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Revolutionizing EKGs in DPC: A Conversation w Dr. Jake Mutch and Dr. Robert Beto

Advancing Cardiac Healthcare Through Innovations in Direct Primary Care

Get SmartHeart for YOUR DPC for $99/month and enjoy
Wednesday, Dec 13th, 9am PST


Direct Primary Care (DPC) presents a paradigm shift in healthcare delivery, and the integration of SmartHeart technology is transforming the diagnostic capabilities available in this model. In this episode of "My DPC Story Podcast," Host Dr. Maryal Concepcion engages with Dr. Robert Beto and Dr. Jake Mutch to explore the innovative use of SmartHeart, a portable ECG technology, in cardiovascular care within the DPC model.

Addressing the Prevalence of Cardiac Disease

Dr. Robert Beto, a cardiologist and founder of HeartNexus, underscores the increasing prevalence of cardiovascular disease and the challenges in accessing specialized care. With cardiac disease claiming more lives than all cancers combined, the need for timely and comprehensive cardiac evaluation becomes apparent.

Transformative Collaboration: SmartHeart and Heart Nexus

HeartNexus's collaboration with SmartHeart brings a novel solution to bridge the gap in cardiac care. Through SmartHeart's portable ECG technology and unlimited 24/7 cardiology review, cardiovascular expertise is made accessible within the DPC model. Board-certified cardiologist expertise is now available with an impressive 15-minute guarantee for ECG review, 24-hour Holter and ECHO turnaround times, and telemedicine visits, particularly vital in areas with limited cardiology services.

Get SmartHeart for YOUR DPC for $99/month and enjoy
Wednesday, Dec 13th, 9am PST


Streamlined Diagnostic Process and Patient-Centered Care

Dr. Jake Mutch, a DPC doctor at Defiant DPC, shares his experience utilizing SmartHeart technology to enhance patient care. Describing the streamlined process of using the SmartHeart device, he emphasizes its efficiency in delivering EKGs without needing traditional paper or sticky electrodes. The device helps create a more meaningful patient-doctor interaction and enables prompt diagnosis and lifestyle changes vital for effective disease management.

The Role of SmartHeart in Direct Primary Care

Integrating SmartHeart in DPC practices presents numerous benefits, including accessibility and patient comfort. Dr. Mutch’s case study exemplifies the device’s role in timely diagnosis, highlighting the potential lifesaving impact of portable ECG technology within the scope of direct primary care.

Advantages of Digital Medical Records and Connectivity

The convenience of digital medical records for practitioners and patients is also underscored. Dr. Concepcion advocates for the ease of sharing and accessing medical records, cementing the importance of seamless communication and connectivity within healthcare delivery.

Changing the Landscape of Specialist Connectivity

The SmartHeart device revolutionizes the relationship between DPC practitioners and specialists, as Dr. Mutch explains. By providing quick access to EKG readings and the ability to obtain expert analysis from specialists in real-time, the paradigm of DPC's connectivity to specialized care is fundamentally transformed.

Decongesting Healthcare Systems with Intermediate Care

Moreover, the role of Heart Nexus in providing intermediate care between primary care and cardiologist visits is vital. This innovative model aims to decongest healthcare systems, ensuring prompt cardiovascular evaluation and intervention, ultimately optimizing patient outcomes.

The Impact of 12-Lead EKGs in Comprehensive Cardiac Evaluation

Through the discussion, Dr. Beto stresses the significance of 12-lead EKGs for comprehensive cardiac assessment and promptly identifying potential issues before symptom manifestation. This underscores the importance of comprehensive cardiac evaluation, especially for populations such as females, diabetics, and patients with a history of cardiac disease.

Democratizing Access to Expertise and Timely Diagnoses

Notably, the accessibility to board-certified cardiologist reviews within 15 minutes provides exponential benefits in ensuring expedited diagnoses and subsequent intervention, particularly in critical cardiac scenarios.

