Clinician Insights: Series 2, Episode 3

You can listen to the conversation here or read the transcript below. How is the development of digital technologies helping in the clinic? Jeff - It has opened up a wide variety of opportunities to adjust how we treat the patient but also systematically record and iterate in the care that we’re providing. It is helping bring the field of a craft closer to a science. There are scenarios where technology may increase efficiency, allow more analyzation of the care that we're providing. Technology allows sharing of information, the ability to as soon as you get a patient's specifications into a computer you can e-mail or digitally share that information and collaborate more effectively, central fabrication wise or gaining expertise from other individuals. In summary it's sort of like there's new things that can be made, there’s better sharing, but also there’s the ability to document, iterate and draw upon more data in the care that we’re providing. Andrea - I can scan sockets that I know aren’t quite right so I don't have to start from scratch, and I can do this quickly and reliably. I can keep track of the final solution and then once the final solution is obtained, I can replicate it multiple times the same way. So I don't have to ask a patient to come over to start the process from scratch, and I can save the amount of visits because of that. Training is also important. I can help new staff and students understand the process by showing step by step on a number of different cases and clinical presentations in a quantitative and visual way. I can report differential maps of changes and rectifications on these cases. Another important part of the digital flow is the legal perspective. If I'm asked to document which were the steps to prepare the prosthesis for a patient, I can go back to the digital files and document what happened step-by-step, and this integrates very nicely with the digital clinical records of patients. What role can you see data playing in future approaches to socket design? Jeff - One of the things I like to say is that if you ask two prosthetists on what's the best socket for a particular patient, you’ll get four answers. That shows a good thinking and an innovative mindset that the practitioner is utilizing to be able to kind of think through these different scenarios because they're very skilled at that, but that can be a very inefficient way of dealing with a particular problem. I could see in the future where there's a point where the data that's out there could help us in deciding which direction to go for each individual patient. However, I’m still very much in the mindset that there are just so many factors involved that it'll never get to the point where you can just use data alone to decide what care we're going to provide. If we have 50 decisions to make, 47 of them might be based on data, and three of them will still go off of our gut instinct, our perception of what has worked before and the perception of the patient. I guess in some ways it decreases the guesswork to a lesser number of factors, but I think there's always going to be a certain level of educated guesswork. That's going to be necessary, and if we can reduce the amount of factors that we guess on, we can increase the quality of care that we can provide. Andrea - With the digital world, we can improve the central fabrication. So I can collect casting remotely, I can scan remotely, I can send everything through to a central fabrication with specific indications about what I want, and then the central fabrication can return back the actual device. So I don't have to send physical components, and this is particularly efficient when maybe your provider of a partial solution is not even in the same continent. In that case, you can really speed it up a lot and also have a good impact on the environment. For the future we can always think about the activities that we've been doing, which is to exploit some of the new knowledge extraction or artificial intelligence to embed part of that knowledge into the software that we develop. So that part of the fabrication can be already carried out by the computer itself and then the prosthetist of course has to judge if the proposals from the computer are fine or not and they will always have to test the check socket and make the final adjustments on the patient. Technology is not going to take the prosthetists’ job. It will help and support the prosthetist in their job, and possibly support in increasing the quality of the prosthetic services. Or in situations where you don't have a super skilled prosthetist next to you. Because we appreciate that prosthetics is a specialism that you have to grow over time, and to manage prosthetics with confidence you have to be exposed to multiple cases. If we can embed part of the knowledge of the very, very skilled prosthetists as a support to less experienced prosthetists then we can probably increase the average level of service that we can provide even in remote or situations where you have a limited accessibility to super experts. Why is it important for technologies to consider the needs of more than a single clinic? Andrea - Firstly, because O&P is very site-based, there are many different methods and techniques applied to approach the same problem, so if you don't have this multi-centre perspective, and you try to be self-centric and focused on your own methods, you cannot be confident that what you are proposing can actually be embraced by your neighbors. So the more you see, the more you discuss with others, the more you can try to come up with solutions that are very globally applicable. I believe that it is very important that we try to develop methods to analyze data that are not just the average or the mean value of something. We need to understand how a certain solution worked for a certain group or a certain subgroup of our enrolled subjects or patients. Stratification of results in subgroups is very important, otherwise we might not see trends that are there. I think this is also very important in prosthetics because we know that each amputation has its own history and condition. So there are a lot of intrasubject personal factors that can play a big, big role in the outcome that we have with patients. Some patients might seem similar, but they actually can lead to results because of these personal factors that we might lose if we just look at the big group. This is a challenge and the more variability you try to embrace because of the multi-centre study, the more you have to be careful in analyzing your data. But it is absolutely essential. So multi-centre studies are the future and it's also a challenge from the point of view of the exchange of data and really from the computer science point of view, from the networking point of view to streamline the possibility to share data in a structured way over centres, over acquisition sites, it's something that will pay off for all the companies and industries that provide solutions. Jeff - I mean it's not an all or nothing type of thing. Nationally and globally more evidence could be applied to every clinical practice out there. You know more than they're currently doing. But it is sort of a gradient, and you know in high income countries it's relatively easy to disseminate information. We have conferences we have sales reps who come and give us information, trade magazines, things like that and all the different blogs and all this different information so to be able to shift towards evidence based clinical practice is relatively easy. Well in low-income countries they don't have all the conferences, they don't have the sales individuals coming to the door asking them and telling them about new things. Some of the blogs or magazines are written in different languages, so they may not be comfortable learning from those. So it gets harder to disseminate that information in a low-income country. With that said once again we can still try and do more everywhere. Massive thanks to Andrea and Jeff! Jenny: Wow! After all of our Clinician Insights discussions, I’m always taken by just how much conversational ground has been covered in a relatively short space of time. I’m sure, like me, you could have followed the chat with Jeff and Andrea for another three episodes. Through this series’ conversations with Jeff and Andrea, I’ve taken away some key perspectives, including: When we talk about the exciting developments that digital technology is enabling in the clinic, we shouldn’t forget about the excellent patient outcomes that are already happening thanks to the craft, skill and expertise of O&P practitioners; tech can enable us to hone our practices for the best possible results for our patients, but innovation shouldn’t replace talented clinicians. We shouldn’t be afraid of tinkering and getting our feet wet, to use Jeff’s phrases! There are so many ways that clinicians can start to experiment with new technologies, and I would absolutely echo Jeff’s call to action to see how you could begin to explore new technologies alongside your existing practice. Patient experience, and confidence, should always be at the front of our mind when considering how to adopt new technologies. Through the work of colleagues in the Socket Guidance workgroup, the future for our industry should be one where clinicians and their patients are confident that the technology being used will perform as intended for the best possible patient outcomes. So that might be it for this episode and this series, but we’ll be continuing the Clinician Insights conversation later this year with two more contributors to understand their perspectives on how digital technology has changed and is developing O&P practice in the UK, US, and beyond. We hope that through following Clinicians Insights, you feel part of an ongoing conversation, furthering understanding of digital technology and research supporting O&P practitioners in providing our patients with the best comfort, fit and socket fitting experience. If you’ve got thoughts, opinions or insight to share we’d like to hear from you; please feel welcome to get in touch at jenny@radiidevices.com

Clinician Insights: Series 2, Episode 3

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Clinician Insights: Series 2, Episode 3

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