Yes, iScan Ultrasound Workshop Partnering with Butterfly Ultrasound

[FiNorman]

 

Hello colleagues, 

I would like to start by stating I have no financial relationships with any of the parties involved.  The only income I receive is from my hourly wage I earn.

My name is Frank Norman and I am the Co-Founder of The Society of Point of Care Ultrasound.  SPOCUS is a non profit, multidisciplinary medical society which is focused on integrating bedside ultrasound into practice and education.  To my knowledge it is the first  and only PA led society which is creating national standards of care, training and education for all of medicine.  

SPOCUS has recently partnered with ultrasound manufacturer Butterfly Network.  The Butterfly Network has created a hand held, single probe ultrasound which plugs into an iPhone.  However, instead of costing $20k for an ultrasound machine, The Butterfly is priced at $2k, unfortunately there is a waiting list to purchase the device.

SPOCUS and Butterly are collaborating on a very unique opportunity.  SPOCUS will offer very affordable ultrasound training workshops for PAs (flipping the classroom with pre-course video lectures and e-books, as well as live ultrasound training) , and Butterfly will offer the opportunity purchase one of their machines, skipping the wait list, to be delivered before the live conference, so the attendees can practice what they have learned through the videos.  In addition, the attendees will also be able to save their practice images to the Butterfly Cloud, and used as a learning opportunity during the live workshop.  The first of these opportunities will be at the AAPA 2019 in Denver, Co, on May 20th.

SPOCUS will also mentor attendees on credentialing, billing, and medical-legal issues and PA Program curriculum integration, regardless the medical specialty (PA students, IM, FP, Peds, ortho, surgery and the subspecialties)

I hope to see you all there,

Thanks,

Frank

[PACali]

This is awesome. Are there any opportunity for PA to get RDMS certified without going to ultrasound school full time? 

[weezianna]

The ARDMS has partnered with the ultrasound certification branch for physicians, the APCA, and offers ultrasound qualifications for physicians.  There is also a qualiication offered by POCUS for point-of-care ultrasound.  Go to https://www.pocus.org. 

From the website: 

The Alliance for Physician Certification & Advancement (APCA) is part of the Inteleos family of Councils that also includes ARDMS. Spun out of ARDMS in 2016 to meet the exclusive needs of physicians, the APCA Council already represents over 20,000 physician certificants. APCA joins ARDMS in furthering its long-standing mission of raising the global standards of excellence in healthcare and patient safety through certification.

In January 2016, the APCA Council, led by physician volunteers, assumed oversight of the physician-specific certifications and examinations, as well as the POCUS Certification Academy. A volunteer POCUS Academy Task Force was responsible for the development of the POCUS Certification Academy. The Task Force created assessments that are shorter in length, with more focused content, than traditional ARDMS and APCA assessments, and that can be delivered in alternative, technology-based formats to accommodate test takers in many locations and in geographies with varying infrastructure and resources.

Today, the Task Force has become the POCUS Assessment Committee. This group of international, cross-specialty volunteer subject matter experts continues to provide direction for the POCUS Certification Academy and to oversee the multiple groups of volunteer practitioners contributing to assessment development, review and approval.

As an ARDMS registered sonographer, I have to comment that this type of certification does not take the place of a bona-fide sonography program nor provide the skills acquired.  

 

L. Pecevich, PA-C, RDMS, RDCS

 

[FiNorman]

In reference to RDMS and other certifications..... I support what every journey a clinical takes to attaining their goal.  However I would remind clinicians that certification is not needed for the performance or billing of bedside ultrasound studies, nor is it needed for the  credentialing, or privileging.  

In fact,  ACEP, SEMPA, SPOCUS, and many other provider centric societies oppose "merit badge testing by external entities".   This policy specifically refers to ultrasound, but also includes opposition to courses like ACLS and PALS.

The reasoning is that requesting permission from outside entities to treat our patients surrenders our profession's right to self determination.  ARDMS and Intelios run a business.

We learn, master and perform many tests which have higher stakes than ultrasound, without taking a certification exam... EKG comes to mind.

SPOCUS has published ultrasound competency guidelines, which mirror the ACEP competency based guidelines.  The guidelines suggest a short CME ultrasound course, 25 scans in each application, and a total of a minimum of 150 ultrasounds to apply for credentialing.

[ohiovolffemtp]

Is there any device analogous to the Butterfly system for Android phones?

