Techmed Talks

From Traditional Method to 3D Technology for Patient Data Acquisition: The Edser Lab Story

November 27th – 2020

Dacey Orthotics Services
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In this episode of the TechMed 3D Podcast, we talked to Jamison Goldberg, who’s the Operations Manager at Edser Lab USA. This international company switched from the traditional method to 3D technology about 10 years ago and now all of their clinicians use 3D scanning for data acquisition! 

Here is an edited transcript of their conversation.

Kate Stern I’m here with Jamison Goldberg, the Operations Manager at Edser Labs USA. Jamison is speaking to us from Miami. How are you?

Jamison Goldberg: Good. Thank you for having me, Kate.

Kate Stern Great to have you. So how did you find out about TechMed 3D?

Jamison Goldberg: So, as I mentioned, the iPad scanning solution in general started to become a priority in the 2016-17 timeframe for me in the US market. [That’s] when we began expanding and taking on some larger and different types of clients that had different demands that needed to be met, which I’ll get into. Once we decided to go in that direction, it was pretty clear from the beginning that TechMed offered the best solution.

We spoke to [TechMed] about using the 3DsizeME software. And they showed us right away that they could customize skin for us, incorporating the Edser company logo and color scheme, and streamline the software platform to provide only the tools and necessary data entry that the Edser company requires from its clients. They also offered the ability to upload our company forms, and take pictures, giving our clients various options for order entry and processing, based off of what they had been doing in the past.

It’s quite difficult at times to get clients to change the way they’ve been doing things forever, especially the way they’ve been doing them with your company [(Edser)]. So, having the ability to adapt and use some of the old tools and some of the new ones was really important for us. All of the above was done rather seamlessly—quickly and affordably. So, at the time, there really wasn’t a comparable alternative that anyone approached us with.

Kate Stern: Mm. It sounds like customization is really important to you.

Jamison Goldberg: Yes! In that sense, another way of putting that is that [TechMed] approached us with a solution that made it as if the 3D scanning solution, with the iPad, was something that we were offering our clients ourselves, and not going through a third party necessarily.

Kate Stern: Right, it looks more professional that way.

Jamison Goldberg: Correct.

Kate Stern: So, what’s the importance of 3D scanning in your daily operations?

Jamison Goldberg: As I mentioned just a minute ago, it [(3D scanning)] became extremely important to us about three or four years ago, for our daily operations. We were able to adapt to the demands of larger and different types of clients.

For example, we have one regional distributor in the US who manages orders from multiple hospitals and private practices. We have another client, who has a team of orthotists, who covers the orthotic and prosthetic needs from a larger group of doctors and locations statewide.

So, the 3D scanner for iPad allows scanning capabilities to be moved easily and quickly from one place to another. This means that patients can be scanned in their treatment room, rather than having to bring [patients] to one specific room where a less mobile scanning unit might be located. And, the scanner can also be moved easily between locations, hospitals, or even for home visits.

Kate Stern: It’s a lot more flexible.

Jamison Goldberg: Yes. We’ve also been able to take on clients from areas which may have previously been more difficult to reach (due to a lack of major distribution centers in that area). As mentioned, we do have a fairly global distribution, with the central lab in Spain, my distribution in the [United] States; we have major distribution in [the] UK, in Israel, in New Zealand, and then some smaller ones. But [despite all that], there are other areas that are difficult to reach.

So [for example], from the US perspective, we’ve always had a strong presence in Puerto Rico, but now my office has added clients from Curacao, Dominican Republic, Vancouver, Toronto, and Montreal. Before the introduction of the iPad scanner, we wouldn’t really have been able to make sense of this logistically: having to cross borders, shipping phones,or casts from them to us, and then [shipping] the insoles back from us to them. So that’s opened up a lot of doors for us.

The UK office has had a similar experience, where they’ve been able to expand to Ireland and Northern Ireland, which they told me was previously difficult, mostly due to shipping delays and not being able to achieve the turnaround times that their clients required. And in Spain, along with Israel and New Zealand, of course, with the distributions, they’ve added small clients in Malta, Oman and Dubai.

So again, just being able to have somebody buy an iPad (which you can mostly get anywhere), and a structure scanner, which you can get online and get sent to you—as opposed to having to ship our heavier laser scanners and do software installations and everything like that—has helped a lot.

Kate Stern: Are all of your clients using scanners now as opposed to plaster?

Jamison Goldberg: I would say that about 60% of our clients in the US are using scanners. However, that probably translates into over 80% of our orders. As I mentioned, we do have some clients who have their own internal operations, like the regional distributor I mentioned, where they actually receive foams, and ultimately scan them before sending us the digital data.

