibition (NCE). At this year’s NCE, with the support of the AAP’s Sections on Telehealth Care and Advances in Therapeutics and Technology, I conducted 2 workshops. In this article, I describe my experience visiting vendors in the NCE’s exhibit hall and detail some of the best tech presented at this year’s workshops.

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NCE exhibit hall floor: Day 1

I learn about new and exciting technologies by doing a lot of reading and searching the Internet for news and information, and then contacting companies who have new products in the pipeline. Only a select few I discuss in these Peds v2.0 articles, and that is why the December article is always titled “Best tech for pediatrics.” I really enjoy wandering the NCE exhibit hall. From the perspective of a “techie,” this is a very exciting experience-not unlike putting a kid in a candy store.

On my first day at the exhibit hall, I made a point of visiting vendors I had contacted previously to go over the nuances of their forthcoming devices. My first discussion was with representatives from TytoCare (Netanya, Israel). Next year TytoCare will distribute an innovative device called the TytoPro, a handheld gadget with a display screen that is like a Swiss army knife of medical equipment. The TytoPro takes the place of your otoscope, stethoscope, tongue blade, and thermometer. Images from the ear canal and throat can be captured and integrated into your electronic health record (EHR) note. TytoCare is also introducing an affordable home version of the device that will facilitate telehealth visits. The home version will enable parents to transmit images from their child’s throat and ears along with heart and lung sounds to their physician via a cloud-based portal.

Next, I paid a visit to the Bionix (Toledo, Ohio) booth. Bionix is known for its cerumen removal technologies. I learned that the company is marketing 2 new products for use in the neonatal intensive care unit (NICU) and/or nursery. Its Preemie Transport Blanket is an occlusive Bubble Wrap-type system for keeping delicate premature infants warm and protected during resuscitation and transportation. The other new Bionix product is the Swaddler, a clear “blanket” for phototherapy, developed to provide comfort to a young infant while reducing stress. The unique fabric allows for over 90% of phototherapy light transmittance to reach the infant’s skin.

I ended my first day at the Contemporary Pediatrics booth spending some quality time with the editors, executives, salespersons, and dedicated readers of these Peds v2.0 articles. I chatted with fellow pediatricians who, like myself, practice “in the trenches.” Pediatricians continue to be concerned about Maintenance of Certification, and overall they are displeased with government regulations that make medical practice more complicated. 

NCE exhibit hall floor: Day 2

On my second day in the exhibit hall, I met up with Peirce Hunter, MD, a longtime friend and colleague at Dartmouth, who shares my enthusiasm for office innovation. For an hour or more, he led me through the exhibit hall to vendors whose products he thought were particularly interesting. We were very impressed with a new device that assists patients with clean catch urine collection. This is the CareFull Catch system (Oldsmar, Florida; www.carefullproducts.com), invented by Colleen Meloff during her pregnancy. As a patient and parent, she recognized how awkward it can be for pregnant women to void in a urine cup, and for parents to collect urine samples from daughters. The system is a disposable plastic wand that holds a sterile urine cup so that one does not “pee on one’s hand.” Meloff surveyed a hundred patients while deciding whether to launch her invention. Not surprisingly, 84% of patients admitted to getting urine on their hands during urine collection. Each CareFull Catch wand costs about $1, with discounts available for volume orders.

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By the way, there is a technique developed by Spanish pediatricians that expedites the collection of urine from young infants. (See “Urine collection, the Spanish way”) I encourage pediatricians to try this method and use the CareFull Catch system to catch a midstream urine while keeping hands clean. Please contact me (Andrew.schuman@ymail.com) and let me know if this works in your practices.

Hunter also directed me to the ClearTriage (Centennial, Colorado) booth. This ClearTriage system was developed by Dave Schmitt with input from his father, Barton Schmitt, who developed our standard pediatric telephone triage protocols (also famous for coining the phrase “fever phobia” in 1980 and developing one of the best mobile apps for new parents called KidsDoc). Schmitt developed a cloud-based system that expedites triage of pediatric patients and facilitates placement of a nursing note in the patient’s EHR. ClearTriage enables nurses to send informational material to patients via fax or e-mail, and also includes medication-dosing information, a very useful feature. It is an affordable subscription-based service, and, by the way, the ClearTriage system has 95 protocols not found in the telephone triage book.

Hunter and I then visited the Rijuven (Wexford, Pennsylvania) booth. Rijuven has introduced the CardioSleeve auscultation system. This modified “stethoscope” enables physicians to record both auscultated heart sounds as well as electrocardiograms from patients and transmit these to a smartphone or tablet as well as to a cloud-based portal. Using established murmur-analysis algorithms, the CardioSleeve indicates whether an echocardiogram should be performed. We spent some time discussing whether Rijuven should add an “off” button to the device-now it just times out and shuts off after 3 minutes of inactivity. Rijuven is also producing a complete line of diagnostic devices for office use as well as an affordable home system that can facilitate telehealth diagnosis and treatment. I will review the Rijuven products in addition to those produced by TytoCare in a future Peds v2.0 article.

Recommended: What's new for auscultation?

Hunter and I then parted ways, he to prepare for the next day’s workshop and me to continue to meet with vendors.

I caught up with representatives from Gobiquity Mobile Health (Scottsdale, Arizona), which has recently updated its subscription-based pediatric vision screening system called GoCheck Kids. It now utilizes the iPhone system (supplied with a monthly $99 subscription) and features an improved interface. The iPhone fingerprint recognition speeds access to the application, and the device now accepts age-related parameters for photoscreening. GoCheck Kids also enables pediatricians to perform visual acuity testing with its new iPhone app, which “gamifies” testing using an application reminiscent of the popular game “Heads up!” I look forward to trying this new system in my office.