[weezianna]

Will pass your comments on to the ARDMS and SDMS.  As a trained sonographer with many years of experience, I find your comments dismissive of the skills that sonographers must acquire for certification.  It seems that you are the one involved in running a business that will make a quick buck on some quick training.    Thank you!

[FiNorman]

"Is there any device analogous to the Butterfly system for Android phones?"

Yes, The Philips Lumify Series runs from certain (not all android devices).  The Lumify has the best image quality of all the hand held devices, and approximates the images produced by quality cart system.  The Lumify system is inside each of the probes, and since the probes derive their power from the android device they will not work with the iPhone systems (iPhone only has the lightning and speaker ports which do not have enough electricity to power the Lumify probe. The advantage is you only have to charge one device (the tablet/phone).  

The disadvantage is you will need a different probe for different applications (high frequency probe for superficial scanning, low frequency for deeper structures).  Each probe costs about $8k, or your could lease each for about $200/month.

My understanding is Butterfly will eventually have an android version, but I don't have a time line or verification.

[FiNorman]

On 2/11/2019 at 11:09 AM, weezianna said:

Will pass your comments on to the ARDMS and SDMS.  As a trained sonographer with many years of experience, I find your comments dismissive of the skills that sonographers must acquire for certification.  It seems that you are the one involved in running a business that will make a quick buck on some quick training.    Thank you!

My comment wasn't made to insult you or sonographers.  I have a great deal of admiration of their skills and abilities, and I certainly have learned a great deal from them over the years.  I also support ARDMS and SDMS regulating sonographers in any way they see fit, as this is their profession.  

With that being said, PAs have the ability to work with our collaborating physician organizations to create the standards which we see fit, and having a profession outside of our profession dictate how we should train our own profession, educate our selves and attain competency is not how we determine the future of our profession.  

ARDMS is well aware of how ACEP and other organizations view their attempt at professional misappropriation, and it is an official policy.  In fact ACEP has called this policy "ludicrous."  APCA/RDMS policy

ACEP policy on Merit badge certification

The ARDMS position is as inappropriate as nursing stating that PAs can't decide what standards are needed to place an IV in a patient, and if they would like to do so they should take a course created by nurses, so they can get a certificate created by nurses, and in the future nurses will decide what education requirements are needed to attain this certification.... and all the proceeds from this endeavor will go to a nursing association.  If nurses want to decide how nurses put in IVs, then I support their societal aspirations, as long as it doesn't harm my patients or interfere our ability to care for patients.  

My position isn't intended to offend you or sonographers, so I do apologize if that was the case.

[PamelaR]

All,

This is great conversation surrounding certification and credentialing of POCUS. I see value in both ensuring that the experts in bedside ultrasound are not held back in any way, while ensuring those that providing care are doing it at the highest level.

As a non-profit, we (Inteleos/ARDMS/APCA) are a mission-driven organization. We do not have a profit motive, only a motive to protect patient safety. Also, many of our programs are accredited by the American National Standards Institute (ANSI) because of the high standard they set and their reliability in determining proficiency.

The POCUS Certification Academy (www.pocus.org) certificates and credentials are not mandatory. In fact, if employers choose to require them it is because they know they can count on practitioners that hold our credentials to be proficient and that they will provide the best care possible. We only test for what practitioners need to know to improve patient safety and provide better care, and as a third party provider, provide unbiased assessment. We do not teach to a particular curriculum or educational course. 

Thank you again for this great forum to discuss.

Pamela Ruiz

Director, Global Services

www.inteleos.org

www.pocus.org 

[Charvelist]

I would very much enjoy a open debate on this topic. 

R

[HMtoPA]

19 hours ago, Charvelist said:

I would very much enjoy a open debate on this topic. 

R

If you get formal training in US according to ACEP guidelines, an additional certification is unnecessary and cumbersome. If you are like most PAs and not residency/fellowship-trained, I can see why you might be interested in not only acquiring this skill, but being able to document and prove that knowledge with a certification. I think the ACEP position is just that they don't want an outside agency encroaching on their turf and forcing an additional expense and layer of regulation upon them, not to mention that they've incorporated standardized US curriculum into their training for some time. Personally, I'm going the fellowship route and will just be damn sure to log my 150 scans for credentialing purposes.