We also have some clients who still prefer to cast or [use] foam. But we’ve convinced them to save shipping time and costs, to have a scanner in their office and scan after the fact and send it to us.

The majority of foam and casts that actually comes into our office in Miami is from lower-volume clients: people that are just doing a handful of orders a month, and are kind of stuck in their ways, or don’t want to make an investment in order to convert. But anyone that’s doing reasonable volume for us has mostly transitioned into laser scanning.

Kate Stern: Mm, so it was easier to persuade people with higher volume to make this switch?

Jamison Goldberg: Yes, absolutely. We do also use the 3D scanner in our office, of course, to digitize the foam impressions and plaster casts that we get from clients who prefer that method in their office and prefer to ship it to [us].

Kate Stern: Oh, that’s cool. I’m wondering, what was the hardest part [of] integrating this technology?

Jamison Goldberg: Honestly, the only thing that really comes to mind is client education. As I mentioned, we had adopted 3D scanning technology previously—probably 10 years before we started with 3DsizeME and the iPad scanner. We were using traditional weight-bearing 2D and 3D scanners, so it wasn’t completely foreign to a lot of our clients.

However, as I just mentioned, those systems were made for weightbearing scans. So, from a laboratory perspective, we see all the different ways that our clients are capturing patient data, on a day to day basis. We see foam impressions, plaster casts, slipper casts, laser scans, pressure analysis, static versus dynamic, and weight bearing, partial weight-bearing and full weight-bearing.

These are all things that can be a part of a clinician’s training (or belief system, or philosophy) that they’ve been doing for years, and they tend to trust how they’ve been trained and what they’ve been doing for a long time.

So, when having these conversations with the clients, you also learn how much of the design process has either changed [the clinician’s way of doing things], or has always been foreign to many of the clinicians. Whereas many of them are concerned with manipulating the patient’s foot to subtalar neutral for casting, or plantar flexing the first ray while casting, or scanning the foot in a partial weight-bearing position, it should be realized that algorithms and AI allow us to rectify all the scans once we digitize them—to position the foot in an ideal subtalar neutral position before designing the orthotic.

Similarly, while many clinicians think of literally filling the “cast mold,” as they call it, of the patient’s foot, CAD software allows us to take those rectified scans, design the insoles to hold to the desired alignment, and smooth the surface for comfort. So, it’s really an experience of educating those clients that some of the things that they’ve been worried about aren’t maybe as important as they think they are.

[Those things maybe aren’t so important] that they need to be casting so that they have control of the device, or they need to be using the foam, or it has to be weight bearing. Our designers, as mentioned, we have designers who have been with the company from the beginning. So, they have over 20 years of experience taking all different types of anatomical impressions, or scans from multiple clients, and multiple devices, and knowing how to design all of that.

So, once [clinicians] understand that there’s a lot more control on our end in order to make things equal before it goes into the design process, then they’re more comfortable with converting over to something that might not be familiar to them.

“In that sense, another way of putting that is that [TechMed] approached us with a solution that made it as if the 3D scanning solution, with the iPad, was something that we were offering our clients ourselves, and not going through a third party necessarily.”

Kate Stern: That’s really interesting. So, when clinicians are concerned, they’re concerned about being able to position the foot correctly. But what you’re doing is going back to them and saying, “you actually don’t need to worry about that, because the technology takes care of it.”

Jamison Goldberg: Yes, I mean, I’m not undermining the importance of those things. It’s just that there are tools to adapt and accommodate for those things and we have experience with all of them. So it’s the weight of wanting the perfect cast or impression, or weightbearing scan the way that you’re used to doing it, versus the positives of increased efficiency, decreased mess of using plaster in your office (or foam boxes), decreased costs, improved shipping time—and then you give them the option at the end of  weighing the positive versus the negative for them, and then it’s easier for them to make that choice.

The majority of my newer clients are all choosing the 3D scanning solution with the iPad, and a lot of the old ones have converted as well. The only other obstacle is, as I mentioned, upfront costs, and that’s something that’s always been an obstacle for technology integration over the years. But, in that sense, the iPad scanning solution has lowered the cost of moving to {this] technology integration. So, with a bit of that technical education, and the presentation of the long-term savings, it’s been a pretty smooth transition.

Kate Stern: I just want to pick up on something you said about “weighing getting the perfect plaster cast versus all the benefits of 3D scanning.” I’m wondering, is it the case that the plaster cast actually has a better outcome—like, [it results in] a more perfect cast?

Jamison Goldberg: So, again, we don’t find that. I’m not sure if some of my clinicians would tell you otherwise; I don’t have specific cases where one has told me, “I want to try one with a cast and one with a scan of the foot and decide which one’s going to be better.” As I mentioned, my expectation is that ultimately, it’s going to come out the same.

