Greggory R. Devore, MD

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Doppler of the Uterine and Umbilical Arteries: Clinical Significance

:  "Hi, I'm Eric Blackwell, and I'm Co-Chairman of  the History of Ultrasound project for OBGYN.net and the Society of  Diagnostic Medical Sonographers along with Joan Baker and with  tremendous technical help and support from Terry DuBose.  We're  delighted to have visiting with us today Dr. Gregg DeVore who is  currently at the Fetal Diagnostic Center of Pasadena in California.  Dr.  DeVore, of course, is well known to most of you out there I'm sure if  you're in ultrasound.  He's a true pioneer in fetal echo and in the  teaching methods, which make this understandable to the rest of us.  I'd  first like to ask how you first got into ultrasound and how did you  become one of the first in line?"
       
       

:  "When I was at Yale University as an  intern in internal medicine in 1975, I decided to switch into obstetrics  and gynecology.  I moved over to the Department of Obstetrics and  Gynecology, and John Hobbins was a new faculty member.  John had  ultrasound that he was using and he thought that this was a useful tool  so after my first year of residency I realized that ultrasound may have a  future so I stayed and did a fellowship at Yale in Maternal-Fetal  Medicine with a heavy emphasis in Ultrasound."
       
       

:  "What sort of equipment were you using in those early days with Dr.       Hobbins?"
       
       

:  "We initially had what are called  'static scanners' where you had an articulated arm and you would move it  across the abdomen and obtain a still image.  Then when real-time first  came out, they had green screens and they had little images that would  flicker on the screen that you would think could be a fetal head or a  fetal leg.  So we had the very first real-time units in the United  States at Yale and from that evolved the current experiences."
       
       

:  "As far as the fetal heart, as opposed to anything else specific, that seems to be a niche that you are very, very good at."
       
       

:  "What happened was when I was at Yale  I was preparing for my fellowship, and ATL came out with a machine that  for the very first time allowed the clinician with real-time imaging to  place an M-mode cursor through the heart and know where you were going  so you record the M-mode from the real-time image.  It was a  breakthrough in echocardiography and so I applied for a research grant  from a foundation and received over $75,000.  We bought one of these  machines, which were the hottest item at the time and the question was -  could we apply this to the fetus?  Because of the size of the heart,  which is the size of, perhaps, a thumbnail in the second trimester, we  had to ask could we see in a miniature heart the detail that we would  see in a newborn or adult heart?  So those were the first questions that  we addressed."
       
       

:  "The topic that I think we really  ought to move to is you've certainly been a pioneer in the use of  multimedia and computer assisted teaching aides and have done it right,  at least in my book, in terms of making things that bring clarity  instead of confusion to the field.  How did you first come to do that?"
       
       

:  "It's interesting, when I was  thinking about writing a textbook on fetal echocardiography unlike other  images in ultrasound like a liver or a kidney that can be a still  image, because the heart is moving the question was how do I teach the  features of a moving heart to identify pathology or other abnormalities  that the clinician needs to know about.  So I realized that multimedia  with the ability to show the beating heart was a priority, and I went  out and contacted professionals who'd created multimedia programs in the  educational arena and asked them which programs they used.  The first  program I used was a program called 'Quest' and it sold for over $4,000.   I wrote the check, and my wife killed me when she saw the stub.  I  created my first multimedia program using Quest and from that point I  then evolved to using software that was even better so it was just a  matter of a need.  I taught myself, I didn't have any formal schooling,  and I didn't go to any classes.  I got the manual, used the program and  tried to figure it out, and with time I was pretty successful doing  that."
       
       

:  "I understand that your first sales  efforts were you at a table with a few hundred that you'd burned or had  burned.  It was quite popular."
       
       

:  "Yes, we were at an international  meeting in Rotterdam, I sat at a table next to a publisher, and I had my  laptop computer.  I had brought with me about 300 or 400 CD's in my  briefcase, I started showing it, and pretty soon I had 1, 2, 20, 30, 40  people around the table.  For three days they bought every CD; it was so  embarrassing in the sense that we walked out and I had money coming out  of my pockets, I didn't know what to do with it all.  We sold it to  them for something like $35 or $39 and it was an instant success."
       
