JMIR Publications

ABSTRACT

Background:

Despite its established clinical value, point-of-care ultrasound (POCUS)[JC5.1] use remains limited by access to expertise and challenges with workflow integration. Remote interpretation, enabled by cloud-based platforms, such as Presuna, has the potential to address these challenges by enhancing accessibility.

Objective:

Evaluate the usability and diagnostic agreement of Presuna across device types for lung and inferior vena cava (IVC) ultrasound scans to inform clinical implementation in remote settings.

Methods:

Four clinical vignettes with associated lung and IVC ultrasound scans were reviewed by four physicians using Presuna across three device modalities (laptop, tablet, smartphone) over three sessions. We calculated inter-rater diagnostic agreement between participants and a reference standard and assessed System Usability Scale (SUS) scores via surveys. Thematic analysis[JC6.1] was conducted using NVivo from observations and participant interviews to gain insight into the overall user experience.

Results:

Chance-adjusted agreement was substantial for laptop (0.80), tablet (0.68) and smartphone (0.72). Observed agreement mirrored these results with the laptop (lung = 83%, IVC = 75%, clinical impression (CI) =78%) having slightly higher results than the tablet (lung = 81%, IVC = 73%, CI=78%) and smartphone (lung = 80%, IVC = 74, CI=77%). Participants[JC7.1] found Presuna appealing, particularly for its remote asynchronous capabilities. The laptop version of the platform was favored over tablet and smartphone versions, with SUS scores of 76.5, 55.0, and 59.5 respectively. However, participants emphasized the unique portability advantages of handheld devices, which would be particularly convenient for physicians working remotely.

Conclusions:

To support the successful clinical integration of remote POCUS interpretation software, image quality, language clarity, interface design, and pre-implementation training are essential design components to consider.