Field Tested: Using the Omni Pro in Europe’s Refugee Camps

Published on October 6, 2016
Omni Pro packs 11 medical devices—including a stethoscope, oto/opthalmoscope, audiometer, tuning forks, and an examination light—into a single device weighing 145 grams. Learn more at hmdmedical.com

Dr. Raymond uses Omni Pro to examine a patient at a refugee hostel.

With more refugees moving across the world than ever before, and with so many doctors now volunteering for remote assignments, it is just the right time for a system that allows a complete physical exam without the need for the traditional Medical bag. “Omni Pro Multifunction Medical Devices” provides 11 exam tools in a single medical device.

A Hong Kong physician, Dr. William Hasbun, along with a team of engineers, designed Omni Pro to do in 145 grams what has traditionally been accomplished with five kilograms; the device includes—among other features—a stethoscope, oto/opthalmoscope, audiometer, tuning forks, and an examination light. When medics have to carry all their equipment, medications, and supplies on their back, the weight savings with Omni Pro is significant.

Omni Pro makes sense in the field, but it is also precise enough to be used in the clinic or hospital. The micro USB recharging unit and cable can be attached to all electrical sources worldwide, including photovoltaic or solar panel backpacks. It typically takes two hours to charge fully from zero, and lasts up to several days depending on duration of use.

My colleague and I put Omni Pro to the test in a refugee hostel in Austria, just north of Slovenia. There, we examined Afghan and Kurdish refugees from 3 weeks old to 50 years of age. Unlike most first time gadget users, I read the instructions, but for the most part the exam system was intuitive to use. The dimmable light for oto/ophthalmoscope is a nice touch, making the experience more pleasant and useful for both patient and examiner.

All the features of the Omni Pro function remarkably well, with rare exceptions, although some physicians may find the unit small in the hand. Adjusting and adapting the units from otoscope to ophthalmoscope was easy and quick. The specula provided are Omni Pro specific, and, although disposable, are also amenable to multiple use following an alcohol swab. The replacement specula tube price is pending but will likely be minimal. Omni Pro’s manufacturer, HMD, states that standard specula can be used, but those do not lock in place. We also found that, due to the small aperture, one cannot pass instruments through it for procedures as with standard otoscopes.

The audiometer is a nice field screening tool, but significant deficits identified would warrant referral to a proper testing facility. Reading the tiny display required reading glasses, but with regular use the steps could be memorized for easy documentation.

I found the electronic tuning forks did not meet expectations. They simply weren’t powerful enough. Even placing it on the forehead, rather than the top of the head, in the 512 setting was insufficient to produce the needed bone conduction for a Weber test. Similarly, the Rinne test was limited, as it performed well in air conduction, but bone conduction was dodgy. When compared to normal tuning forks the results were inconsistent.

Tuning forks are very useful in the field, so I was pleased that they were available in the Omni Pro, but disappointed when they failed. In addition to the standard function, I use the 128 hertz tuning fork to assess for bone integrity. As we cannot carry an x-ray machine to a remote outpost, a 128 tuning fork, when applied to a bone, is a quick and dirty way to determine if a fracture is present. The bone fragments will vibrate against each other with a fracture when there is no obvious displacement or deformity of the bone. Under such circumstances, the test, when performed, is exquisitely painful, but if a fracture is absent the patient remains comfortable. This test essentially determines or eliminates the need for splinting. The Omni Pro could not perform standard tuning fork tests, much less this one.

Ideally, in the next iteration, replacing the electronic tuning fork with a digital thermometer would be preferred. The only other items I carried with me included a blood pressure cuff, fluorescein strips, and a thermometer. Eliminating the latter would add utility to an already marvelous exam tool. I’d also like to see the charging cable attached to the stethoscope hose, as it is easily lost.

This is the view of the Omni Pro from orbit. In the hands-on face-to-face encounter, the patients felt the instrument was professional in function and appearance. The reflex hammer did not appear makeshift and was useful in abdominal percussion with the hand in place, allowing us to diagnose a sigmoid volvulus.

The sensitivity of the Omni Pro stethoscope was excellent. Detection of subtle cardiac valvular disease could be appreciated and was no different from a standalone Littmann Master cardiology stethoscope. For infants, the diaphragm was much too large, but the tradeoff was its multiple functionality. A standard adapter could be carried and added to meet the needs of pediatric patients.

Neurological exams were easily accomplished using the device, particularly with peripheral two point discrimination. An Afghan refugee with a history of seizure disorder, possibly as a result of traumatic brain injury, tolerated and even preferred the smaller device during the testing. (Interestingly, while attending a German lesson he suffered a violent outburst, one of many apparently, which we suspect was due to accessing a damaged part of his frontal lobe when learning. Police were called and he was detained, but I pointed out to them a possible medical cause to his violent behavior which they took under advisement for future encounters.)

HMD is poised to introduce Omni Pro for the use of medical students and residents, allowing them to do complete exams on the fly. Besides being clever, the device also saves them money. Due to be released in October 2016, Omni Pro has a suggested retail price of $499 USD.

To compare Omni Pro to standard equipment, I referred to Amazon.com to price out the standalone tools. Littmann Master Cardiology stethoscope: $199.72; Welch Alyn Oto/Opthalmoscope set: $574.20; Maico Diagnostic Portable Audiometer: $696.51; Taylor Pocket reflex hammer and 2 Tuning Forks: $13.25; Pen light: $5.48. Total cost for the standalone comparable system: $1,489.16 vs. $499.00 for Omni Pro. Basically, a complete set of equipment for one-third of the price.

Personally, as the price for handheld ultrasound comes down, I believe they will replace stethoscopes entirely. Transducers can now be attached to smart phones and used with an application, but the price is simply out of reach for the average practitioner (≥$3000.00 USD).

My colleague felt that the unit was overall too flimsy and could be subject to breakage when tossed into a backpack with other equipment. The plastic makes it light, but metal reinforcement, while adding weight, might also provide some greater durability and reassurance for the practitioner. The temperature range advised for operation is 59 F to 104 F, making its utility in cold climates limited, although I suspect this has more to do battery life than anything else. As most exams are done within this temperature range, this is a minor issue.

I still believe strongly in the power of the physical exam, and Omni Pro is a step into the future with equipment that is precise, portable, light, and inexpensive. For the physician in the field it is an indispensable asset.

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