       

:  "Now how many generations of product have you gone through from your first $39 CD?"
       
       

:  "A year after that I developed a 2-CD  ROM series, and it evolved from maybe having 30 video clips on the CD  to over 500 so now we have a full featured 2-CD ROM set on fetal  echocardiography.  I have a new program coming out this summer to  address the use of ultrasound in identified Down syndrome for genetic  ultrasound, and we'll have many cases of Down syndrome with a lot of  features with that one as well."
       
       

:  "On aside to our viewers, just before  this meeting of the 45th Annual Convention of AIUM which is in Orlando,  there was a pre-meeting conference.  Dr. DeVore along with several other  people including Phillippe Jeanty, a gentleman from Brazil, and a woman  from Mexico - all very knowledgeable in multimedia and teaching -  presented a wonderful program.  So if those names show up and it's  something you're interested in, I would encourage you to catch them the  next time they're able to offer this.  Also, Dr. DeVore has a website at       

        so that would be another place you could go for more information  about what he's up to in this realm.  One final thing, I always like to  ask people - where do you see things going from here both in terms of  educational approaches and media and in the field itself?"
       
       

:  "I think if we compare ultrasound  today with what it was years ago when I first started, the technology is  superior.  There are more dials, knobs, and buttons to learn about, and  I think that education using multimedia will help shorten the learning  curve because many people who buy this very expensive equipment often  don't know how to use it to its fullest capacity.  So I think the  multimedia will allow companies and other physicians to teach their  colleagues how to better use the equipment because it's like anything  else, if you know how the car functions, you can drive it better.  If  you fly a plane and you know all the instruments, you ultimately won't  crash as often.  Same thing with ultrasound, the better you use the  tool, the better the diagnostician you're going to be."
       
       

:  "Thank you very much, Dr. DeVore.   We're delighted that you've been with us, and we look forward to hearing  what you're up to a year or two down the line."
       
       

OBGYN.net Conference CoverageFrom 45th Annual Conference of the AIUM - Orlando, FL 2001

New Teaching Techniques in Multimedia

: "I'm Dr. Greggory  DeVore and we're at the AIUM Annual Convention. I'm interviewing Don  Parker who is the founder of Sonultra, which is a corporation that  provides material and programs for ultrasound OB reporting. Don, I know  that you're not a physician and you were trained in the business world,  so why did you become interested in OB reporting a number of years ago?"

: "Several years ago I was asked to organize a  group and put together an outpatient ultrasound facility. At that time  we were looking for ways to develop better documentation and a better  audit trail for keeping track of the information that was being recorded  so that the physicians could have better communication between them and  the sonographer that was doing the exam. Also, they would have  something to compare when the patient returned for her second or  follow-up ultrasound exam."

: "So this came about because you owned a  practice as a business person and wanted to have a better reporting  system so you could follow and track the patients. Is that the reason  for it?"

: "That was part of it, the other part is when we  started the business one of the things that I think any practical  business person should do is attend to their audience or their  clientele. We interviewed several of the physicians in the community and  we asked them what they were looking for from an ultrasound report.  What we discovered was what they were looking for was not really being  provided by the physicians or at least the radiologists that were doing  the exams in the community at that time. They said they were looking for  something that was more definitive so when they got a report they knew  exactly what was going on and what to do without any kind of variability  in determining what the report was saying. They were looking for a very  specific diagnosis or direction on how to manage that patient."

: "I know that over the years, for example,  many times obstetricians and even radiologists have provided simple  paragraphs or one line reports saying the fetus is normal. Now with the  accreditation occurring and with the insurance companies demanding  evidence of a proper examination, reporting now has really come into the  forefront. I'm curious, what's been your experience as you've gone in  and shown your program that Sonultra has now currently developed to  physicians who have not been exposed to an upscale report? What have  been the responses when they've seen your particular system?"

