Bill Klaproth (Host): This is Columbus Community Hospital Healthcasts. I'm Bill Klaproth. With me is Dr. Kevin Montgomery, the Emergency Room Medical Director at Columbus Community Hospital, here to discuss emerging trends in emergency medicine where technology meets emergency care. Dr. Montgomery, thanks so much for your time.

Kevin Montgomery, MD: Hey, thanks for having me, Bill.

Host: Yeah, it's great to see you. So, let's start with this. What emerging technologies do you believe are having the biggest impact on emergency medicine today?

Kevin Montgomery, MD: Well, I'd like to start with today and then move on to kind of looking forward. So today, I think one of the newer technologies that we utilize and that we're trying to utilize more in CCH emergency department is point-of-care ultrasound. That's really revolutionized care of patients at the bedside, in emergency medicine, because it can give us real time answers. Oftentimes when we are needing to assess people's volume, status or their cardiac activity, looking for fluid collections and soft tissues, things of that nature, we order ultrasounds or we do imaging. And we have to go back to the computer, put those images requests in, and then they have to be sent off to Radiology. Point-of-care ultrasound really gives us a huge benefit in efficiency as well as just real-time answers that we can talk directly with the patient and use our tactile feedback on the tissues to tell us what's going on right then. We can bring that ultrasound in with us, take direct look at the area of interest and then discover what we need to from there and add that into our clinical intuition. So, that's really helped us moving forward. And we can use that in routine evaluations of musculoskeletal complaints and up to during if we are running a code and need to assess someone's cardiac status or evaluate for blood clots in the lungs or fluid in the lungs, all of those are options that we can use.

Host: Yeah. So, point-of-care means you bring it actually into the room and you can do all those diagnostic tests there instead of wheeling the patient into another room and then waiting. Is that right?

Kevin Montgomery, MD: Correct. Yes.

Host: I could see where that would definitely help speed things up. So, I would imagine in a hospital setting, you're used to doing things, trained to do things one way. Are there still barriers that exist in adopting new technologies in emergency settings? Is it hard to adopt these new technologies?

Kevin Montgomery, MD: There's always barriers to it, and some of those are training-related. Some of them are cost-related, some of them are workflow-related. How do we add this into our specific setting because it might be different than other hospital settings. We try to anticipate and work through those prior to fully implementing a new technology, just to minimize any snags as they occur.

The number one thing that we look at is training on whoever's going to be utilizing these modalities, whether it be nursing, clinicians, techs, and they need to know how do you use it at the point-of-care, as well as how to troubleshoot it and what type of answers they can expect to get from using the technology and what they shouldn't expect to get from using the technology, because there's limitations to every new technology as well.

And the other thing we look at is, on the top of my mind is, do we need this technology? Because not every technology is right for every setting. So, having new innovations just for the sake of innovation when it's not going to add directly to patient care is also something we take a look at. Most of the time that's already been rigorously tested and when we know that it's going to add value, otherwise we wouldn't be looking at it of course. But always something to keep in the back of the mind. And the biggest thing is just training whoever's going to be utilizing the equipment or the technology and then trying to implement that in the safest way possible.

Host: Yeah, that absolutely makes sense. And like you said, you don't want to just use. Things just for the sake of using things. You want to make sure things are thoroughly vetted and appropriate for use in the hospital setting where you need them. So of course, mobile apps and wearables and things like that certainly are everywhere now. So, are mobile apps and digital platforms helping streamline emergency workflows for physicians and nurses, those types of things?

Kevin Montgomery, MD: I think they are because a couple of the different apps that we use are related to clinical decision rules, as well as patient care apps that patients have their medical records on are highly utilized as well. Those are kind of the two big ones that we look at on the clinician side. We want to be as efficient as possible. And when we're working through patient complaints and have multiple patients that we're juggling, that takes up a lot of bandwidth as far as your processing power, just like a computer. So, having those apps is kind of like having a peripheral brain, where you can offload a little bit of that data and say, "Okay, I don't need to memorize this clinical decision rule. I'm going to open the app now and input the values, and then I can integrate that back into my workflow and how I'm utilizing that information."

Something that really is helpful here is when patients have their medical information on a, a mobile app from either a different healthcare system or from Columbus' Healthcare system, because there's times when cross-communication between systems does not occur and we may not have access to those lab values that even they just got earlier in the day or yesterday, especially if it's at a different facility. So, them being able to pull ,that up and now I have a baseline lab value to go off of or I can see, yes, the image that you had done yesterday showed this, which is actually not worrisome and is why you're here because of these values and make sure that it's just, for instance, because this has happened before, it's not a misreading of the image description or something of that nature.

The wearable devices are also on more than one occasion, I've found someone to be in atrial fibrillation based off of their wearable device, which basically functions as a Holter monitor that we sometimes prescribe people upon leaving the ER if we did not see dysrhythmias while they were here. So, more than one occasion that's actually changed my management of patients. So, I think they're, mostly helpful.

