Cardiovascular disease is the leading cause of death in the US. Clifford Thornton explores the impact of technology on medical devices, cardiography and treatment, with Jim Cagliostro.

 

Episode Introduction 

Clifford explains the two types of echocardiograms, the benefits of 3D versus 2D echoes, and why it takes $72 million and a decade to launch new medical devices in the US. He also highlights how spending on cardiovascular care has risen to $600 bn a year and offers a Top Gun analogy to emphasize why healthcare leaders must carry out competitive and environmental scans. 

 

Show Topics

 

• Two different types of echocardiogram 
• Advances in technology have transformed echocardiography
• 3D echo versus 2D echo
• A $72 million barrier to new technology 
• Choosing the right medical device for your patients
• Staying ahead in your market (learning from Xerox) 

 

 

05:50 Two different types of echocardiogram (echo)

Clifford said there are two main types of echo, surface and invasive. 

‘’So to really answer your question, echo is basically an ultrasound or sonogram of the heart, which is why we also refer to it as a cardiac sonogram. So those who perform this test are called an echocardiographer technician or a cardiac sonographer. There is a movement to change it to an echo specialist. Some people are not so thrilled with the technician annotation. I don't have a problem with it, but there's some discussion around that just for everyone's awareness. Of course. So echoes, they can be broken down into two main types and they basically use a different type of probe. One is on the surface and one is invasive. I say invasive, but through the esophagus. I guess it is invasive. The more common and more easily performed surface echo, or you can call it a vanilla echo, is the transthoracic echocardiogram, which we also call a TTE as an acronym….So that's the one type and the other, and this is a little more complex, this requires a healthcare team, a clinical team. So it requires the performing cardiologist, whereas the surface echo and echo tech can do it alone, just the tech and the patient.‘’

 

10:34 Advances in technology have transformed echocardiography

Clifford said both patients and healthcare employees benefit from the impact of technology. 

‘’Look where we've gone from our Texas instrument scientific calculators to smart watches. And I remember always running with the Sony Walkman, the Sony cassette Walkman and the Discman, and now we have iPods. So echo is no different. It's amazing, right? To answer that, echocardiography and its related technology because as we know, it relies a great deal on technology. So meaning the design and engineering of the cardiovascular ultrasound systems, it has actually evolved immensely since the beginning, and that was about 40 years ago. You see as techs, we joke around about those early machines that were beef, like little tanks to push around. And just like other techs, they've gotten more and more compact and lighter. And that of course makes techs’ lives much easier and more ergonomically friendly. I'm sure you know from a nurse's standpoint, how important that is. Actually, the number one occupational injury for nurses is moving patients in the country, ergonomics. So we as techs love these new machines, me included. So for example, one thing I love about what's called the Philips iE33 system, it's one of their more modern systems is that the monitor actually pivots for angles in different directions to so many physicians. It's really neat. So since I'm actually an oddball, lefty scanner, most echo scanners are righty, for me that's super helpful. Most ready techs, they're facing away from the patient, but the positive for lefties is I'm facing the patient. They can actually look at the screen. So this type of flexibility with the machines, it's a godsend, especially for bedside echoes where we go and do the echo in the unit.’’

 

13:17 3D echo versus 2D echo

Clifford said 3D echoes give a more real perspective of the heart, enhancing interventional procedures and patient care.

‘’Really though, the most meaningful advance for echo, what really has changed, it has been the growing availability use of 3D echo versus the standard 2D. So there's been a growing availability of 3D echo over the last decade or so. And today I would say there's about 75% of availability of 3D echo….about 35% of all US labs probably use it routinely. So you can see it's become pretty standard. The clinical benefit, it may not be readily apparent sometimes, but I thought it was pretty neat. I definitely found it to be a more real perspective of the heart. But there really is a benefit to the 3D TEE, and it actually plays a pivotal role in the growing prevalence of interventional procedures. Especially things like transcatheter valve replacement. Some other important advantages of the 3D echo include it eliminates geometric assumptions, quantifying complex geometric shape volumes, the ability to view structures from any perspective, and also assessing a lesion in what we call simultaneous multiplane. So with 2D echo, as tech cardiologists, we have to kind of imagine things, but the 3D gives it more of this real visualization.’’