: "What we discovered is a couple of things; one  is that many times physicians are not necessarily aware of the kind of  documentation that some of these are looking for, whether it's the AIUM  accreditation standard or what insurance companies want. Backtracking a  little bit, what few people know is that the reason for this big push  for accreditation and, of course, the insurance companies jumping on the  bandwagon for regulating their reimbursement based on accreditation is  because of a study done in 1997 by the American College of Radiology and  some of the insurance agencies. What they discovered was that 80% of  the reports that they reviewed were substandard. Based on that, the  insurance companies thought they're not necessarily getting the kind of  documentation they're paying for and that's how all the standards came  about. We've always developed our system to enable the physician to do  what they want whether it's a minimal report or as comprehensive as they  want but all in line with the standards whether it's ACR, AIUM, ACOG,  or the insurance committees. The physician is able to do what they want  but it's all run by the fact that this 1997 study is pushing insurance  companies to say - we want a standard that we can count on so that we  can get the information we need to do an evaluation."

: "So it's reimbursement related if reports  don't indicate what they've done, then why should they reimburse for  the codes that the physicians have submitted."

: "Now I know there are several companies  who have systems similar to what you have developed at Sonultra, what  are the differences you see currently in the playing field for reporting  systems that you think your system highlights and others may not or are  they all comparable? What are some of the differences and  similarities?"

: "I think the biggest difference is recognizing  that each practice is different, and each physician has their own  protocol and their own mechanism by which they do things. So our thought  process was to develop a system that was fairly basic in its approach  meaning you have certain things that everyone reports on and everyone  follows. Then on top of that, integrate our system not only as a  reporting system but a development tool that enables the end user to  easily customize it to fit their particular practice needs, how they do  their reporting, and what their workflow is. So our flexibility in how  our system works enables the physician to maximize their workflow and  get the type of report that they're looking for."

: "Do you have image acquisition or the  ability to take and capture images from the ultrasound and put it on  your report so they can go out to the referring physician?"

: "One other issue that always is important  as a physician and seeing patients and doing ultrasound is the question  comes up, and you addressed this a moment ago, the use of time. What do  you think the estimate is as far as the efficiency factor using a  reporting system that you have developed versus a traditional dictation  report that the radiologist or the specialist dictates? How much time do  you think you can save them in turning around the report and processing  patients by using this particular system?"

: "If you're looking to compare apples to apples  in terms of what our report can report on versus a similar dictated  report, we could probably save between 50%-75% of the time. What we  found is that we're able to integrate information from prior exams into  the current one such as fetal trending. We also have discovered when  people see the type of information that's included in our report they  generally expand the type of information that they're reporting on.  Additionally, we're able to gather the statistics necessary for them to  evaluate their practice, evaluate it from referral patterns, and  evaluate it in terms of organizing their data for accreditation. There's  a number of additional benefits from using a reporting package that has  a database that you can work with and gather a lot of information about  your own practice."

: "Now if somebody wanted to look further  at your particular program and evaluate it, do you have a free time  period where they can download the program or obtain the program, use  it, and see if they like it?"

: "Yes, we have a philosophical approach that we  started way back when the company first began in 1986, and that is we  don't want anyone to use our program unless they're familiar with it or  they purchase our program and they're familiar with it and comfortable.  So if someone is interested in a reporting system, we will send them out  a CD, we will support them, we will if necessary upgrade them during  that time, address issues or concerns that they have, and we want to  make sure that they're comfortable and familiar with the product before  they make a decision to purchase. Nothing's more important than an  educated consumer in our mind."

: "So then basically, I could try your  program, see how it works, and it wouldn't cost me a dime other than  installing the program in my computer?"

: "There's no cost at all. It costs you a little  bit of time; training takes about an hour over the telephone. You always  have full support and, again, we're only interested in customers that  are happy. Therefore, if you get to use the product, get familiar with  it, implement it in your practice, and see how it helps your work flow  then you decide whether or not you want to purchase it."

: "Do you have a website, and say I wanted to contact you on the Internet since we're viewing this video, how do we do that?"

AIUM 46th Annual Meeting - Orlando, Florida - March, 2001

Author | Greggory R. Devore, MD

Articles

Doppler of the Uterine and Umbilical Arteries: Clinical Significance

New Teaching Techniques in Multimedia

Better Documentation and Audit Trail Methods