The Future of Cardiovascular Care in DPC

The use of SmartHeart technology in Direct Primary Care holds immense promise in revolutionizing cardiac healthcare. With its potential to prevent hospital readmissions post-hospital admission and its direct-to-consumer program, SmartHeart is poised to democratize access to diagnostic expertise and technological advancements in cardiac care.

SmartHeart technology, alongside the vision of pioneers such as Dr. Beto and Dr. Mutch, signifies an exciting shift in cardiovascular care delivery. Ultimately, the episode emphasizes the pivotal role of innovation and collaboration in transforming the landscape of cardiovascular care within the dynamic and patient-centric model of direct primary care.








  Primary care is an innovative, alternative path to insurance driven healthcare. Typically, a patient pays their doctor a low monthly membership and, in return, builds a lasting relationship with their doctor and has their doctor available at their fingertips. Welcome to the MyDPCStory podcast, where each week, You will hear the ever so relatable stories shared by physicians who have chosen to practice medicine in their individual communities through the direct primary care model.

I'm your host, Maryal Concepcion, family physician, DPC owner, and former fee for service doctor. I hope you enjoy today's episode and come away feeling inspired about the future of patient care, direct primary care.

  In today's episode, we are talking about SmartHeart, the only portable 12 lead ECG technology with unlimited 24 7 cardiology review. SmartHeart is transforming the way healthcare professionals, like DPC doctors, diagnose and manage heart disease. And you'll hear today how SmartHeart can elevate your direct primary care practice.

Our first guest, Dr. Robert Vito, FACC, earned his medical degree from West Virginia University School of Medicine, followed by an internal medicine residency and cardiology fellowship at the same institution. Dr. Vito's career has been dedicated to advancing cardiac care and delivery, and he has been instrumental in constructing state and national programs focused on improving cardiac health outcomes.

And he has received recognition as an exceptional instructor and mentor in the field of cardiology, guiding and preparing future cardiologists. Throughout his career, his profound concern remains in the increasing prevalence of cardiac disease, which continues to claim more lives than all cancers combined.

Motivated by the stark reality, Dr. Beto founded HeartNexus with a vision to address this critical problem of cardiovascular disease that affects so many. And today he will share about how he's teamed up with SmartHeart so doctors like yourself and myself and patients can have access to a cardiologist directly through the SmartHeart app.

Our second guest, Dr. Jake Mutch, is a familiar voice and the Successful DPC doctor, who we welcome back to the podcast. Today, he will be talking about how he and his wife, Dr. Christina much use smart heart in their clinic, defiant DPC. Dr. Much is a family physician and a Virginia native. He is a graduate of the college of William and Mary.

And for med school, he attended West Virginia school of osteopathic medicine. It was there that he learned the limitations of the rushed seven minute patient visit, which often hindered meaningful lifestyle changes necessary for disease management. In August of 2020, directly after residency, he and his wife established Defiant DBC in Williamsburg, Virginia, where they continue to practice family medicine, and they have recently added a third physician.

thank you so much everyone for joining us today on this special bonus episode sponsored podcast talking about SmartHeart because SmartHeart has an exciting offer that's coming that DPC doctors can access and so, Just to be transparent, I've been a smart heart user since before I opened my clinic. And on the podcast today we have two physicians, Dr. Robert Beto and Dr. Jake much. Dr. Robert Beto. You heard a little bit about him and his intro but we'll hear about how his company HeartNexus has paired with Smart Heart.

And then we'll also hear from Dr. Jake much who's shared his journey in DBC before opening. After residency at your anniversary, year one, year two, and year three, just recently and you'll be able to hear from him from the DPC physician perspective as to how the smart heart device is used in his clinic and why it means so much to his practice, defiant DPC.

So with that, Dr. Beto, I'd like to turn the mic over to you. Tell us a little bit about your journey into cardiology and how you created HeartNexus.

