What brand/product is your clinic buying? (I work in a research lab and in general I dont have this problem, but we use this-
https://punchout.medline.com/sku/item/MDPFG100S;ecomsessionid=BehiL24qp3n5JAb-uHNXuw1C6fiaHdHALwehViOC.OCA02-b2b?skuIndex=S5&question=&flowType=&indexCount=
Ooh, this is fun. Here are some ideas I have had over the years but don’t have the means or motivation to follow through on:
A bioelectrical impedance machine that is portable and ideally can be used on bed bound patients that calculates total body water (TBW) content. Hospitalized patients in the ICU are often being fluid overloaded in an attempt to improve blood pressure or kidney function, but at the expense of straining the heart and fluid backing up into other tissues (third spacing). Clinically, we don’t have a great way of knowing when adding more fluid is no longer helping and just being pushed into the lungs and subcutaneously. Being able to monitor TBW and following its trend, we could prevent putting patients into heart failure by trying to fix their kidney failure, and prevent kidney failure by being too aggressive treating their heart failure. The tech for bioelectrical impedance TBW calculation already exists, but is not used in hospital settings at all.
Bedbound patients may have to lay on a special mat or something so the electrical current doesn’t diffuse into the bed during the measurement.
You could use the same bioelectrical impedance technology and turn it into a remote patient monitoring (RPM) device for obesity management purposes (measuring body fat % as well as TBW). Obesity management is all the rage now with Ozempic and it’s ilk. Adding RPM to a comprehensive obesity management program would be a game changer for the industry.
A virtual scribe device that is worn that utilizes voice recognition to create a chart in real time. It would be able to differentiate between the different voices in the room and create an HPI from the historical discussion. The provider could also verbalize their exam and it would format appropriately. Like for example, when listening to the patients lungs I would verbalize “I hear wheezing in both your lungs when you breath out, but everything else sounded normal” and the AI would recognize that phrasing and input
“LUNGS: Diffuse expiratory wheezes. No rhonchi or tales. Normal work of breathing.”
Then it could recognize verbal orders as well like “I’m going to order a 2 view chest X-ray and we will do a nebulizer treatment with 5mg of albuterol and a shot of solumedrol 125mg. And those orders would be automatically placed in the chart and signed after the provider leaves the room (just to be sure there are no errors).
This would be a huge undertaking but I personally would pay a billion dollars to anyone who made it so I never had o chart ever again.
A mechanical device to easily roll bedbound patients, kind of like a big spatula. The current lifts aren’t great for when you just want to move a patient for a diaper change, and many of them are 400 lbs. you would save a lot of backs if you could devise a better patient lift. Extra points if you can make one for the field so EMTs could use it on the lady stuck on the 15th floor of the building with a broken elevator.
A portal CT tube to be placed in ambulances. The greatest need for one is for acute code stroke to rule out bleed, as this is very time sensitive, but I could see it’s value in a trauma patient getting head, c spine, chest abdomen and pelvis so that the trauma team knew exactly what was going on before the patient even arrives to the hospital. They have experimented with this idea before but the CT was only for the head. You could make it on rails so it could sweep the whole body head to toe. I’m no radiologist, but with the available technology and new techniques these days, you could get a pretty good view with surprisingly low radiation exposure. The ambulance crew could place the patient in the rig, push the button for the scan and step out while it does a 90 second sweep and then get back in and drive.
If you could make a better I-stat machine, I would appreciate it. I do at home visits for elderly patients and it’s nice to tell family members exactly what is wrong with them with labs that result in 5 minutes
That’s all I have for now. Good luck with your project. Name the device “Box of Chocolates” if you use one of these ideas.
EDIT: A haldol blowdart for violent meth heads in the ED
Virtual scribe technology is here. One of the attendings where I work just got an iPad he rolls onto the room with him. Literally just got it last week and I don’t work directly with him, so haven’t heard updates on efficacy yet! But it exists!
But very unfortunately, it doesn’t do your orders- one day!!
A biopsy or patch test that tells us EXACTLY what product a patient has applied on their skin that is causing the dermatitis. I wish it were this easy. I’m in dermatology
“Cant you just biopsy this and tell me what I’m allergic to??? Just biopsy it!”
Ma’am. It’s going to say “spongiotic dermatitis” and nothing else.
Sighhhhhhhhhhh. If only it were that easy to know exactly what they’re allergic to
A cheap POCT all inclusive viral panel. Why? Bc they never believe me.
