Point-of-care ultrasound can transform primary care in India

The 2017 National Health Policy recommends strengthening the delivery of primary health care by establishing “health and wellness centers” to provide comprehensive health care in rural areas of India. The recommendation is to transform existing “health sub-centers” and “primary health centers” (PHC) into “health and well-being centers” (H&W centers) to ensure universal access to a wider range of health services. primary health services. Some of the services provided by these H&W centers will include care during pregnancy and childbirth, newborn and child health care services, screening, prevention, control and management of noncommunicable diseases, health care services. elderly and palliative and emergency medical services.

Point-of-care ultrasound (POC-US) can help improve diagnostic accuracy, reduce diagnostic time, improve patient safety, and reduce complication rates. If deployed with proper controls in SSP-H&W centers, it can help reduce disease burden in rural India. In addition to pregnancy monitoring, there are several areas where POC-US can help improve the quality of care in rural India. Below are some examples:

  • Almost a quarter of all deaths in India are due to cardiovascular disease (CVD). CVD death rates for rural populations are higher than in urban areas. More women than men die from this disease each year. The prevalence of cardiovascular risk factors among the elderly in rural India is high. Ultrasound is used effectively to monitor heart health, the presence or absence of heart function during cardiac arrest, determine the underlying cause, monitor response to cardiopulmonary resuscitation, etc.
  • The POC-US can be used as a fast and accurate technique to assess critically ill people, including conditions ranging from life-threatening trauma to shock.
  • Chronic Obstructive Pulmonary Disease (COPD) is the second leading cause of death in India after heart disease, killing around 1 million Indians each year. The prevalence of COPD is higher in the rural population compared to urban areas. Spirometry is the most reproducible, objective, and non-invasive lung function test for COPD. The POC-US can be used to differentiate between different emerging lung conditions, including exacerbations of COPD, pneumonia, pulmonary embolism, and pulmonary edema.
  • The burden of echinococcal disease is high in rural India (around 150,000 people are affected each year). Early detection can help in better management of the disease. Portable ultrasound has been shown to be beneficial in diagnosing and monitoring treatment for this disease.
  • Elevated intracranial pressures can be detected using ocular ultrasound, for example, pediatric cerebral malaria.

There is a lack of comprehensive understanding of the benefits of diagnostic ultrasound in primary care. Determining the sex of the baby during pregnancy is prohibited to prevent female feticide in India. This ban restricted the use of ultrasound in a primary care setting for fear of misuse. While it is necessary to take all measures to prevent female feticide, this has inadvertently reduced the quality of care and increased the economic burden on people living in rural areas of India. People now have to travel long distances to a district hospital for an ultrasound.

Over the years, significant advancements have taken place in information and communications technology, artificial intelligence (AI), cloud, and transducer technology. The tools for training ultrasound technicians are more intuitive. Specialized ultrasound transducer probes to scan different parts of the soft tissue body have helped improve image quality. The cost of data storage has dropped significantly.

Regulators need to take notice of these technological advancements and work with healthcare tech companies to find a solution to deploy ultrasound devices in PHC-H&W centers while preventing gender determination. While taking on this challenge, here are some of the aspects that can be explored further:

  • The Preconception and Prenatal Diagnosis Techniques (PC and PNDT) Act 1994 was enacted in response to the declining sex ratio in India over the years. The main objective of the passage of the law is to prohibit techniques of sex selection before or after conception and to prevent the misuse of a method of prenatal diagnosis for selective abortion. The 2003 amendment brought ultrasound within the scope of the law by allowing its use only to detect a few types of cases. With technological changes and the benefits of using ultrasound, a more pragmatic approach is the need of the day.
  • For example, a radiologist operating in a district hospital should be able to register the portable ultrasound device at a remote site (SSP-H & W center). Guided by the radiologist (who makes the diagnosis), locally trained staff can capture the image. This process would require shorter and more accessible training for rural practitioners in ultrasound probe placement.
  • A log of all activities such as scheduling patient appointments, registering patients for analysis, capturing images, ultrasound probe used, time stamps, radiologists and rural practitioners involved, etc., could be automatically captured in the cloud infrastructure and linked to the patient’s unique health. ID (UHID) to prevent abuse. Temporary local storage would be required to automatically store data locally in the event of connectivity issues.
  • Making sure the portable ultrasound system has GPS tracking will help track the location of the device 24/7 and prevent it from being moved out of the recorded location.
  • AI algorithms will need to play a crucial role in the deployment of ultrasound devices in rural India. There are several areas where AI can have an impact. When performing a scan, organ identification, image capture and recording of required measurements are now possible in some ultrasound devices. A default masking of the genital area of ​​the fetus, ensuring proper controls and accountability for unmasking the genital area, can be further explored. Stored images and associated data are currently manually audited on a small, randomly selected sample to detect any suspicious activity. This process can be automated using AI algorithms for 100% coverage.

There are several examples where POC diagnostic ultrasound has been used safely and successfully in low-resource settings. Several non-medical professionals are trained to use ultrasound for various types of exams including echocardiography, rheumatic heart disease, trauma, lungs, and more. Lugufu refugee camp in Tanzania, Dutch medical helicopter crew, etc.

For the deployment of ultrasound in a primary care setting to be successful, several challenges must be addressed. These challenges include the lack of health personnel in PHC, communication infrastructure, maintenance of the ultrasound device, intermittent power supply, etc.

The SSP-H & W centers will help improve access to healthcare for people living in rural areas of India. It is necessary to review the list of medical devices made available in these centers. A portable ultrasound machine can improve the screening and diagnostic capabilities of these centers. A more pragmatic vision of the PC & PNDT law is needed. The solution must ensure improved controls to prevent the determination of the sex of the fetus.

Emerging technologies such as AI, cloud, 5G and advancements in ultrasound transducer technology will play a critical role in this deployment.

(Srinivas Prasad is Founder and CEO of Neusights and the opinions expressed in this article are his own)

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