There had been tremendous growth in point-of-care ultrasound (POCUS) use in the years leading up to COVID-19, and then there was a massive boost for its use during the pandemic. However, unless clinicians receive at least some sort of basic training on the use of ultrasound, they may not know what they are looking at or how to scan the required images for a diagnostic quality exam. The American Society of Echocardiography (ASE) recognized this issue early on and stepped forward to offer training for various POCUS users and to bring them into its membership.
With the entry of small handheld ultrasound systems on the U.S. market over the past decade, there has been a widespread prediction by physicians that these systems could replace the stethoscope. Ultrasound does offer more clinical information than a stethoscope, but experts agree there needs to be some standardization in terms of training and how basic exams are performed. Once there is standardization and acceptance of any new guidelines created, this could open the door for conversations on POCUS reimbursement.
ASE President Stephen Little, MD, and James Kirkpatrick, MD, physician program chair for ASE 2023, spoke with Cardiovascular Business about this topic in June.
"The ASE is for all users of cardiovascular ultrasound; that is our mandate," Little explained. "And there are an increasing number of users who do not necessarily work in an echo lab, and are not necessarily anesthesiologists who are very skilled and facile in transesophageal echo (TEE)."
ASE decided to become involved as many POCUS vendors were offering compact or handheld ultrasound systems to perform basic cardiac assessments. ASE moved beyond echo assessments to now offer training in critical care, lung and other types of fast assessments.
The society also created its first speciality POCUS group to provide guidance to members and outline needs for training and standardization. The first ASE council to be established that is outside of traditional echocardiography with a focus on POCUS is the Critical Care Echocardiography Council.
Other areas of concentration for POCUS include the emergency room, internal medicine and looking at patients in hospital wards during rounds.
"POCUS is a new field, so there are challenges. One of the first challenges is the nomenclature, and defining what POCUS is. Is it just a single view of a single diagnostic concern? What is the difference between a POCUS or a limited transthoracic exam? So step one is to untangle the training, education and ultimately the payer conversations around how do these studies get covered. You have to be able to speak the same language across the enterprise. So one of the things ASE is doing is we have a writing group with a guideline in process and to define the nomenclature around POCUS," Little explained.
Kirkpatrick said ASE has all the POCUS stakeholders involved in this process, including emergency medicine, critical care, anesthesiologists and internal medicine physicians.
"This is a rapidly evolving field and we are involving all users of POCUS, it does not matter what specialty," Kirkpatrick said. "We want to be their representative and we want to all work together to use this amazing technology for the good of patients."
He is a member of the ASE Critical Care Echocardiography Council, which Kirkpatrick said transitioned very quickly in just a couple years from an ASE special interest group to become a full council in the society. "We are now moving forward at light speed to really broaden the tent and bring everyone in and to figure out how to use this great technology in a really responsible and coordinated fashion," he explained.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com