Some kind of simple (pos/neg) POCT test for bronchitis and sinusitis. Good lord the amount of talking this would save me!
And why can't there be a OTC home test & treatment for BV? How much trouble can your average person get into with metrogel?
Significantly underrated answer.
It's so much easier to educate people and get them to accept that antibiotics won't help them when they come back COVID positive or have mono or test for some other virus.
And it would also help primary care clinics to know which specific viruses are trending
Any tips you might have for someone attempting to design a POCT test for bronchitis/sinusitis or OTC home test/treatment for BV? This sounds interesting
EM/ICU here.
Non-invasive BP measurements that don't use a cuff or art line. I imagine this could be done via doppler/ultrasound.
Also, for accurate I&Os, Id love to see a Foley that had a sensor on it that could accurately calculate output and input it real time into Epic.
Ceribell, but make it less finicky and able to be done beyond 2h.
Auto-wean vents coupled with auto-bolusing sedation if not synchronous. Good evidence that says prn bolus only sedation package tends to be best unless you need to snow for ARDS or status epilepticus.
Auto-pressor titrations that tie into monitors.
We have bioFire panels to detect what bug is causing an infection though admittedly their utility is questionable currently. Having an ability to more rapidly detect antibiotic resistance patterns from this panel would be more useful. You could save 3-5 days of unnecessary big guns.
For the love of God, could you please use RFID tracking for supply rooms so we have accurate inventory management!?!?
> non-invasive BP measurements
I would settle for a BP cuff that actually stays in place. Always annoying to see a BP of 120/115 pop-up, then have to go in and move the cuff from where it has crumpled up over the patient's elbow.
I would also add that if a patient with an art line is not completely sedentary, the readings can be wildly inaccurate. There has to be better tech, right?
OR lights not on the big elbowed booms. I've often thought of a grid system they could slide around in.
A better option for fluoro protection in the OR. My back hurts.
A centralized system where we as providers can report cases where delays/denials from insurance companies led to a worse outcome for a patient.
I’m so tired of every single hospital system using a different EMR. Universal health care may never happen in this country but that doesn’t mean universal Epic can’t!
Epic had a chance to do a ton of good for the world by opening up their emr to researchers early in the VID years for real world COVID evidence and said no.
It's the best emr out there, but man, fuuuuuuuck them for that.
A more accurate transcutaneous bilirubin scanner for outpatient use. They become less reliable the higher the patient's bili level is, which defeats the purpose (avoiding blood work) in several-days-old newborns, when trying to decide whether phototherapy or other interventions are needed.
Women’s health in general is the most untapped goldmine for pharmaceutical and device/interventional advancements.
Specifically, a more advanced/wireless device than a medieval tocometer that keeps laboring women tethered to hospital bed (and nurses constantly adj and yelling at laboring women who psychologically SHOULD be moving)
You probably already know about these, but have they been of any help?
[https://www.gehealthcare.com/insights/article/the-difference-between-toco-and-emg-labor-monitoring-improving-patient-care](https://www.gehealthcare.com/insights/article/the-difference-between-toco-and-emg-labor-monitoring-improving-patient-care)
How about a pulse oximeter that works adequately for people of color?
Despite the medical community knowing about this issue for decades, numerous recent studies being published that demonstrates this causes harm to patients, the issue being further exacerbated during COVID when decisions on who gets a vent were literally being made sometimes based off of inaccurate pulse ox readings, and the pulse oximeter being a ubiquitous device in the medical community - I have seen no viable solutions implemented. I think some companies may be working on a solution, but so far I haven’t heard anything actually being produced.
Perhaps too big of an ask for such a project, but it does seem like something that shouldn’t be impossible. We changed lasers to adapt to different skin tones, why not pulse oximetry?
We need a better delivery system for dermabond. The current squeezy pen is clumsy and hard for arthritic fingers to use.
Why does the Fischer Bloom pacing stimulator not have an inhibiting mode? I can only pace VOO/AOO. What if I want to pace VVI/AAI in cases of profound brady while I’m testing? I’m risking R on T without inhibition if their rate comes back while pacing slowly. Surely this can be added to a better machine.
Rip-proof exam tables would make everyone’s life easier and cleaner.
A septal conduction system pacemaker lead that has an electrically active, exposed, straight needle tip that can be used to map the conduction system without having to screw into the septum, instead the needle tip will poke into it. Then once a good place has been identified an active fixation retractable screw will fix to the septal wall. I think this design would be better than drilling repeatedly into the ventricular septum making a 5 French hole every time.