Well, thank you. First of all, I salute you and, and Jake for supplying quality, affordable health care to your patients. I do the same in cardiology.

I practiced in academic cardiology for many years, more than I'd like to admit. But you know, towards the end of my career in the cath lab and you know, in academics and, Uh, and research. I noticed that there was a lack of access to cardiologists over the years. That always seemed to be a theme.

So I had access to many of the fellows that I have trained over the years from coast to coast. And you know, I started this company that Offered board certified cardiologists expertise with a one one phone call. We guarantee 15 minute reads. We 24 hour Holter and echo turnaround times. We have telemedicine visits with cardiologists all across the country.

We serve, we try to serve groups where it's difficult to get cardiology services, rural areas, prison systems. There's some of the areas where in the state where I live where there's a lot of cardiologists within 150 miles circumference. So, that's the void we're trying to fill.

It's amazing and I think that it's a really smart move that HeartNexus has paired with SmartHeart because DPC doctors are in every state in the nation and this movement continues to grow and when we have tools that make our jobs, you know, even more valuable to our patients.

You know, as physicians who are able to just give health care the way that health care should be delivered to a person, no matter, you know, what their zip code is, no matter, you know, if they have a seven figure salary, or if they're not in that financial position.

Direct primary care, like you said, you know, it really makes health care accessible. And so when you talk about your company and, and then we talk about how it's pairing with SmartHeart it's just incredible that your, what you just shared, you know, having a board certified cardiologist be able to read an EKG on a SmartHeart device in 15 minutes.

It's, it's just you know, how can you argue with the awesomeness of that, right? So tell, tell us about, you know, when you were looking at companies to pair with, what was it about Smart Heart that made you say great, HeartNexus would love to be the readers of. The smart heart EKGs that are coming from people like DPC physicians.


right. First of all, the platform, the platform is amazing. You know, I just looked out my office today and I saw, I saw a tech pushing an EKG machine down the hall and all those 12, all those 12 leads were dragging on the floor behind like a sled. But anyway, it's the, the platform, the reading platform, the interpretation platform.

And then the the quality of the tracings are are unparalleled. I think all I'm echoing what all of our cardiologists would say in these, do you get an unreadable one from time to time? Of course, but that happens with any type of EKG machine. But I think the platform, the way that you receive it and the way that the, the, the way that the sender receives the, the, the Interpretation back is unparalleled.

Well, I definitely agree. As a smart heart user, you know. The use case scenarios that I've gone through, whether it be an office or in a person's home, it's one less thing that I have to worry about I wish I had a 12 lead. Cool. Go out to the car and get your smart heart.

It's literally as simple as that. And so, you know, when it comes to the, just going back and highlighting the overreads by you and your team How does that happen in terms of a person is doing a smart heart EKG? They've got an EKG on their device. How is it then sent to you guys?

And how do you guys get that turnaround time down to no more than 15 minutes?

We have a designated doctors and designated states where they're licensed. And the algorithm is within the smart heart. platform. So if we have a guy in California who it's his day on or his week on call, it'll automatically go to him.

He'll read it and it directly goes back to the performer, the test for interpretation. So it's, it's pretty simple. It's not really complex. It's pretty simple, pretty straightforward. It took some time on our end, building the algorithm with the licensed doctors in every state. But yeah, it's, it's seamless right now.

That's wonderful. And I love that, you know, you know, in terms of details, it's that's pretty much it. It's you do it, it comes to us, and it goes back to you. It comes

back to you. Correct.

Correct. And, you know, people, some, some people who are using the smart heart devices in Europe, you know, they're, the smart heart device is being sent out with people post hospital admission to help, you know, help prevent bounce backs.

But in the DPC world, if we have a patient where we're like, you know, we can check out a smart heart device to you or whatever. How would a patient be able to access a cardiologist override if that were needed from the patient's perspective?

wE're, we're partnering with them on a, on a new program.

