GRAND CHALLENGE CASE STUDY: INTELEOS ULTRASOUND PROFICIENCY

6 min readSep 7, 2023

Without sonographic proficiency, practitioners can misdiagnose what they see.

Medical ultrasound devices are fast becoming ubiquitous due to their plummeting cost — small, wearable transducers that monitor organ function are currently in development and are anticipated to cost as little as $100 — and their powerful ability to see what is going on inside the body, without invasive surgery or other costly medical imaging. Medical ultrasound devices are poised to replace stethoscopes around the world, soon. Yet, without sonographic proficiency, practitioners can cause severe patient harm by misdiagnosing what they see. It is imperative to ensure everyone who uses a medical ultrasound device knows what they are doing.

Why Is Proficiency So Important?

Ultrasound is one of the most powerful diagnostic medical imaging technologies in the world. When used by well-trained medical professionals, it can be a safe and inexpensive tool to detect and diagnose many medical conditions. Innovation is changing everything about ultrasound devices: what they are, who uses them, where, and how. Proficiency in the use of medical ultrasound must keep pace.

The price of this technology is dropping precipitously. Miniaturization is increasing convenience and access. Portable handheld devices, linked to a smartphone, now make it possible to perform ultrasounds at the point of patient care, rather than in a specialized lab, even when that point of care ultrasound equipment is at a rural clinic in a low-resource environment with minimal infrastructure.

Affordability and rising access to ultrasound equipment provides opportunities to impact the vast global disparity in healthcare, especially in the developing world, where maternal-fetal mortality is highest. However, as low-cost ultrasound equipment becomes increasingly prevalent, access to equipment outpaces healthcare providers’ ability to hire proficient clinicians, so the need for training and assessment grows more acute. For the sake of patient safety, care providers need to use these devices correctly and maintain their knowledge and skills as the technology evolves with its impact in clinical care.

As a non-profit organization governing the certification of medical professionals in ultrasound procedures, Inteleos™ recognizes its leadership role in addressing the profound need for global ultrasound proficiency. That’s why Inteleos is working on creating partnerships to establish proficiency that can be implemented around the world. The work begins with creating partnerships in low to middle income countries (LMICs), where the skilled use of ultrasound will improve maternal and fetal mortality rates.

There is a rise in the global use of Point-Of-Care Ultrasound (POCUS) for general practitioners, and a significant rise in use in emergency medicine. Currently lack of physician and healthcare professional training is seen as the major barrier. 1
A 2020 study conducted in VA Medical Centers found that 78% of primary care clinic chiefs reported lack of trained providers, and 41% reported lack of funding for training. 2
A 2021 NIH study reported that while use of POCUS for medical diagnosis is expanding in almost all medical specialties, the need to establish a unified, integrated formal curriculum and adequate training for safe and effective use is a priority. 3

How Is Inteleos Addressing Proficiency?

Inteleos has responded by launching the Ultrasound Proficiency Grand Challenge (UPGC) under Inteleos’s emerging 501(c)3 public nonprofit. The Inteleos Foundation was established in 2021 with a mission to positively impact global health and spur transformational changes in advancing medical imaging through education, training, and innovation. To launch the UPGC, a leadership group has come together with members from healthcare, non-governmental organizations, academia, funding bodies, and medical industry entrepreneurs.

“The Grand Challenge, with Seth’s guidance, focused our organization and strategy on our North Star, which is the strategic goal of reinventing proficiency assessments for the 21st century.”
Dale Cyr — CEO Inteleos

The goal of the Ultrasound Proficiency Grand Challenge is to enable every user of medical ultrasound in the world to be proficient by 2030. Put simply, the patient can be confident the person who is using the ultrasound device on them knows what they are doing. Inteleos is leading the way.

The first pilot program in the Grand Challenge will take place in Kenya and has two related goals:

Reduce maternal mortality in Kenya by 10% in 5 years. The UPGC will increase the number of providers who can correctly use ultrasound at the point of care. Inteleos is partnering with the Ministry of Health, the Kenyan Healthcare Federation and AMREF International University for a pilot program that will train and certify midwives and clinical officers in a state-of-the-art healthcare facility, the Kenya Women and Children Wellness Center.
Increase educational and job opportunities for women in nursing and midwifery. Programs will empower young women through educational tracks and opportunities to serve as healthcare providers in their communities. Inteleos is activating the ecosystem in the global healthcare space to develop job pathways for young women and conduct accreditation, maintenance of licensure, funding, and research.

According to the World Bank, Sub-Saharan Data on Maternal Mortality for 2023 is projected at:

Kenya: 530 women died per 100,000 births.
South Africa: 127 women died per 100,000 births.
Nigeria: 1047 women died per 100,000 live births. Nigeria accounts for 20% of all maternal deaths globally

Up to 50% of these deaths are preventable.

As of mid-2022, the Inteleos UPGC is deploying the key elements to create a social movement, including science-based research, coalition building and government involvement. The UPGC is an example of a Grand Challenge in its early stages: Measures of success will be determined at a future stakeholder summit in late 2023, convening leaders who work together to assess and improve the effort. Pilot projects will be reviewed, and successes amplified and next steps determined to bring the UPGC closer to its goal of achieving global ultrasound proficiency.

Said Inteleos Executive Director Dale R. Cyr: “The Ultrasound Proficiency Grand Challenge focuses the organization and global healthcare communities to align values, resources and missions to ultimately improve global health. The impact of the Grand Challenge is linked to the UN SDG 3.1 and its results should be dramatic in maternal-fetal health.”

Funding

The Inteleos Foundation is a 501(c)(3) public non-profit and works to raise funds for the UPGC and other education-based programs. Partnerships with other funding bodies are in development. Visit www.inteleosfoundation.org for more information.

Outcome

Anticipated results of this work in Kenya are:

Enabling policy and regulations to recognize midwives, nurses, and clinical officers to practice obstetric ultrasound screenings at a national level.
Standardized implementation of curriculum, training and certification in validating skill transfer and proficiency.
Quality assurance mechanisms are established and maintained through ongoing mentorship and professional development.
Sustainability through financial and human resource modeling that provides a value proposition for patients, providers, education and healthcare systems, device manufacturers and government.
Research and evaluation of impact on maternal outcomes over at least a five-year span.

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1 Bjarte Sorensen and Steinar Hunskaar, The Ultrasound Journal, Springer Open, Nov. 19, 2019, Point-of-care ultrasound in primary care: a systematic review of generalist performed point-of-care ultrasound in unselected populations, https://theultrasoundjournal.springeropen.com/articles/10.1186/s13089-019-0145-4

2 Robert Nathanson, MD, Jason P. Williams, MD et.al., The American Journal of Medicine, Alliance for Academic Internal Medicine, Feb. 22. 2023, Current Use and Barriers to Point-of-Care Ultrasound in Primary Care: A National Survey of VA Medical Centers, https://www.amjmed.com/article/S0002-9343(23)00108-0/fulltext#:~:text=Barriers%20to%20POCUS%20use%20were,and%20clinician%20champion%20(39%25)

3 Ahmed Hashim, Muhammad Junaid Tahir, et.al, PubMed Central, NIH National Library of Medicine, Nov. 2, 2021, The utility of point of care ultrasonography (POCUS), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8606703/