Clinician Insights, Episode 1, Series 2

To hear the conversation, listen here. Or read the transcript below. Could you tell us how you see the current status of digital technology in the clinic? Do you see the impact of digital tech in your practice? Jeff - In the past, we were very much tinkerers who had a scientific basis in what we're doing. But when it came down to it, it was a craft; there was no manual, or standards, or anything that said “This is how you provide care.”. We would just take this scientific and medical knowledge and then figure out how to utilize our craft to take care of people. Today, I think that digital technologies are making it so that we could actually function much more like a science. Andrea - Since the introduction of CAD and CAM technologies years ago, digital technologies have been changing the way we do prosthetics and orthotics. Currently, everything is receiving a big push probably because instruments and the computational power has become more accessible, and the costs for scanners has dropped a lot. So the way technology is changing is very important; now we are able to quantify exactly what we do. So we can quantitatively say “I want to have this little change here” in that if I want 5mm, I can get exactly 5mm in a certain spot. Jeff - We might be able to make lighter, stronger, less cumbersome protheses, because we don't need to throw the kitchen sink at it every time. Currently, we're fairly universally using liners in our prostheses. Let’s say most are 6mm; of course it varies patient to patient, but I’m confident that none of my patients require 6mm of silicone around the whole residual limb. With that silicone being an insulator, what we might be doing is making that person’s leg very hot and sweaty. We’re making heavier than necessary devices, and we’re making it more difficult than it could be to don. This all happens because we’re not exactly sure what we need and what forces we need to control. So, what is the relationship between digital innovations and the expertise of an O&P practitioner? Should the profession be concerned about the growth of these technologies, or should we be seeing this as an opportunity? Andrea - Sometimes when you talk to your colleagues in the field that do clinical work there might be constructive contrasting feelings about new technologies. This is because they are to some extent disruptive in the way they come into your work, so I think it's very important that we first of all recognize all the good and excellent clinical practices there are now. With the current method, technologies and materials, we should never forget how easy, practical and reliable certain present solutions can be, and we really need to be focused on the things that we want to change to be effective, so don't just throw everything away. Just be conscious about what is good now and try to tackle the problems that people in the clinics do have. On the other side, people should not be afraid to embrace new methods; this is very important because it can be a very good learning process. Keep up with how the world is changing. If you embrace it with courage, you will never feel that you have been left behind or you are old. You will always be up to date. So it's a big challenge, but it should be embraced with courage to look for the future. We have to realize that we fit thousands of prostheses and we have people walking every day on what we do now. So that's not an unsuccessful story; it is a very successful story! We know that there are reasons and rates of abandonment and rejections that we have to mitigate a lot, but then it's good that we start thinking about how to improve or even completely change the way we do things. But we have to recognize where we are starting from to really see the way out, or the improvements. The weight of the prosthesis and the mechanical resistance strength of the final product is also something to keep in mind. We have to be very cautious about proposing new fabrication methods before having a good understanding of the mechanical performance. How can colleagues feel encouraged to experiment with some of the innovative tech available to them? Jeff - There's no doubt in my mind that every practitioner should be getting their feet wet in new technologies today. Figure out some way to use more digital technology to a certain degree in their practice, because it's not a question of ‘Is this coming down?’, or “Is this going to be critical in the future of care?” It's just a question of how critical it is going to be, at what point in time. If someone said to me, “Are we going to exclusively use digital technology in two years?”, my answer is no. If someone asked me, “Are we exclusively going to be using digital technology in 10 years?” My answer might be maybe and so there's sort of everything in between there. For pretty much everyone who's currently practicing, they should have that comfort level so that when it becomes clear and obvious that the digital path is the right path to go down, they're comfortable to move over to that space. It could be as simple as taking a cast, making a plaster model then scanning that plaster model for a record, or some kind of digital analysis or something like that. That in itself could be a first step. Then there's also some low cost or free CAD software out there that people could tinker with and play with. Beyond that you get to more efficient technologies that do cost money, but you get the levels of efficiency and more features when you get to those things. So practitioners can decide how far they want to go into this, but in my mind it's absolutely 100% clear that they should be at least getting their feet wet. And that’s us for today! Jenny - Well, we managed to fit a huge amount of insight into the answers to just a few questions asked of Jeff and Andrea. Thank you to Andrea and Jeff for sharing their insights. I think it’s so helpful to take a step back and reflect and discuss where we are in O&P today. As Andrea said: it’s an incredibly successful story, and it’s so important that the focus on developing digital technology doesn’t forget the excellent clinical work being carried out every day. I’m pleased that our conversations with Jeff and Andrea touched upon the potential that technological developments could offer clinicians in the future for gathering more data and evidence, and the enablement of expertise sharing that could come with such advancements. On that note, we’ll see you in July for episode two which is dedicated to the work of the AOPA Socket Working Group, including how guidance could support embracing innovations. Thank you for joining us for these conversations. Clinician Insights is an ongoing conversation; we’d love to bring more people in to share their insights. You can join the discussion, comment, or tell us your thoughts by getting in touch at jenny@radiidevices.com .

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