Creating Lower Limb Prosthetics with 3D Files: The OPC Story
December 15th – 2020
In this episode of the TechMed 3D Podcast, we talked to Michael Weiss, who’s the Clinical Director for Orthotic and Prosthetic Centers (OPC). This US-based company integrated 3D technology into its fabrication process 10 years ago. As of today, 90% of patient data acquisition is done using 3D scanning!
Here is an edited transcript of their conversation.
Kate Stern: I’m sitting down with Michael Weiss, the clinical director for Orthotic and Prosthetic Centers, also known as OPC, which actually has 20-something locations in four states in the US, but is based in St. Petersburg, Florida. Thanks for being here, Michael, how are you?
Michael Weiss: I’m doing great. Thank you so much for having me.
Kate Stern: So, let’s start off with how you first heard about the TechMed 3D solution.
Michael Weiss: Well, we go back a long way trying to implement scanning and alternative limb capture technology at OPC and we have tried just about every scanner and just about every implementation possible over the course of the last 10 years. And most of them either failed, because they were too difficult for the clinician to use or just too difficult to transport. They weren’t consistent enough.
I was walking through a trade show, and I ran into Benoit and the rest of your team, and they were working with the occipital scanner—which honestly, we had used and put aside in the past because it wasn’t effective enough—and I got to speaking with them about possibly a bigger solution that involve more than just the scanner, that went all the way to an app. So that wasn’t just the hardware, but how we could actually use it in our clinics, and they had all the right answers.
So, I kind of thought it would be something that, you know, died at the conference. [But] they reached out and they worked every step of the way. So, it worked out okay.
Kate Stern: And when you say you tried every scanner, what were the usual problems you were finding?
Michael Weiss: It wasn’t that they didn’t work, it was that they weren’t always consistent enough. Either it required too much time and effort to actually capture the scan, it was necessary, or there was a hyper focus on how accurate the scanner was, which—it’s just my opinion, but I don’t know that it’s “how accurate the scanner is” that matters the most; it’s more how consistent it is at capturing the image.
And some of it was just, it didn’t fit a real, live, O&P clinic model where we are not always in an office setting. So, it’s not always so easy for us to take that—to capture that limb in a patient’s home, or in a facility—if the device being used to take the scan is not really portable. So that’s where we ran into an issue with a lot of it, is it required kind of NASA control at a desk to be able to operate.
Kate Stern: And the TechMed one was more portable, and more accurate, or just as accurate?
Michael Weiss: In my opinion, it’s just as accurate. I’m sure that if I was selling all of them, I would identify that it is less accurate, but it is very, very consistent. And that’s really all that—at least in our industry—that’s all that I think I’m concerned with, is if we can take some of the margin of error based on how tightly we wrap a cast, or casting technique, or the layers used underneath it to control tissue… if we can take some of those variables out, even if [the TechMed scanner is] not as accurate, it’s absolutely consistent across the board no matter who’s holding the scanner.
Kate Stern: That makes sense. Are you mostly focused on feet at the Orthotic and Prosthetic Center or other limbs as well?
Michael Weiss: Anything that can be missing, we’ll work with. So we have experimented with our TechMed app and the scanner on just about everything. We’ve worked with transradials. We do use it for orthotic care as well, so we do use across the board, but we are prosthetically focused as a company so we are primarily prosthetic.
Kate Stern: So, mostly your clients are people who have lost a body part?
Michael Weiss: Yes, and as with most people in the industry, the majority are lower extremity amputations. But we have used the software for the upper extremity as well.
And how important is 3D scanning in your daily operations?
Michael Weiss: We knew it would be helpful and it would improve our efficiency. I don’t know if we knew quite the extent. My hope was to get at least 50% buy in, and I would say at this point, a year or so after we rolled out the technology, we scanned more than probably close to 90% of our patients.
We do have specific scenarios where it’s not appropriate or it isn’t the preference of the clinician to do it. It’s not something that we mandate, obviously. But we do have it available to every clinician and I’d say 90% of them, especially transtibial amputees, below knee amputees, they’re scanned in almost every case.
