Digital Workflows Show Benefits for Clinicians and Patients

Many clinicians can relate to a middle-of-the-night aha moment. You’ve been working for weeks or months to create the best solution for a patient, and finally it hits you. What if, instead of having to go to your facility and work with plaster and other modeling materials, finding the best solution was only as far away as your laptop? Enter digital modeling. Digital workflows are making fast and impactful inroads in O&P, bringing the convenience of anytime, anywhere modeling. Mecuris is among those bringing digital workflows for modeling of orthotics and prosthetics creation to clinicians and singing digital’s praises for enabling more seamless workflows and improved results for patients. “With accurate input information, there are many patient benefits, including less discomfort, a cleaner process, the elimination of the need for casts or saw blades, and a more interactive component to working with their provider,” says Richard Miltenberger, CPO, who has been in the O&P profession for 15 years and is now the US-based clinical specialist for the software provided by the Mecuris online platform. [caption id="attachment_247205" align="alignleft" width="300"] immimagery/stock.adobe.com[/caption] Digitizing Manual Processes Once a patient scan is uploaded to the platform, clinicians can work with three tools: Mecuris3D Correction, Mecuris3D Modeling, and Mecuris3D Creator. Mecuris3D Correction allows joint correction within the patient’s scan. Mecuris3D Modeling is used to create a positive model, and Mecuris3D Creator allows clinicians to design and finish the printable device. The modeling tool, Miltenberger says, is essentially a digital recreation of an O&P workbench that simulates the plasterwork typically involved. “There are techniques you can only find in a digital environment. This is a plus because you can make a copy to simulate another side or have two copies to work from to compare ideas,” he adds. “You can’t do that easily with a plaster model.” Users can merge scans with a digital plaster model of an orthosis or prosthesis, rotate it, smooth it, and see where plaster has been added or removed via a heat map. “It allows you to do all the things you can do in a plaster workshop, giving you a smooth model in minutes,” Miltenberger explains. “Then you can send it to milling, machining, or create a 3D-printable shape.” And while 3D prints cannot be made of carbon fiber, Miltenberger says there are some printing materials that have advanced to the point where they are appropriate for patient use. Mecuris’ tools can be used together in an overall digital process or integrated individually into a manual workflow. The solution is similar to modeling tools used in construction and building industries. “CAD design has been in O&P for a while, but it hasn’t been widely accepted,” Miltenberger says. “But there are many benefits for CPOs, including accuracy, time savings, cost savings, documentation of digital measurements, and the ability to retain digital models for future work or remakes.” Benefits of Digital Workflows Modeling accuracy and the ability to make modifications more easily are the most relevant benefits of working in a digital environment versus working manually with plaster and tools. Modifications can be tried and undone with a mouse click rather than having to scrap a physical model, and past modifications can be saved for future reference. Nothing is lost in a digital environment, and the clinician can document the entire process with a patient. Reducing the amount of storage space solves another problem clinicians, including Miltenberger, can relate to. “Not having to store all those molds is huge—they’re just stored as files,” he says. “When I was practicing, I had a boneyard of molds and sockets that I didn’t want to lose, and I would write on them with a permanent marker so I would have a model to start from. Anyone who has worked really hard to customize something understands that you need those references to go back to.” The ability to store many iterations of an orthosis or prosthesis doesn’t only benefit the clinician. It also allows them to better serve the patient by providing multiple options and versions and being able to turn those around much more quickly. [caption id="attachment_247206" align="alignright" width="300"] lidiia/stock.adobe.com[/caption] Innovative Solutions Miltenberger says clinicians have an extremely innovative mindset but are often tied to manual and labor-intensive workflows that find them trying to find solutions while the patient is sitting in the waiting room. He says it’s important to note that technology does not take the place of the provider relationship, but instead enhances it. With a digital workbench, providers can work out a problem before the patient arrives. “It can be difficult to change and digitize techniques and methods you’ve perfected over 20-plus years, but it’s really just a mindset change. And we’re getting to the point where the pros outweigh the cons.” While adoption of digital techniques has been slower in O&P than in other industries, they are beginning to gain acceptance. “Everyone is understandably concerned with the excellence of their craft,” Miltenberger says. “At the end of the day, it’s really about providing the best patient care—that’s what we’re here to help clinicians do.” The benefit of a digital platform, Miltenberger says, is that it allows clinicians to maintain that craftsmanship and then provides a tool to transfer that to a digital environment and capitalize on all the benefits that provides. And the 3D printing functionality is well suited to customized devices where mass production doesn’t work. Through a collaboration with practitioners, Mecuris identified the functions most critical to positive modeling, including: Posture correction and alignment of a joint: The platform allows clinicians to create a skeleton scan where they can adjust extension and flexion, and the varus and valgus of a knee joint, for example. OBJ files: OBJ files can be uploaded through the platform so that color information from patient scans can be displayed. Interval measurement: This tool allows clinicians to add a plane and create measurements in defined intervals, such as set distances, to more accurately gauge where to add or remove material. Change local circumferences: With this tool, the clinician can change model circumferences or reduce or increase sections of a residual limb by a defined value. 3D file of the positive model: Once modifications are complete, the file can be downloaded and sent to a clinician’s central fabrication service for carving or 3D printing; sent to a central fabrication service that has the capability to create and 3D print an orthosis or socket; or pulled into the Mecuris3D Creator tool to create a printable shell around a model. The cloud-based platform is designed to be easy and iterative, according to Mecuris. It’s based on a “freemium” model, so clinicians can try it at no cost and upload test scans to work in the real environment to get a feel for the tools. Mecuris also hosts a learning community for user support. “It’s an open system so you can use whatever you have at the beginning or end of your workflow,” says Tara Nicoll, head of business development. “Most people have everything they need—if you have a scan, a laptop, and an internet connection, you can use the software. You aren’t limited to the CAD/CAM specialist in your clinic. You can take this along to everybody.” One benefit of digital tools for clinicians in the field who see multiple patients per day is the ability to capture and upload scans to the clinic without the need to go back to the office between appointments. Digital tools are having a direct effect on workflows as practitioners and technicians look for ways to increase efficiency in delivering quality patient care, and it can be expected to advance in utility and practicality, as more facilities seek them out. Tara McMeekin is a writer and editor based in Colorado.

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