 

17:17 A $72 million barrier to new technology  

Clifford said it takes a decade and $72 million to launch a new medical device in the US. 

‘’On average, it costs about $72 million to start a new medical device in the United States. You need a good amount of money. It's a dynamic, but very challenging intersect between the medical science and business. But I would say the main challenge with all this is it takes around a decade, and I know you're very familiar with this, it takes around a decade or more to develop and refine and test these medications and new medical devices. What could happen in the span, the market evolves and you see new entrants, the economy changes. So this timing aspect, Jim, it's really difficult, extremely difficult. Also, unfortunately, we've seen a lot of biotech, venture capital firms actually exit the United States or pull back significantly. I think the risk is scaring a lot of people. Very risky. For those launching something in this space, some advice. I would say, you really want to make sure it is quite novel and really have a compelling case and the proof of concept, that's your bread and butter. That's a critical early milestone.’’

 

20:39 Choosing the right medical device for your patients 

Clifford explained the key elements hospital leaders should consider in choosing the right medical device. 

‘’Yeah. That's another very important question. It's become difficult to sort through it. You're right there. So my underlying philosophy that I learned from experience and also by studying a lot of successful leaders is that you want to always aim for high quality and strong results. Okay? You want to have your binoculars pointed in the right direction and everything should fall behind that. With that being said, I think the key for hospital leaders is, one, they want to look at how the technology, how it fits into their existing suite of services and how it aligns and how it can bolster their existing services. Two, they must consider if they have the infrastructure, the staff and the resources to support a certain program, say like what we talked about, their percutaneous valve replacement. If they don't have the tools, it doesn't mean never, it means now they need to start building and selling a business plan to amass that capability on all levels, which means the tech, the staff, and related expertise and the infrastructure. Build a business case for that. There are then... Of course, we talked about before with the medical device tiers, the regulations. You got to take that into account.’’

 

28:59 Staying ahead in your market (learning from Xerox)  

Clifford said competitive and environmental ‘’scans’’ are vital with rapid advances in technology. 

‘’And finally, I think this is really key. We talked about this, the piece of change. We talked about the windows of opportunity and so forth, and what we need to do or leaders need to do, and I mean they need to do this constantly and also rigorously, is to do what we call from marketing people, we talk environmental or competitive scans. And the reason for this is you never know what technology or competitor can come out of a field or to identify new opportunities. A lot of people know Xerox was invented some of the early internet technologies, but they just didn't capitalize on it. They maybe didn't look at the competition out there. And now we have Google and there was Netscape and then Google, and the leaders out there. Now Google almost dominates online advertising. So you want to be aware of what's out there…. on average today, companies have only about a three-year window to make a profit on a given product or service.’’

 

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You’ll also hear: 

 

Inspiration from his uncle, and a passion for fitness; Clifford’s journey into cardiology. 

Putting the power of a human heart into context: ‘’They say in a lifetime an average heart pumps enough volume of blood to fill more than three super tankers. So just to give you a picture that equates to around 1 million barrels of blood.’’

Why a good pair of shoes is critical working in cardiac care: ‘’….for one of my first or early echo jobs in Naples, Florida, the job description listed the ability to walk, I kid you not. seven miles per day as a requirement for the job.’’

 

Keeping the focus on people: ‘Just an example, in New York state, they just made a certain nurse to patient ratios mandatory, meaning it's a state law in their intensive care unit. So they have to adhere to these nurse to patient ratios in all New York ICUs now. So managers, they need to work around all these kinds of things and take it into account.’’

 

The cost of treating cardiovascular disease: ‘’…shortly after Medicare was instituted, cardiovascular spending in the United States jumped to around 100 billion a year within 10 years. Today that figure how much we spend on cardiovascular to treat cardiovascular disease in the US is 600 billion a year. And globally, I would say it's around 1 trillion.’’

 

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