Kate Stern: So that’s 90% of about how many clinicians?
Michael Weiss: We have over 20 clinicians right now, 20-something I believe. I don’t remember the exact number to be totally honest with you, but 20 to 30.
Kate Stern: Mm, so scanning is very important.
Michael Weiss: It is. It’s become something we rely on. And because we’re so spread out, and we work in all different sorts of locations, being able to start the process of fabrication nearly immediately is incredibly important. And it’s not just the scanning technology. We can have a clinician, for example, in North Carolina, take a scan, and within five minutes the lab is already working with that scan to fabricate a socket—which takes not only shipping costs out but days of travel.
But it’s the app integration as well, I would say, almost more so than the scanner, because the app allows us to ensure that we get all the information we need to fabricate the right device for the patient. Sometimes with handwritten forms, there’s the possibility of leaving out information that’s not life or death, but it requires a lot of back and forth between the fabrication facility and the clinician to get everything right. The advantage of the app is we can kind of force the information that we need, at minimum, to make the right device. So that’s been a huge game changer for us, efficiency-wise and documentation-wise, because there are no examples of us fabricating something without the right information.
Kate Stern: That’s also such a big part of consistency, that you were talking about.
Michael Weiss: Absolutely.
Kate Stern: What sort of questions do get your clinicians to ask, like what do you think are the key pieces there?
Michael Weiss: Ask that one more time?
Kate Stern: The key—when you said, if it’s just handwritten, sometimes you don’t have all the information you need to make the right device.
Michael Weiss: Okay, so I think, I don’t think it’s even in our industry, it might just be human nature. But forms are generally treated as a suggestion. And there are basic pieces of information, it seems silly, but like a date of birth, which might be the identifying feature for that, or identifying piece of information for that particular patient.
So if we were to take that all the way down the line, if we’re going to maintain that impression, that digital impression of the patient limb, and use it in the future for re-fabrication of devices or as documentation for volumetric changes in the patient’s limb, anatomical changes… If we don’t have a true identifier beyond just their name, we might not be able to do that effectively and certainly not to the point that it would count as medical documentation.
So, a date of birth being forced as a field is pretty important. And in fabrication, a lot of times we will identify… we’ll take a cast and assume the cast is going to tell us everything, but something as simple as an overall length measurement of the limb is often omitted, because we figure we’re going to be able to get it from the impression. And if we can’t—even if that number exists in the world somewhere—it slows our process down to have to go back and get it. So, to ensure that’s on the form right from the beginning, takes one of those pieces of little guesswork out of it.
“We knew it would be helpful and it would improve our efficiency. I don’t know if we knew quite the extent. My hope was to get at least 50% buy in, and I would say at this point, a year or so after we rolled out the technology, we scanned more than probably close to 90% of our patients.”
Kate Stern: Mm. So when it’s a piece of paper, people might just skip over that field. But when it’s in the app, they’re forced to actually enter it and that makes sure you have all the crucial information you need.
Michael Weiss: Yeah, if we choose to push it that way, and we did, and that’s been a really big deal. And I will say that it, efficiency-wise, it also gives us a bit of a prompt, I guess is the best word.
I forget things. So, to be able to have the app in front of me with the most critical information prompted to fill out while I’m working with the patient—even though I’ve done it for a little while, I still forget critical pieces of information. Because you get in a conversation with a patient, you care about them, you want to help them, and you might stop thinking about the little teeny details that you would normally ask for.
To have it prompted in front of me means that when I get back to the desk, I get back to fabricate, it’s all there, for sure. So that I can move forward with that patient as fast as possible. I believe that as much as quality care [matters], patients and physicians, at this stage in the world, in the environment, they also want their devices in a timely manner, not just the quality they expect.
Kate Stern: What was the hardest part about integrating this new technology?