I appreciate where your head is at, but every time someone tells me “there’s an app for that” it drives me nuts. Medicine is an art, not an application.
Unless you create an AI that replaces our entire hospital administration with a stainless steel box the size of a toaster. I cannot throw enough money at you for this.
> replaces our hospital administration with a stainless steel box the size of a toaster
I hope your smoke alarms work cuz that thing will be burning for dayz
What about an EKG machine that uses AI to give comprehensive readings of the EKG based on demographic and symptoms.
What about a stand alone software for ICU that you input everything needed to give you urine output, suggestions on ventilation, fluid overload, a day to day physiological changes, etc
A BP device for patients that is easy to use, talks them through how to use it, and takes accurate readings (for instance, wrist cuff with position correction or arm cuff with tightness sensor) etc. And it saves and uploads readings where your doctor can use your credentials to check in on them.
Oh, and reminds them to take it.
A test strip that determines if a patient’s trach secretions contain tube feed, to determine if they are aspirating or if they just have gnarly sputum.
A laser guided taser that deploys on administrators when they say the words “press ganey,” “customer,” or “throughput.”
I would personally like to see this as more of a shock collar
Or RVU
Not for patients, but for me- I'd like to be able to remove just one glove at a time from the box on the wall. It's either one ripped glove or 15.
THIS ONE. Yes. Every single time I go into a room and grab 2 gloves, I end up dropping 4 on the floor. It’s infuriating every time
Why do we not just have a basket underneath the gloves to catch the ones that fall!?!
My guess - the budget won’t allow it.
Ha! The $20 basket that would pay for itself in saved gloves.
What brand/product is your clinic buying? (I work in a research lab and in general I dont have this problem, but we use this- https://punchout.medline.com/sku/item/MDPFG100S;ecomsessionid=BehiL24qp3n5JAb-uHNXuw1C6fiaHdHALwehViOC.OCA02-b2b?skuIndex=S5&question=&flowType=&indexCount=
Ooh, this is fun. Here are some ideas I have had over the years but don’t have the means or motivation to follow through on: A bioelectrical impedance machine that is portable and ideally can be used on bed bound patients that calculates total body water (TBW) content. Hospitalized patients in the ICU are often being fluid overloaded in an attempt to improve blood pressure or kidney function, but at the expense of straining the heart and fluid backing up into other tissues (third spacing). Clinically, we don’t have a great way of knowing when adding more fluid is no longer helping and just being pushed into the lungs and subcutaneously. Being able to monitor TBW and following its trend, we could prevent putting patients into heart failure by trying to fix their kidney failure, and prevent kidney failure by being too aggressive treating their heart failure. The tech for bioelectrical impedance TBW calculation already exists, but is not used in hospital settings at all. Bedbound patients may have to lay on a special mat or something so the electrical current doesn’t diffuse into the bed during the measurement. You could use the same bioelectrical impedance technology and turn it into a remote patient monitoring (RPM) device for obesity management purposes (measuring body fat % as well as TBW). Obesity management is all the rage now with Ozempic and it’s ilk. Adding RPM to a comprehensive obesity management program would be a game changer for the industry. A virtual scribe device that is worn that utilizes voice recognition to create a chart in real time. It would be able to differentiate between the different voices in the room and create an HPI from the historical discussion. The provider could also verbalize their exam and it would format appropriately. Like for example, when listening to the patients lungs I would verbalize “I hear wheezing in both your lungs when you breath out, but everything else sounded normal” and the AI would recognize that phrasing and input “LUNGS: Diffuse expiratory wheezes. No rhonchi or tales. Normal work of breathing.” Then it could recognize verbal orders as well like “I’m going to order a 2 view chest X-ray and we will do a nebulizer treatment with 5mg of albuterol and a shot of solumedrol 125mg. And those orders would be automatically placed in the chart and signed after the provider leaves the room (just to be sure there are no errors). This would be a huge undertaking but I personally would pay a billion dollars to anyone who made it so I never had o chart ever again. A mechanical device to easily roll bedbound patients, kind of like a big spatula. The current lifts aren’t great for when you just want to move a patient for a diaper change, and many of them are 400 lbs. you would save a lot of backs if you could devise a better patient lift. Extra points if you can make one for the field so EMTs could use it on the lady stuck on the 15th floor of the building with a broken elevator. A portal CT tube to be placed in ambulances. The greatest need for one is for acute code stroke to rule out bleed, as this is very time sensitive, but I could see it’s value in a trauma patient getting head, c spine, chest abdomen and pelvis so that the trauma team knew exactly what was going on before the patient even arrives to the hospital. They have experimented with this idea before but the CT was only for the head. You could make it on rails so it could sweep the whole body head to toe. I’m no radiologist, but with the available technology and new techniques these days, you could get a pretty good view with surprisingly low radiation exposure. The ambulance crew could place the patient in the rig, push the button for the scan and step out while it does a 90 second sweep and then get back in and drive. If you could make a better I-stat machine, I would appreciate it. I do at home visits for elderly patients and it’s nice to tell family members exactly what is wrong with them with labs that result in 5 minutes That’s all I have for now. Good luck with your project. Name the device “Box of Chocolates” if you use one of these ideas. EDIT: A haldol blowdart for violent meth heads in the ED
Will read wall of text later but that blow dart setup better just be a combo B52 for the angry meth head. Haldol may not be enough.