[LT_Oneal_PAC]

23 minutes ago, HMtoPA said:

If you get formal training in US according to ACEP guidelines, an additional certification is unnecessary and cumbersome. If you are like most PAs and not residency/fellowship-trained, I can see why you might be interested in not only acquiring this skill, but being able to document and prove that knowledge with a certification. I think the ACEP position is just that they don't want an outside agency encroaching on their turf and forcing an additional expense and layer of regulation upon them, not to mention that they've incorporated standardized US curriculum into their training for some time. Personally, I'm going the fellowship route and will just be damn sure to log my 150 scans for credentialing purposes.

You should see if they’ll provide an additional certificate for EM POCUS. Mine gave me one and it’s nice to submit to the credentialing committee to make it easy approval for those privileges.

[HMtoPA]

7 hours ago, LT_Oneal_PAC said:

You should see if they’ll provide an additional certificate for EM POCUS. Mine gave me one and it’s nice to submit to the credentialing committee to make it easy approval for those privileges.

I mean, I wouldn't say no if they gave me a certificate, but realistically they're not going to give me something that they're not giving the physicians I'm training alongside with. Besides, if it's considered a core competency of your training program, you shouldn't have to validate that with an additional document.

[LT_Oneal_PAC]

8 minutes ago, HMtoPA said:

I mean, I wouldn't say no if they gave me a certificate, but realistically they're not going to give me something that they're not giving the physicians I'm training alongside with. Besides, if it's considered a core competency of your training program, you shouldn't have to validate that with an additional document.

Oh, I agree. I didn’t know they were giving me one until they just handed it to me after my ultrasound rotation. Not sure if the physicians get one. It’s just nice to have it on top of my procedure log. Maybe no one cares.

[rev ronin]

17 hours ago, LT_Oneal_PAC said:

Oh, I agree. I didn’t know they were giving me one until they just handed it to me after my ultrasound rotation. Not sure if the physicians get one. It’s just nice to have it on top of my procedure log. Maybe no one cares.

The nice thing about Butterfly Cloud is that it keeps whatever you upload--stills or movies, tied to patient name, DOB, date, and whatever you put in for presentation.  Procedure log? Who needs that when you have all that info accessible indefinitely (for an annual subscription fee, of course--that's the razor blades or printer ink of the arrangement)

[LT_Oneal_PAC]

14 minutes ago, rev ronin said:

The nice thing about Butterfly Cloud is that it keeps whatever you upload--stills or movies, tied to patient name, DOB, date, and whatever you put in for presentation.  Procedure log? Who needs that when you have all that info accessible indefinitely (for an annual subscription fee, of course--that's the razor blades or printer ink of the arrangement)

Love my butterfly IQ for this. Wish I had it in residency to make logging easy. 

[HMtoPA]

Yeah, the Butterfly looks pretty slick. I haven't used one, but one of the senior residents in our program has one. The problem is, he still has to use the regular US machine for anything beyond a cursory look because we're required to record our scans fo QA purposes.

Also, it's hard for me to justify the $2000 upfront cost (plus whatever the ongoing costs are) when I have a perfectly good (and I assume more capable) full-sized unit on the floor.

I could see the Butterfly being useful in austere environments, but then you get a little into the "so what?" realm - by which I mean, there is sort of a limit to the value of out-of-hospital diagnostics, in that subsequent therapeutic options are so limited that management in the field likely won't change.

Edited July 26, 2020 by HMtoPA

[rev ronin]

15 hours ago, HMtoPA said:

Yeah, the Butterfly looks pretty slick. I haven't used one, but one of the senior residents in our program has one. The problem is, he still has to use the regular US machine for anything beyond a cursory look because we're required to record our scans fo QA purposes.

Also, it's hard for me to justify the $2000 upfront cost (plus whatever the ongoing costs are) when I have a perfectly good (and I assume more capable) full-sized unit on the floor.

I could see the Butterfly being useful in austere environments, but then you get a little into the "so what?" realm - by which I mean, there is sort of a limit to the value of out-of-hospital diagnostics, in that subsequent therapeutic options are so limited that management in the field likely won't change.

The butterfly records, and it has PACS integration so you can link studies from the Butterfly cloud into an EMR, as desired.  Yes, the up front price is steep, but if you're a 1099 and choose to buy one as a capital expenditure, that's likely a pre-tax $2000 (consult your tax professional).

Yes, there are good OOH uses for a Butterfly.  I'd like to see them on medic rigs for checking for cardiac standstill.  They're using them to diagnose HAPE at Everest base camp. In a family medicine clinic, it's the only imaging I have, so I make do with it, and still probably end up sending too many folks for full imaging if I'm not conclusively able to answer my clinical question.