Passing by the Otometrics (Schaumburg, Illinois) booth, 2 devices caught my eye. First, the company markets the MADSEN AlphaOAE (otoacoustic emissions) hearing screener that plays a cartoon to engage a child during the brief examination. The second is the Sentiero Screener, which lets you perform an audiogram on a child who refers following OAE screening, age permitting. The device is also the only office OAE screener that can test 2 ears simultaneously, thus expediting hearing screening in the office.

I next visited the Tortle (Greenwood Village, Colorado) booth. Jane Scott, a Kenyan-born neonatologist, invented the Tortle Head Repositioning Beanie that can be used to prevent positional plagiocephaly as well as to treat this condition in its early stages. The device is sold on Amazon.com for $20. The beanie’s “magic” is a soft cloth “bump” that is placed behind the child’s ear and switched to the opposite ear at intervals to prevent plagiocephaly. To treat mild plagiocephaly the bump is place over the occipital area. Scott has also developed related products for head positioning of sick, hospitalized premature infants as well as hospitalized older infants. These include 2 cotton beanies: the Tortle NICU Midliner and the Tortle Air. The Tortle NICU Midliner is used for preemies weighing up to 3.5 kg, while the Tortle Air is ideal for feeder/growers in the NICU, typically 1.5 kg and up. The products are helpful in preventing intraventricular hemorrhage and preventing and treating cranial asymmetry.

I have long been a fan of Brymill (Ellington, Connecticut) devices for freezing warts with liquid nitrogen, and I have reviewed several of its products in the past. During my brief visit to the Brymill booth, I learned they are now distributing a small canister cryotherapy device called the Cry-Baby. Perhaps not the best name for a product that will be used in a pediatric office, but nonetheless the device fits easily in the hand, conserves liquid nitrogen, and lets you direct the liquid nitrogen spray more easily compared with larger canisters. Great idea (but bad name!).

I was running out of steam by the time I visited the Kentec Medical (Irvine, California) booth, distributor of the Thermomedics (Miami, Florida) Caregiver infrared, noncontact thermometer system. This is a sturdy, clinic-grade, infrared noncontact thermometer that sells for about $360. To use it, you shine the emitted light on the forehead and read the results. I am now trialing the device in my clinic and I plan to write a review to be included in a future article on office thermometry, so stay tuned.  

The workshops

Unlike last year, my 2015 workshops were prepaid “ticketed” events. They were sold out and, unfortunately, we had to turn away many interested pediatricians. I began by presenting an overview of office tech circa 2015 and included a discussion of telehealth, indicating that it has the potential, when used correctly and in the proper situation, to improve patient care. Workshop attendees rotated through 3 stations where 5 teaching assistants (TAs) and I presented our gadgets and gizmos. The discussions were lively. There were several standout devices at the workshop, according to our attendees.

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Pediatricians really like the Buzzy4Shots device, an inexpensive gadget that is placed on the arm of an apprehensive patient prior to receiving an injection. The device is connected to a cold pack and it vibrates, confusing nerve endings and actually making most immunizations less painful while distracting our patients. This is a very popular item among patients and nurses in my own clinic.

Other standouts included the Alere i instrument for rapid diagnosis of strep and influenza, and the CardioChek and Alere Cholestech LDX screeners. At my station on mobile and telehealth devices, patients liked the Gobiquity GoCheck Kids system discussed previously, along with the CellScope device, which turns your iPhone into an otoscope that can capture images and place them in your EHR. Attendees were also intrigued with the affordable CloudVisit telehealth portal that enables pediatricians to conduct HIPAA-compliant telehealth visits.

When I asked participants about EHRs, universally they responded that they disliked their EHRs, with most pediatricians not able to complete their EHR charting during office hours and needing to complete their notes at home. I then discussed and demonstrated the Augmedix Google Glass-based virtual scribe system (see Peds v2.0, November 2015), and most attendees were keenly interested. I also indicated that Dragon Dictate Medical, now available for the Mac, is very accurate when used correctly and can cut the time to EHR note completion in half.

Closing thoughts

Overall, the workshops went well, and the TAs and I were exhausted when we finished packing up all the devices. I have already agreed to conduct the tech workshops again at the 2016 NCE in beautiful San Francisco. I welcome your suggestions regarding what gismos and gadgets we should consider presenting next October, and remember-buy your tickets early!

The author thanks the following teaching assistants for their help with the workshops: Naveen Mehrotra, MD; Manuel Vides, MD; Eugenia Marcus, MD; Larry Desch, MD; and Peirce Hunter, MD. He would like to also thank Ms Virginia A Mason for serving as timekeeper!

Urine collection, the Spanish way

·      The first step is either breast-feeding or providing formula intake appropriate to the age and weight of the newborn. Twenty-five minutes after feeding, the infant’s genitals are cleaned thoroughly with warm water and soap and dried with sterile gauze. A sterile collector is placed near the baby in order to avoid losing urine.

·      The second step is to hold the baby under the armpits with legs dangling. One examiner then starts bladder stimulation, which consists of a gentle tapping in the suprapubic area at a frequency of 100 taps or blows per minute for 30 seconds.

·      The third step is stimulation of the lumbar paravertebral zone in the lower back with a light circular massage for 30 seconds. Both stimulation maneuvers are repeated until voiding starts, and a midstream urine sample can be caught in a sterile collector

SOURCE

Herreros Fernández ML, Gonzáles Merino N, Alfredo Tagarro García A, et al. A new technique for fast and safe collection of urine in newborns. Arch Dis Child. 2013;98(1):27-29.

Dr Schuman, section editor for Peds v2.0, is adjunct assistant professor of pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, and editorial advisory board member of Contemporary Pediatrics. He has nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.