Like I said, when you’re dealing with the majority of labs, and certainly with our lab, we’re not recreating that plaster cast or taking it and filling it and just giving them an orthotic straight back. In my opinion, that wouldn’t be us doing the proper service of being a custom orthotics lab which is designing orthotics for them. [If we did that,] we would just be doing “work” of pouring plaster into a cast and then molding it. [Instead] we’re actually putting experience and putting design into it.

Kate Stern: Putting some thought into it.

Jamison Goldberg: So either way, those feet [in the orthotic molds] should end up the same—no matter which solution you use to get there.

Kate Stern: Right, that makes sense. My final question for you is, how do you see the future for this industry?

Jamison Goldberg: Honestly, it’s probably going to sound like what you hear from a lot of people, but we see the future in digital, and we see it in 3D. And for me, in that sense, the future is already here.

One thing I had some reservations about, that I know is a new release for 3DsizeME, was moving beyond the Structure and Mark II scanners and using only the true depth or lidar capabilities of the iPhone. From a patient presentation standpoint—

Kate Stern: Right, you mean the iPad?

Jamison Goldberg: The iPad or the iPhone.

Kate Stern: Oh! Interesting.

“Honestly, it’s probably going to sound like what you hear from a lot of people, but we see the future in digital, and we see it in 3D. And for me, in that sense, the future is already here.”

Jamison Goldberg: With the new technology in the front camera—and now on the iPhone 12, I believe the back camera—the same or similar technology used for facial recognition is now allowing the three-dimensional scans of anatomical parts.

I was a little bit worried that from a patient presentation standpoint, by removing the specialty device that you attach to the iPad, and just using a smartphone (which most people, or a large portion of the population, has in their hands all the time or just sitting at home) might take something away from the experience for [patients]. But at this point, honestly, I think I was wrong.

The data-capture abilities, and accuracy and ease of use for 3D anatomical and postural scanning is incredible and there’s software being developed for the iPad and iPhone for biomechanical and video analysis as well. I just think it’s really game-changing.

And for our story, at least at Edser, 3D scanning went directly in line with 3D printing. We started that right afterwards on HP’s multi-jet fusion platform. So, I also think it’s widely recognized that 3D printing is the future, on the manufacturing side. There are some companies already, Edser and some others that we know about, that are really doing special things with orthotics and prosthetics.

For us, the key moving forwards is reproducibility and scalability. Now that’s for us as a large laboratory and manufacturer, rather than a clinic. We are seeing great results with our AFOs [(ankle foot orthoses)] that we started making a little over two years ago, but we’re constantly tweaking the design features to improve each device.

This is just another amazing thing with 3D scanning and 3D printing: that you can kind of save these designs for later and tweak them little by little, whether it’s for the same patient in the future or for future patients, and really get a consistent reproducible scalable device.

Edser, for example, has also developed shin guards for soccer, face protection for issues with the nose and malar bones, and we hope to offer wrist splints, prosthetic sockets and spinal bracing in the next year. Without 3D scanning and 3D printing, none of that would have been possible.

Kate Stern: So that’s a good case of being wrong about the iPhone, iPad camera capabilities.

Jamison Goldberg: [Laughs.] I don’t know that I am wrong yet. It’s just something that I felt, because even with the iPad, we had one obstacle that I didn’t mention before, which was just seeing whether it’s [an additional device that is being] put on an iPhone or an iPad.

[If you] just put the device and tell the patient to put their foot up, you position [the foot], and then take a scan of it, they might think you’re just taking a picture of [their foot]; maybe they don’t understand what the technology is inside of the device, because it’s a smaller device.

I had some concern about that at the beginning, and clients did also. But within months, all we got were “wow’s” about that: you know, you turn [the iPhone or iPad] around after you take the 3D scan of the patient’s foot and you show them what you just did and they’re amazed.

So, my concern, again, was just that dropping off that supplementary piece that you had to put onto the iPad, and now if it was just using an iPad, I had some fear that the patient would be like “I could do this at home. I don’t have to come into this doctor’s office to use specialty equipment like an MRI or x-ray machine, or something comparable, I can just use my phone.”

But I think it’s so powerful, and people understand that the iPhone is so powerful, at this point, that it’s not a concern of mine anymore.

Kate Stern: Right. So, you’re not so concerned with how impressive it is, because it speaks for itself with the result.

Jamison Goldberg: Exactly. Yes.

Kate Stern: Well, thanks so much Jamison. That’s all I have to ask about today.

Jamison Goldberg: All right. Thank you very much. Thank you for having me.

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