Host: Yeah, that's really interesting. I have an Apple watch and, yeah, it's got that AFib tool right on there, so that's really interesting. You mentioned patient's medical information. So with the increasing use of connected devices, how is patient data privacy being managed in emergency settings?

Kevin Montgomery, MD: We utilize the hospital system, which is all encrypted end-to-end. We undergo extensive IAT training as far as how to protect the healthcare system's information and patient care information. Not responding to phishing emails. They actually test us occasionally with fake phishing emails to make sure we're not clicking on those and we report them needed. And IT does a great job here of managing that and making sure everybody's up-to-date in compliance. And we change our passwords frequently to limit any potential hackers or information getting leaked elsewhere. And then, like I said, just at baseline, all of that information is encrypted end-to-end, secure email systems. We have an intranet that's kind of constrained and on the servers here, which all helps protect client information.

Host: Yeah, that's really important in today's digital age, the steps that you're taking to protect patient data, for sure. So with all of this new stuff-- I shouldn't say all of this-- but when you do adopt new technology into an emergency room setting, can you talk a little bit about training or how you prepare clinicians to integrate these evolving technologies into their daily practice?

Kevin Montgomery, MD: So, it kind of goes on three different levels. I would say oftentimes it's just a, "FYI. This is now available." It's usually integrated into, you know, for instance, a clinical decision app. those are very straightforward. We just, you know, email brief, "We should use this in this instance. This is the evidence that says so." And we can kind of read through that. And people are pretty quick to adopt those types of things.

Other things are a little more extensive and maybe they're niche and how they should be applied, or take a little more hands-on training. So, we may need to do online CME modules that are a little more lengthy and go into the specifics and have links to evidence that you can read through at that time or your leisure. And then if it's something, for instance, like the point-of-care ultrasound we referred to earlier, that takes some dedicated hands-on experience if you've not had training with it previously. It's very user-based. The sensitivity specificity of it is entirely based on how, skilled the user is with the ultrasound. So, we want hands-on application of that in simulation models, on real patients under supervision of someone who is skilled in the use of it. We utilize those kind of levels as appropriate as we feel.

Host: Absolutely. So, I'm just thinking about the point-of-care diagnostic tools you were talking about earlier and how that's speeding up the whole process. When I think of the emergency room, I think of kind of at times high-pressure environment, right? The point-of-care diagnostic tools, are they changing-- I would imagine, for the better-- the decision-making process when it comes to these high-pressure environments. Would that be right?

Kevin Montgomery, MD: It absolutely is, especially in instances of emergent pathology where you're trying to differentiate, for instance, do I need to give this patient fluid or are they fluid overloaded? Because you can have low blood pressures from both. That's something we can utilize the ultrasound and really clarify which direction we should be going in real time right then, which absolutely changes instead of, "Okay, we'll give a little bit and see how they respond." We can just directly assess some of those things,

Host: All this information, Dr. Montgomery, is really, I think, crucial and interesting for potential patients to know. We've all been in emergency room settings before and it just seems that point-of-care diagnostic tools really can help you do your job better, speed the process up as well for the patient, and really provide better outcomes. Would that be right?

Kevin Montgomery, MD: That's absolutely true. It's really helpful for us. You know, we get to see in real time what is actively happening and can disambiguate some of the situations that we're in, that lead to quicker decision-making and ultimately better patient outcomes at the bedside, which is what we're here for.

Host: Absolutely. That totally makes sense. And then, last question. I want to thank you so much for your time. We haven't talked about AI yet, but is there anything else you'd like to add? Is AI coming into the emergency room soon?

Kevin Montgomery, MD: I think it will eventually be coming. In what role? I do not have an idea as of yet. You see studies every day talking about utilities that they're trying to add into healthcare. I don't know how that's going to take a form currently directly in the emergency department. I know from a hospital-wide perspective, it sounds like it's being utilized in the billing department to help scan charts. But I don't know what role it'll have moving forward.

There's certainly some exciting fields they're looking into, whether that be integrating some of these clinical decision tools with some form of AI to help further specify and just be more, specific to the current situation or if it is going to help us with increasing our speed and efficiency, looking through databases to help with specific patient presentations to expand our differential and get more accurate diagnoses in a time-efficient manner. That's certainly something that we're looking into as well.

Host: Absolutely. Well, I know you'll stay on it. Dr. Montgomery, thank you so much for your time.

Kevin Montgomery, MD: Absolutely. Thank you for having me again. I was happy to do this.

Host: Yeah, a lot of fun having you on. Once again, that is Dr. Kevin Montgomery. And for more information and resources, please visit columbushosp.org. And if you found this podcast helpful, please share it on your social channels and check out the entire podcast library for topics of interest to you. This is Columbus Community Hospital Healthcasts. Thanks for listening.