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Goodbye, Stethoscope; Hello, Vscan

Listening to a patient’s heart with a stethoscope can yield only so much information.

That’s why some local health care experts are predicting that it won’t be long before that old-fashioned but reliable stethoscope, invented in 1816, is replaced entirely by a pocket-sized ultrasound device that allows doctors to actually peer inside the patient’s body.

Dr. Eric J. Topol, a cardiologist at Scripps Clinic and chief academic officer at Scripps Health, has just released results from a study on the effectiveness of using a hand-held sonogram tool compared with a full, traditional echocardiogram, a more cumbersome ultrasound used to detect heart problems.

He and his research team at Scripps measured the accuracy of the Vscan, a portable product from GE Healthcare that’s roughly the size of a smartphone, on 97 patients. The Vscan has been on the market since early 2010, but until now there has been no public data documenting its accuracy compared with standard echocardiograms.

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Topol’s findings: The mobile tool could significantly reduce costs and improve the quality of the patient experience compared with the common practice of solely relying on echocardiogram procedures. The research, funded by an award from the National Institutes of Health, appears in the July 5 issue of the Annals of Internal Medicine, a peer-reviewed journal published by the American College of Physicians.

“Pocket echos used during physical examinations may have the potential to reduce the number of unnecessary echocardiograms, particularly when used by a clinician trained in obtaining and interpreting the images,” Topol said, in a statement. Topol is also vice chairman and chief innovation officer of the San Diego-based West Wireless Health Institute.

Better Diagnosis for Budgets?

While boosting patient care is a key benefit of using mobile ultrasound tools, according to the study, hospital CEOs may be just as interested in the cost-cutting aspect.

“Cost savings is a continuing issue for health care everywhere, in San Diego and all over the globe,” said Robert McCray, president and CEO of the Wireless-Life Sciences Alliance in San Diego.

Topol said that approximately 20 million echocardiograms are conducted in the U.S. every year, each at a cost of $1,500 or more, and the procedure requires patients to return for a second appointment lasting about 45 minutes at a hospital or clinic echo laboratory.

While a Vscan isn’t cheap — it was launched last year at the price of $7,900 per unit — it and other similar products can help doctors diagnose patients faster and send them speedily on the best path of care, Topol said.

“A regular physical examination won’t let you see how well the left ventricle is contracting,” said Dr. Anthony DeMaria, director of the Cardiovascular Center at the University of California San Diego.

DeMaria was the first doctor in the United States to use the Vscan tool. He sat on GE Healthcare’s scientific advisory committee and provided input on the development of Vscan, and he also has experience using earlier-generation echo devices.

Up until this point, adoption of the tool has been slow, he said. Early versions of portable ultrasounds “were a little too big, and frankly, a little too expensive,” he said.

The Lab Coat Factor

The Vscan’s price will be an impediment to it being quickly adopted, but more doctors may be receptive to using it because it has been “miniaturized” to the point that it fits well into the pocket of a white lab coat just about as easily as a stethoscope, DeMaria said. “Not only does it fit into the pocket, but there’s also room for a tube of gel,” he said.

DeMaria has no doubt that the tool improves quality of care. In fact, he conducted his own study several years ago using a bulkier mobile echo device and found that 20 percent of the time, use of the tool changed the course of treatment.

What he’s not so certain about, however, is whether cost savings will immediately result for hospitals. “As has been true in all of medicine, when you have new technology that is more effective than the previous generation, you detect more disease in patients and that stimulates more testing. You have to balance that with the fact that you can make diagnoses more quickly and treat the patient more rapidly.”

Nonetheless, he said that “someday, every physician will have one of these in their pockets.”

Topol agrees. “Medical schools might one day be giving these devices to students on their first day of school. In many ways, it will replace the traditional stethoscope,” he said in a statement.

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