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A Conversation with Dr. Joseph Minardi: Revolutionary Workflow Will Propel POCUS Education

When medical practitioners receive improved technological investments such as revamped workflow solutions for ultrasound exams, their medical practice improves overall, and patients benefit from speedier diagnosis and treatment. The Exo team recently sat down with Joseph J. Minardi, MD, Director of West Virginia University's Medical Center for Point-of-Care Ultrasound, to learn more about his experiences with point-of-care ultrasound (POCUS) workflows, and how improvements can have impacts downstream to other areas of healthcare, including medical education.

Dr. Minardi teaches more than 500 medical students per year and directs both the curriculum and POCUS fellowship program at West Virginia University’s medical school – he has experienced the need for an intuitive POCUS workflow firsthand. A better workflow solution will inevitably help to encourage more widespread POCUS adoption, he remarks, comparing it to building roads and bridges in a city: “If you build the infrastructure, traffic will start filling up.”

Problems with POCUS workflow

In most hospitals and clinics, many healthcare professionals use a patchwork of do-it-yourself solutions to capture, store, and review ultrasound images—a process that extends the time between a procedure and getting patients their results. There is no infrastructure that allows physicians to easily get information out of their ultrasound device of choice — cart or portable — and into emergency medical records (EMR). Cobbling together an ultrasound’s critical documentation and billing makes it more cumbersome to do essential tasks, which takes doctors away from patients. Worse, when ultrasound workflow hinders a doctor’s ability to address a patient’s health in a timely fashion, it means important documentation can get lost, which has monetary impacts downstream for hospitals and providers in getting reimbursed for utilizing POCUS.

While ultrasound has been used in medical education for decades, POCUS has not yet seen widespread adoption in medical schools and residency programs. Dr. Minardi considers how, from his experience, a cumbersome workflow for the devices has been the main reason for a slow rollout, “Ultrasound shouldn’t feel like some special thing. It should be a part of my day of seeing patients.” He shares that a seamless process for point-of-care ultrasound will accelerate its use, since healthcare professionals won’t need to think twice about using such devices.

Dr. Minardi works at multiple hospitals, including West Virginia University’s Medicine Center, that use convoluted systems to retrieve medical records. “It’s a rocky process,” he remarks. “It’s challenging when you have a critical patient who isn’t registered in the system, or you don’t have time to go to the EMR to put the information in an order.” When an exam isn’t cataloged correctly, studies can get lost, making it difficult to maintain an accurate archive and keep track of who’s done what assignments, or determine if the assignment was accidentally assigned to the wrong person.

Providing feedback in a timely manner

An administrative piece is missing from many current POCUS workflows, and this prevents it from being successful from an education perspective — real-time quality review and feedback of student studies. With hundreds of students enrolled, Dr. Minardi’s only opportunity to provide feedback to his students on their ultrasound studies is in-person, through live demonstrations or evaluation sessions. Not only is this process incredibly time-consuming, but it’s literally impossible to provide feedback in one day. With nothing on record, students don’t have access to review examples of their work, so they must wait to receive feedback at a later date. Minardi notes that, because of this process, students rarely spend the time revisiting feedback needed to further their skills. Instead, they spend most of their time keeping track records of their own POCUS scans on spreadsheets, which he considers a huge waste of time.

In an educational setting, a convoluted POCUS workflow limits the learning experiences for many students, which causes a decline in much-needed POCUS skills. “If POCUS workflow is not part of their usual practice, they won’t adopt the process. It’s a vicious cycle of complacency,” Dr. Minardi says. “And the biggest risk in not having a streamlined, intuitive and effective workflow is that it slows down adoption of point-of-care ultrasound altogether.”

For example, the use of bedside ultrasound is important, because it not only saves time, but it also saves money and decreases stress on physicians. “It’s about reducing friction to uptake,” Dr. Minardi remarks. While ultrasound doesn’t solve every single clinical problem, it provides more diagnostic certainty. “Without ultrasound, you’re making educated guesses,” he says.

Finding a workflow that works

After facing challenges in both the classroom and hospital setting, Dr. Minardi integrated Exo Works™, an intelligent POCUS workflow solution, into his lesson plans to manage exams for compliance, quality assurance, credentialing, and education. “It looked great from the get-go,” he reminisces of the first time he saw the software. “It’s a great workflow. It’s intuitive.”

Further explaining his implementation of Exo Works, Dr. Minardi remarks how much time he’s saved in providing feedback to students on their ultrasound scans, “It’s day and night – I wouldn’t even compare it, because it’s not the same.” Beforehand, to review and provide feedback would have taken an hour for each study. He smiles, “Yesterday, I reviewed 20 studies in 15 minutes.”

“Students are more excited when they get immediate feedback,” he says. “The goal is to give them an opportunity to practice ultrasound scanning and have them graduate with a portfolio in hand.” The idea of a portfolio is especially exciting to Dr. Minardi, since it gives students tangible evidence of their expertise when applying for the next steps in their medical careers.

Because it has been designed to be device agnostic, Exo Works presents additional value to Dr. Minardi for its potential to integrate with his other healthcare workflows and devices. “If I had my way, I’d be incorporating it even further into my other clinical workflows.”

Dr. Minardi also remarks that, because of Exo Works, his students now have more flexibility — the new workflow can be accessed on any mobile device, making it faster to review studies, and easier to upload and store scanned images. In one cloud-based interface that maintains HIPAA compliance, Exo Works helps users perform exams, document notes, apply billing codes, archive images, and accelerate ultrasound education.

“I can use Exo Works anywhere. It’s easy to justify from a patient care perspective,” Dr. Minardi emphasizes.

To learn more about Exo Works, visit our webpage.