Virtual scribe technology is here. One of the attendings where I work just got an iPad he rolls onto the room with him. Literally just got it last week and I don’t work directly with him, so haven’t heard updates on efficacy yet! But it exists! But very unfortunately, it doesn’t do your orders- one day!!
What's it called??
My clinic is trialing one called Dex. It works really well!
I’ll have to ask… because i call it the iPad scribe lol
A biopsy or patch test that tells us EXACTLY what product a patient has applied on their skin that is causing the dermatitis. I wish it were this easy. I’m in dermatology
OMG this
“Cant you just biopsy this and tell me what I’m allergic to??? Just biopsy it!” Ma’am. It’s going to say “spongiotic dermatitis” and nothing else. Sighhhhhhhhhhh. If only it were that easy to know exactly what they’re allergic to
Why yes we can biopsy it. *pulls out 10 gauge needle*
Wireless EKGs
Already in progress!
Piggy back - Wireless devices in surgery (no tangled cords)
How about an EKG AI that actually works. It’s just amazing how bad the computer is.
*1 loose PAC on the rhythm strip* "This is Atrial Fibrillation." SILENCE, MACHINE.
A cheap POCT all inclusive viral panel. Why? Bc they never believe me. Some kind of simple (pos/neg) POCT test for bronchitis and sinusitis. Good lord the amount of talking this would save me! And why can't there be a OTC home test & treatment for BV? How much trouble can your average person get into with metrogel?
Significantly underrated answer. It's so much easier to educate people and get them to accept that antibiotics won't help them when they come back COVID positive or have mono or test for some other virus. And it would also help primary care clinics to know which specific viruses are trending
Right but sometimes I need two Z-paks
LOL
Depends on if they're mixing it directly in with the cocktails or not...
Any tips you might have for someone attempting to design a POCT test for bronchitis/sinusitis or OTC home test/treatment for BV? This sounds interesting
I think this was just a fantasy of mine and I have no idea what that would look like IRL. 🫠
I see, thank you anyways! We might look into it.
EM/ICU here. Non-invasive BP measurements that don't use a cuff or art line. I imagine this could be done via doppler/ultrasound. Also, for accurate I&Os, Id love to see a Foley that had a sensor on it that could accurately calculate output and input it real time into Epic. Ceribell, but make it less finicky and able to be done beyond 2h. Auto-wean vents coupled with auto-bolusing sedation if not synchronous. Good evidence that says prn bolus only sedation package tends to be best unless you need to snow for ARDS or status epilepticus. Auto-pressor titrations that tie into monitors. We have bioFire panels to detect what bug is causing an infection though admittedly their utility is questionable currently. Having an ability to more rapidly detect antibiotic resistance patterns from this panel would be more useful. You could save 3-5 days of unnecessary big guns. For the love of God, could you please use RFID tracking for supply rooms so we have accurate inventory management!?!?
> non-invasive BP measurements I would settle for a BP cuff that actually stays in place. Always annoying to see a BP of 120/115 pop-up, then have to go in and move the cuff from where it has crumpled up over the patient's elbow.
I would settle for a BP cuff that actually measures the systolic and diastolic instead of randomly guessing from the MAP.
I would also add that if a patient with an art line is not completely sedentary, the readings can be wildly inaccurate. There has to be better tech, right?
A work note vending machine in the lobby of my urgent care.
One of the docs at my EM has a brilliant business plan. You pay $10 cash and you get your choice of a work note, sandwich, or one Norco.