Michael Weiss: Just change. Even change for the better, or change that improves efficiency, is always difficult, and part of what makes our particular industry (orthotics and prosthetics) interesting and feel like a community is that a lot of our clinicians are multi-generational. As far as their involvement in the field, their parents did it, their grandparents did it, they’ve done it forever, they’ve been taught since they were kids.
And this is absolutely new technology, and there is a feeling that the more your hands are on every part of the process—literally, the casting process, the modification process, the fabrication process—the better the outcome is, and I believe that there are places where that is absolutely beneficial.
But there are places like in scanning where if you can take variables out, I don’t know why you wouldn’t, for consistency across the board. And so that is a kind of a mindset across the board that was the hardest thing to go up against. And we still have clinicians that absolutely would rather avoid scanning as their capture mechanism, but because we’re involving the app as well, and integrated that into our fabrication process, there are options to still be hands-on with your casting technique and your measuring technique. It does not force you to use the scanner (which is still a matter of preference with our clinicians), and we do not force them to do it, it is what they prefer.
Kate Stern: So, a lot of them have really got onboard with the consistency aspect, rather than the handcrafted aspect?
Michael Weiss: They handcraft at different points in the process. So, it doesn’t eliminate it, it just takes that step away. I mean, it’s only one step, just the casting, but we still have to be creative with how we capture our scan, because we do rely on our hands to shape the mold when we’re taking it in real time and the scanner is so hands-off that we do need creative solutions that we’ve had to work through to be able to capture the limb as if it was being casted, but without our hands on it.
Kate Stern: There’s still an element of handcrafted, artisan work there.
Michael Weiss: I think there has to be for it to be done well.
“And the ability to consistently transfer complete and accurate information back and forth between clinicians in the field and the people that are doing the fabrication is going to become more and more critical.”
Kate Stern: Yeah. I’m wondering if, looking back at all that you’ve accomplished in terms of integrating this technology, if there’s anything you would have changed or done differently?
Michael Weiss: I think there’s always stuff we would change. I think we were very careful with rolling it out. We saw a lot of the pitfalls ahead of time. So, it was probably close to a year, nine months to a year of beta tests in the background before we provided iPads and scanners to actually put it into practice.
Because I don’t think that if it failed, the technology would ever come back from that. It needed to work from day one. So, I don’t—there are always things that I would change, and I know there’s things that clinicians would request for change, and we’re still making changes, probably annoying TechMed with our requests, but we’re making changes regularly to try to improve our workflow. But the biggest thing that avoided huge re-dos and restarts was making sure that we beta tested it for a long time, probably longer than we needed to.
Kate Stern: Yeah, it’s so much better to roll it out slowly and be sure that it will work than to have it go wrong and have people not be willing to try again.
Michael Weiss: Yes.
Kate Stern: My final question: How do you see the future for this industry?
Michael Weiss: It seems that our industry is moving toward larger groups of clinics, it’s the “one offs,” the small like mom and pop one and two shops are becoming harder and harder to grow on, which is not necessarily a good thing, but it is the trend. And I think as that happens, central fabrication is going to become more and more important, whether it’s central fabrication within that company like we have, or central fabrication to an outside fabrication facility.
And the ability to consistently transfer complete and accurate information back and forth between clinicians in the field and the people that are doing the fabrication is going to become more and more critical.
Also, consistency, because someone fabricating their own devices, or a single tech fabricating for a few clinicians, can learn the styles and the nuances of a couple different clinicians. But when you’re a fabrication facility that’s working with 20-30-50-100-200 clinicians, that all have slightly different techniques, it leaves a lot of room for error on the technicians’ part and a lot of room to omit information on the clinicians’ part. So, standardizing it and improving consistency in what we provide to them is going to help with patient outcomes, because the devices we get back will be more what we want for our patients.
Kate Stern: Mm. It’s a trend towards greater consolidation, like in so many industries.
Michael Weiss: It’s not unique to us.
Kate Stern: Well, thank you for those insights. I think that was really helpful for our listeners.
Michael Weiss: Thank you so much for having me on.