Ultrasound experts – Ask a POCUS pioneer: Interview with Marco Daoura

In our series of interviews with experts to understand the Covid-19 crisis and the context of point of care ultrasound’s role better, we speak with Marco Daoura, a Washington-based entrepreneur innovative-strategist and expert in ultrasound hardware and software innovation.

Marco provides his perspective about healthtech innovation, and how ultrasound and other technologies can help in the Covid-19 crisis.

Marco Daoura graduated from the University of Washington with both a Bachelor of Science in Electrical Engineering and a Master of Science in BioEngineering with focus on Control Theory and Molecular Biotechnology. He is currently an Innovation Lead Consultant at Premera Blue Cross and remains heavily involved in helping Health-Tech start-ups with how to best take their innovations from ideation to commercialization (I2C), in such a heavily regulated industry. Marco has over 20 years in the healthcare industry from Philips Healthcare to Fujifilm Medical Systems, UltraLinq Healthcare, Novuson Surgical, and consulting with Healthcare companies.

Our team sat down with him for an interview to ask him, as an ultrasound technology expert, what he wants the public to know about POCUS (point of care ultrasound) Covid-19 crisis from an ultrasound, POCUS and health innovation perspective.

MD:  Thank you, Courtney for the opportunity to share my thoughts with you, and however my experiences and knowledge may help you or others continue to innovate in this space.

Yeah – so let me preface this by saying, while I have dedicated the largest portion of my career in medical devices and namely in the Ultrasound technology, I am not a clinician. Not even close. I’m an engineer who spent a good deal of years working in R&D, and was intrigued enough by the many facets of Healthtech that I challenged myself into Product Services, Sales and Marketing, and Product Management. And through my journeys I got to spent a lot of time with the customer who often is the Provider (the physician using the ultrasound tech) and sometimes is the Patient as this technology gets closer and closer to the consumer space. And so, a lot of my opinions, ideas, and strategies in this space while grounded by technology, are heavily influenced by having worked much of my time with clinicians. To understand their needs, their workflows, and the gaps they experience, and have had to shadow them countless of times to understand what a day in the office means to them – You know what they say – fall in love with the problem first and then connect it back to the technology and the solution.

CW:  How have you seen handheld ultrasound evolve?

MD:  Through my journeys, and this is going to date me now, I’ve worked on ultrasound systems that were as big as a washing machine all the way to tablet and phone sized solutions. Ultrasound is so unique because it is still the only tech, to date, that allows you to visualize through the body, and it fits in your pocket. And I’ve had the opportunities to experience how it evolved from traditional clinical spaces all the way to completely remote locations without a physician in site! And when we talk specifically about handheld, technology has never been the barrier to adoption. Other barriers may have been cost or training needed to read the Ultrasound image. So yes, it has evolved quite a bit, and I think its biggest evolution is yet to be observed, when is demystified as training becomes mainstream in med school curriculum, with telemedicine … and telesonography, with augmented intelligence, (I am not going to say the buzz word AI here) ……

CW:  With your experience in ultrasound, what is your opinion about POCUS as a triage tool for Covid-19 and other urgent situations?

MD:  It amazes me how when certain resources or tools get meager we resort to new ways or tools. So you know we all herd the story, in one of the hospitals dealing with COVID in Italy, Dr. Volpicelli started triaging with ultrasound, a technique not yet peer reviewed for diagnosing COVID19, but he and his colleagues became convinced that lung ultrasounds should be done at the bedside for all patients suspected of infection, even people with mild symptoms…

Now early on this was just a new technique, but while misunderstood as a Diagnosing solution at first, it became clearer afterwards that Ultrasound is not the tool to diagnose rather it is the tool to confirm the disease severity in the Lung or the Heart, and I emphasize both here Lung and heart,  which is even as import if not more important than the lab diagnosis,  to help the physician make more informed decisions about the next best care path options for the patient. So again, and as I learned from experts whom I connected with and read their articles, the approach with ultrasound for COVID19 triaging, is that Ultrasound itself DOES NOT DIAGNOSE COVID19, but it’s a great tool to evaluate known or suspected patients, it helps define the extent of the disease, should the patient be admitted and get a respirator? Or ultrasound may suggest alternate processes

Also, these patients are usually really sick: Ultrasound comes in real handy there to visually guide venous access for managing fluids and medications, or if they are in shock and need a shock assessment. And last but not least Ultrasound is the only tech that can do the job at the bedside by the physician and reducing virus contact and exposure to other clinicians – without involving a tech, without having to take the patient to an imaging lab etc…so it does reduce exposure to personnel, and other patients in the hospital.

CW:  What’s the next frontier for POCUS and what technologies or integrations do you see that are promising?

MD:  I truly feel Ultrasound is evolving as it should – taking full advantage of tech miniaturization and consumerization. I mentioned Augmented Intelligence earlier, computing on Ultrasound is so powerful that image processing, analysis and intelligence can certainly help us make faster decisions. And just as we’re learning more and more today with COVID19, the importance of telepresence and telemedicine – and telesonography follows that as well. Why? Well let me step back first. So I always talk about the three levels of proficiencies in Ultrasound 1) knowing how to use the tech ( use to call it knobology now it’s just knowing how to use a common sense intuitive interface) 2) knowing the anatomy and knowing where to position the probe complemented with my knowledge on how to use the tech (this takes some training for sure and many clinicians are empowered to do this NPs, PAs, etc.., 3) the third level is really left for the experienced user who can read the image – the physician specialist who understands the pathology and is able to make diagnosis. Now we’ve practiced for a while that we can train one person to take the image and rely on another to diagnose, the question is can we do it instantaneous as if the expert was in the room, when it is normally so difficult to do that. I think the other concept for evolution in Ultrasound is not o much at the POC (POCUS), but at the POL because the patient may not be in a care location, but in a living location going about their life. So how can I in the future as a family man buy an ultrasound for use at home with my family, and use it as instructed by my remote clinical assistant, and remoting into my mobile device? That is really the future and going beyond the Star Trek Tricorder!

CW:  What advice do you have for POCUS users right now?

MD:  Today Train early, Practice a lot – and not just physicians, but paramedics, Emergency medical Response personnel….Midwives, Nurses, Physician Assistants…

Tomorrow, be very open to doing things that don’t have a protocol set yet – Basically be ready to use ultrasound in ways never thought of before, create new workflows, and set the path for new protocols and clinical needs. Challenge the status quo, and it’s intriguing how much attentive policy makers are now, and receptive to new ways of thinking and caring, so we do have their listening ears to create a more impressive future for Ultrasound. The ultrasound technology has so much more to offer! And we’ve just scratched the surface on what it will be able to do in the future.

CW:  Marco, thank you very much for sitting down and discussing POCUS with me today.

MD:  I hope my Insights were thought provoking!