At the American Academy of Pediatrics (AAP) National Conference and Exibition (NCE) in October, I again presented 2 workshops on office technologies, sponsored by the AAP’s Section on Advances in Technology and Therapeutics. I made every effort to make this year’s workshop a unique experience, showcasing some new technology while including some of my old favorites.
This year, I learned a lot from the attendees regarding the obstacles that prevent pediatricians from integrating technologies into their practices. In this article, I will share some observations from the workshop as well as my experiences in the NCE exhibit hall, and present this year’s selection of the best gadgets and gizmos for pediatric practice.
This year’s workshop
I was surprised to learn that most workshop attendees were not screening young children for hearing loss despite the AAP’s recommendation to screen children at ages 4, 5, 6, 8, and 10 years routinely (and at other ages per a risk assessment), although otoacoustic emissions (OAE) hearing screeners make screening quick and easy. In addition, many pediatricians said that they would like to photoscreen children at their yearly well-child visits, to identify the 1 to 2 children per hundred with amblyopia so they can receive prompt treatment from ophthalmologists. However, many pediatricians were not screening because they considered photoscreeners unaffordable.
I shared with the attendees that technology can facilitate screening and, despite what appears to be a hefty price tag, the return on investment of these devices enables physicians to recoup their investment within a few months. Because photoscreeners and OAE hearing screeners also speed workflow, additional patients can be seen in a day, which also should be taken into account when considering purchase.
Reimbursement for photoscreening averages about $25. In my practice in New Hampshire, the range is from a low of $16 to a high of $60. So, if you do 20 tests per week, you will generate $26,000 in revenue each year and you will pay for that $7000 device in less than 4 months! Even if medical practices balk at purchasing the Spot Vision Screener (Welch Allyn; Skaneateles Falls, New York) or the plusoptiX S12C portable vision screener (Plusoptix; Atlanta, Georgia), practices can subscribe to the GoCheck Kids photoscreener mobile system (Gobiquity; Scottsdale, Arizona), which can be used for as little as $60 per month. Similarly, the $15 reimbursement for an OAE hearing screen means that if you do 20 screening tests per week, these $4000 devices will generate $15,600 per year and also will be paid off in less than 4 months!
What I found most revealing was that virtually all the 100 or so pediatricians who attended both workshops could not complete their charts each day and had to complete notes at home! As I had just completed my November Peds v2.0 article on “preventing physician burnout,” this prompted me to encourage physicians to seek ways to expedite note completion. I told the attendees that this can be accomplished if physicians time stamp visits, try to write less verbose notes, and consider using scribes in their office or using voice dictation software.
Best new tech
This year, there are lots of great technologies to report, and I learned about several of these from wandering the NCE exhibit hall.
I treat many patients with warts over the course of a week. Depending on the size and location of the wart and the stoicism of the child, I sometimes use cantharidin, but frequently I use liquid nitrogen delivered by spray. Last year, I reported that Brymill Cryogenic Systems (Ellington, Connecticut) has a new palm-sized cryogenic delivery system called the Cry-Baby. The $595 Cry-Baby holds 150 mL and avoids wastage of liquid nitrogen. I have been using this device for nearly a year and I can honestly say the small size improves my ability to freeze warts while avoiding injuring surrounding healthy tissue.
Brymill also markets a variety of freeze cones as well as a freeze plate that can isolate the wart, in addition to attachments that enable you to cool a metal probe of varying shapes and sizes. Once cooled, the probe is applied directly to the wart and “lifted” to avoid extending the freeze too deeply. I was pleased to learn that early next year, Brymill is releasing an updated version of its discontinued Cry-Ac Tracker. This device monitors and displays the skin temperature and indicates when a freezing temperature has been reached. I look forward to becoming reacquainted with the new version in the first quarter of 2017.