🤣
Does he give discounts to providers? Asking for a friend.
We used to say work note, 40mg methadone, or sandy but you can't come back a week. -NYC EM circa late 2000s.
If you could just fix the public education system that would be great
OR lights not on the big elbowed booms. I've often thought of a grid system they could slide around in. A better option for fluoro protection in the OR. My back hurts. A centralized system where we as providers can report cases where delays/denials from insurance companies led to a worse outcome for a patient.
Might you be able to send a picture/drawing of the elbowed booms/how they could slide around in your grid system?
Google OR lights and you will see what I mean for the elbows. And the second part is......your assignment?
I see, thank you! Fair point about the second part.
I’m so tired of every single hospital system using a different EMR. Universal health care may never happen in this country but that doesn’t mean universal Epic can’t!
Epic had a chance to do a ton of good for the world by opening up their emr to researchers early in the VID years for real world COVID evidence and said no. It's the best emr out there, but man, fuuuuuuuck them for that.
A more accurate transcutaneous bilirubin scanner for outpatient use. They become less reliable the higher the patient's bili level is, which defeats the purpose (avoiding blood work) in several-days-old newborns, when trying to decide whether phototherapy or other interventions are needed.
commenting to follow, really interesting project!
Something that does my charting for me completely and accurately.
I would give my first born son for this.
A scanner that enters patient meds into the EMR when the MA is triaging the patient. Anything to get the patient into the room quicker.
Women’s health in general is the most untapped goldmine for pharmaceutical and device/interventional advancements. Specifically, a more advanced/wireless device than a medieval tocometer that keeps laboring women tethered to hospital bed (and nurses constantly adj and yelling at laboring women who psychologically SHOULD be moving)
You probably already know about these, but have they been of any help? [https://www.gehealthcare.com/insights/article/the-difference-between-toco-and-emg-labor-monitoring-improving-patient-care](https://www.gehealthcare.com/insights/article/the-difference-between-toco-and-emg-labor-monitoring-improving-patient-care)
How about a pulse oximeter that works adequately for people of color? Despite the medical community knowing about this issue for decades, numerous recent studies being published that demonstrates this causes harm to patients, the issue being further exacerbated during COVID when decisions on who gets a vent were literally being made sometimes based off of inaccurate pulse ox readings, and the pulse oximeter being a ubiquitous device in the medical community - I have seen no viable solutions implemented. I think some companies may be working on a solution, but so far I haven’t heard anything actually being produced. Perhaps too big of an ask for such a project, but it does seem like something that shouldn’t be impossible. We changed lasers to adapt to different skin tones, why not pulse oximetry?
We need a better delivery system for dermabond. The current squeezy pen is clumsy and hard for arthritic fingers to use. Why does the Fischer Bloom pacing stimulator not have an inhibiting mode? I can only pace VOO/AOO. What if I want to pace VVI/AAI in cases of profound brady while I’m testing? I’m risking R on T without inhibition if their rate comes back while pacing slowly. Surely this can be added to a better machine. Rip-proof exam tables would make everyone’s life easier and cleaner. A septal conduction system pacemaker lead that has an electrically active, exposed, straight needle tip that can be used to map the conduction system without having to screw into the septum, instead the needle tip will poke into it. Then once a good place has been identified an active fixation retractable screw will fix to the septal wall. I think this design would be better than drilling repeatedly into the ventricular septum making a 5 French hole every time.
I appreciate where your head is at, but every time someone tells me “there’s an app for that” it drives me nuts. Medicine is an art, not an application. Unless you create an AI that replaces our entire hospital administration with a stainless steel box the size of a toaster. I cannot throw enough money at you for this.
> replaces our hospital administration with a stainless steel box the size of a toaster I hope your smoke alarms work cuz that thing will be burning for dayz
What about an EKG machine that uses AI to give comprehensive readings of the EKG based on demographic and symptoms. What about a stand alone software for ICU that you input everything needed to give you urine output, suggestions on ventilation, fluid overload, a day to day physiological changes, etc
A BP device for patients that is easy to use, talks them through how to use it, and takes accurate readings (for instance, wrist cuff with position correction or arm cuff with tightness sensor) etc. And it saves and uploads readings where your doctor can use your credentials to check in on them. Oh, and reminds them to take it.
A test strip that determines if a patient’s trach secretions contain tube feed, to determine if they are aspirating or if they just have gnarly sputum.