The Democratization of Ultrasound

By Michael Lilly, MD, RPVI, RVT

The pandemic has accelerated an already rapid evolution in the use of point-of-care ultrasound (POCUS) across the healthcare industry. While COVID-19 sparked a surge in POCUS usage among emergency room and intensive care settings, the technology was already spreading across most clinical applications thanks to its noninvasive efficacy, speed, economics, and superb safety record. In 2020, the global POCUS devices market generated $2,186.8 million in revenue and is expected to experience a compound annual growth rate of 7.9% during the forecast period (2021–2030), according to P&S Intelligence.

But while the “democratization of ultrasound” via POCUS technology is good news for healthcare providers, the technology has the potential to increase risks for patients if used incorrectly. Misuse of these handheld devices can lead to incorrect diagnoses, delays in care, or even death. The expanded use of POCUS technology must be supported by equally broad adoption of usage standards, ensuring that healthcare professionals receive proper training and certification.

There are numerous drivers of ultrasound’s democratization, but they tend to fall within three general trends: new technological advancements in ultrasound, new applications, and new users.

New technological advancements in ultrasound
Improvements in size, mobility, cost, and functionality have contributed significantly to the increase in uses and users of diagnostic ultrasound. Portable miniaturized ultrasounds allow clinicians to confirm suspected diagnoses at the point of care and more rapidly initiate treatment. These devices have been one of the biggest breakthroughs in accessibility. Many other professionals (EMTs, physical therapists, and nurse practitioners, among others) now have a portable ultrasound device as part of their practice.

Handheld ultrasounds can be cleaned and put back into rotation much more quickly than larger traditional diagnostic units—especially helpful in overcrowded hospitals. The price point has boosted adoption as well, with some miniaturized ultrasound devices available for under $2,000.

New applications for ultrasound

Diagnostic applications for ultrasound can be found in nearly every area of clinical medicine, including OB-GYN, cardiology, vascular, orthopedics, critical care, emergency medicine, and many areas of oncology. We are also seeing innovative uses of POCUS in diagnosing musculoskeletal issues, deep vein thrombosis, and (due to COVID-19) expanding areas of lung health, to name a few examples. This growing universe of uses stems from ultrasound’s ability to reveal information about a patient quickly, cost-effectively, and without the use of radiation—giving patients greater safety and peace of mind.

New users of ultrasound
POCUS is gaining acceptance across a wider range of healthcare providers and clinical specialists who traditionally may not have used ultrasound, such as primary care and emergency medicine professionals, nurses, and midwives. Anesthesia providers are increasingly adopting the technology as well for more effective management of emergencies.

The need for certified proficiency

The influx of uses and users of ultrasound will inevitably result in some misuse by inexperienced individuals. When clinicians do not have the proper training, they can inadvertently cause serious harm to their patients through improper technique or flawed interpretation of findings or artifacts. Recently, the ECRI Institute, an independent, nonprofit healthcare safety organization, found that POCUS was the second highest cause of healthcare tech hazards, due to the adoption rate outpacing policies and procedures that prevent misuse and incorrect diagnoses.

Because the democratization of ultrasound with POCUS has been so rapid, there have not been sufficient developments in training and standardization of protocols to meet the needs of new users and patients. The best way to prevent missed or erroneous diagnoses is to develop a consistent, universal set of standards for using POCUS technology. Independent, third-party validation of ultrasound user knowledge, skills, and abilities, combined with practical assessment and certification, will be key to the efficacy and safety of this powerful new tool.

Ultrasound certification programs need to ensure that training and education is equitable, accessible, and clinically relevant across all clinics and hospitals in specific cultures and practices. Fortunately, as more people become proficient and certified, there will also be more qualified trainers to further the education process. Patients need to feel confident that excellent ultrasound care is available wherever they go, and standardized certification protocols are essential for achieving this.

Michael Lilly, MD, RPVI, RVT, is chairman on the Board of Directors for Inteleos, a non-profit certification organization that delivers rigorous assessments and cultivates a global community of professionals dedicated to the highest standards in healthcare and patient safety. Dr. Lilly also is a tenured professor of Surgery at the University of Maryland School of Medicine and serves as chief of the Department of Surgery, director of Vascular Center, and medical director of the Non-Invasive Vascular Lab, all at the University of Maryland Medical Center (UMMC) Midtown Campus.