Workflow and Framework for Collecting and Implementing Point-of-Care Ultrasound Data in the Management of Heart Failure Patients
July 12th, 2024
This protocol presents a scalable workflow for the use of point-of-care ultrasound in the management of hospitalized and outpatient heart failure patients.
Our work is intended to demonstrate a workflow for acquiring and integrating POCUS data into the electronic health record for the management of patients with heart failure. We intend to share our workflows that have been developed and standardized as a template for incorporating POCUS data in heart failure management. Some of the current experimental challenges include access to low cost POCUS devices, different user expertise, the limited availability of expert instruction, and the limited number of easily incorporated POCUS workflows for implementation in clinical care settings.
Our protocol demonstrates a workflow for integrating real-time POCUS data into the live electronic patient record. This includes images and measurements that can be compared and observed for an individual patient, reflecting physiological changes with the treatment and the response to heart failure. This workflow allows for comparative prospective assessments of heart failure patients.
It also offers a path for the development of a database of POCUS treated heart failure patients. To begin, position the patient appropriately to expose the area of interest. Ensure the ultrasound machine is set up and calibrated correctly for the type of scan needed.
Choose the appropriate ultrasound probe based on the depth and type of tissue being imaged. Adjust the frequency and depth settings on the ultrasound machine to optimize image resolution. Position the patient on their back for optimal POCUS image acquisition.
Apply a sufficient amount of ultrasound gel to the skin surface to ensure good acoustic coupling and reduce air between the probe and the skin. Use a phased array ultrasound probe to obtain IVC measurements at the level coddle to the insertion of the hepatic vein. Capture the IVC image with measurements displayed, including the anatomy and beam depth gauge on the image display screen.
Record the IVC measurement into a pre-built discrete data field within the electronic health record flow sheet. Include the pre-built IVC measurement data field flow sheet within the electronic health record and attach screen captured images to the patient progress note. Position the patient upright or in the lateral decubitus posture, alternating between the right and left sides serially.
Utilize a two to five megahertz phased array probe to scan for echo-free space inferior to the lung pleural border, and superior to the ipsilateral diaphragm during scanning. Document yes for the presence of pleural effusion identified by increased echo-free space in the ipsilateral pleural space, or no for the absence of pleural effusion. Enter the response into the corresponding cell in the electronic health record flow sheet.
After completing the scan, clean the ultrasound probe and machine, then dispose of the used ultrasound gel appropriately. Identify actionable findings that influence clinical care decision-making on a patient by patient basis. Identify IVC images consistent with physiology associated with elevated or reduced central venous pressure.
Overview
This protocol presents a scalable workflow for the use of point-of-care ultrasound (POCUS) in managing heart failure patients. It details the integration of POCUS data into electronic health records to enhance patient care.
Key Study Components
Area of Science
- Cardiology
- Ultrasound Technology
- Patient Management
Background
- Heart failure management requires effective monitoring and assessment techniques.
- Point-of-care ultrasound (POCUS) offers real-time imaging to aid in clinical decision-making.
- Challenges include access to devices and user expertise.
- Standardized workflows are essential for effective implementation in clinical settings.
Purpose of Study
- To demonstrate a workflow for acquiring POCUS data for heart failure management.
- To standardize the integration of POCUS data into electronic health records.
- To facilitate comparative assessments of heart failure patients.
Methods Used
- Positioning patients for optimal imaging.
- Using appropriate ultrasound probes and settings for different tissue types.
- Documenting findings in electronic health records.
- Cleaning and maintaining ultrasound equipment post-use.
Main Results
- Successful integration of POCUS data into patient records.
- Identification of pleural effusions and central venous pressure through imaging.
- Creation of a database for POCUS-treated heart failure patients.
- Enhanced clinical decision-making based on real-time data.
Conclusions
- The standardized workflow improves heart failure management.
- Real-time POCUS data enhances patient monitoring and treatment.
- Future studies can build on this protocol to further refine heart failure care.
Frequently Asked Questions
Executive Industry Relevance
Standardized integration of point-of-care ultrasound (POCUS) data into electronic health records enables real-time, quantitative monitoring of physiological changes in heart failure patients. This workflow supports scalable, reproducible data capture for longitudinal assessment and treatment response, directly impacting predictive confidence in clinical management. The approach provides a template for enterprise-level adoption of imaging biomarkers in disease monitoring pipelines.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Enables objective, serial measurement of physiological parameters relevant to disease progression.
- Supports biological de-risking by providing real-time imaging data for functional validation.
- Facilitates hypothesis testing regarding treatment effects on central venous pressure and fluid status.
Screening & Assay Development
- Standardizes imaging data collection for reproducible quantitative outputs across patient cohorts.
- Prepares validated imaging endpoints for downstream analysis and comparison.
- Enables scalable data capture suitable for integration into digital health platforms.
Translational & Preclinical Research
- Aligns imaging biomarkers with clinical endpoints for translational continuity.
- Supports risk-adjusted advancement decisions by providing actionable, patient-level data.
- Facilitates database creation for retrospective and prospective analyses of treatment response.
Pipeline & Workflow Integration
This POCUS workflow bridges clinical data acquisition with digital record integration, supporting discovery through translational research phases.
- Discovery Biology: Provides real-time physiological readouts for hypothesis testing and pathway clarification.
- Screening: Delivers standardized, reproducible imaging data for quantitative assessment.
- Analytics: Enables direct comparison of serial measurements and treatment responses.
- Translational Research: Connects imaging endpoints to clinical management and outcome tracking.
- Enterprise Reuse: Establishes a scalable framework for imaging data integration across studies and sites.
Operational & Enterprise Impact
- Scientific Value: Increases predictive confidence and reduces mechanistic ambiguity in patient monitoring.
- Operational Value: Promotes standardization, reproducibility, and scalability of imaging workflows.
- Strategic Value: Improves go/no-go decision-making and capital efficiency by enabling timely, data-driven interventions.
- Portfolio Impact: Supports risk-adjusted prioritization and advancement of digital health-enabled monitoring strategies.
Implementation Considerations
- Requires expertise in ultrasound imaging and data interpretation.
- Needs access to calibrated POCUS devices and electronic health record integration.
- Demands cross-team standardization of data fields and workflow steps.
- Must adapt protocols for different patient populations and clinical settings.
- Considers limitations in device availability and user training as operational barriers.
