Point-of-Care Echocardiography in the Accountable Care Organization Era

Disruptive Innovation? Portable Ultrasound SystemsTechnological advances over the past 2 decades have made ultrasound equipment quite portable, with functionality and image quality similar to high-end ultrasound systems used in dedicated imaging laboratories.1 Echocardiography and vascular laboratories are using these portable ultrasound machines to perform studies on patients who are unable to travel to the imaging laboratory. The same equipment now enables other healthcare providers to perform ultrasound examinations at the point of care (POC), that is, ultrasound examinations performed and interpreted at the bedside in real time. At present, the most commonly used devices for POC ultrasonography include portable, cart-based machines that are smaller and lighter than traditional systems, while offering the same features as larger ultrasound systems.2 The cart-based machines are often equipped with batteries and have bootup times as short as 15 seconds. Although a wide range of cart-based ultrasound systems is currently available, these systems have demonstrated adequate image quality to answer focused POC questions, even in patients with obesity or chronic obstructive pulmonary disease.3,4More recently, pocket-size ultrasound devices have been developed by various vendors. These devices have sizes approaching those of smart phones and are equipped with a battery and a single transducer. Although these devices currently do not have advanced features such as spectral or tissue doppler, they allow for gray-scale imaging (B-mode) and color-flow Doppler and are capable of recording both still images and video clips.1 These attributes, along with their low cost, allow providers to use these devices like a stethoscope of the future and arguably places them in a disruptive technology category.5 In a recent study comparing the accuracy of a pocket-size ultrasound device with high-end ultrasound systems in 349 patients, concordance with respect to regional wall motion, ejections fraction, and left ventricular (LV) dimensions was very good …