It's their direct to consumer program. So they, they get the device, you know, post stem, post cabbage, you know, post COVID. COVID has opened up a whole new realm of, uh, uses for electrocardiograms, right?

So, you know, these people have this in their home and, you know, they're concerned or they want to get their baseline. They just simply do the test and they have the read back. I think some of the programs that smart heart offers does offer a face to face interaction with one of our doctors cardiologists with their with their package.

But yeah, I mean, it's just it's something that in the real world, you'd probably have to wait six months

to get. Yeah, absolutely. And you know, the, I'm sure there's listeners out there who are thinking about their patients, like their specific patients who had to wait months to get into cardiology. And in the meantime, they had to suffer.

XYZ problems. So totally, totally relatable. When you talk about the delayed care.

You know, the density of cardiac disease is amazing. It kills more people than all cancers added together, right? The density of the disease and the paucity of, providers who are prepared to deal with it.

You put that combination together. It's not the formula is not good. So, you know, that's the that's the basis that we build heartNexus on. Hopefully we're chiseling away at some of this deficit, right?

Definitely. And, you know, not only with the number of cardiologists a number of people who are able to handle cardiac disease compared to the amount of cardiac disease out there, especially in this country but also, you know, the layers of what they have to go through to get their code, to get their prior auth, to get their whatever.

That in, in our world is, is eliminated for the most part. I mean, clearly people need to get referrals sometimes, but what you guys are bringing to the table as board certified cardiologists and what we're able to access as DPC physicians, it's just here's one to the other.

As you said, you know, it's so simple. It's just like, send us an EKG, you'll get an EKG response back. So love it.

Yeah. We do believe that there's a level of care in between the primary care level. and the cardiac cath level, the cardiologist visit. There's a level of care in between there where somebody could access a cardiologist, get a 12 lead EKG, you know, have a 15 minute conversation.

It's going to really decongest this whole system.

Totally. Can you speak to the non 12 lead EKG? We have devices like, you know, wearable devices. We have devices where you could get a six lead EKG.

You have devices there, like a business card that you can fit into people's wallets. Can you speak to the power of the 12 lead EKG as a cardiologist versus using one of those especially for those people who haven't historically known that smart heart exists or that This new 99 per month offer is coming down that DBC doctors can access.

Do you, do you have two hours? So the, the 12 EKG you know, from the, back in the day when Dr. Einthoven invented it, the 12 leads are, 12 areas of the heart. It's looking at 12 different areas of the heart from different directions. These single lead, two lead, six lead they, they're, they're just different devices.

And, you know, we always argue that how do they advertise that as a EKG? It's not an EKG. An EKG has 12 leads. These things are rhythm strips, right? The rhythm strips a single two or six leads but to get a full view of the heart, you need 12 leads, you know?

Yes. We went to medical school. We know that. But in terms of, I feel sometimes when we're looking at the overhead And, and figuring out, like, where do we want to spend our money you know, I, I get it. I was there. I opened a DPC practice having no MBA, having no, you know, like I, I, I never thought in medical school that I was going to become a family physician in a DPC model, right?

Like never in my life. And when you talk about the thoroughness of a 12 lead versus something else it's definitely something that I challenge people to think about . We have the ability to identify things before they manifest in symptoms that are making people go to the ER or taking a life.

I reflect on my own experience having a smart heart device in my office. I just love that I have more confidence than if I did not have it in my office. Absolutely. So, one more question in regards to EKGs, because we're talking about, how you have brought board certified cardiologists to the table through the smart heart device. The app is so user friendly, when it comes to a physician who's not a cardiologist who's using the smart heart device to get EKGs for their patients. And they're not sure as to when they should press that button to say like, I want a cardiologist to, to read over my EKG.

What advice would you have for the non cardiology physician if they're using a smart heart and they're like, Is this a reason that I should be, you know, not going to the cath lab, but I need to get a cardiologist who is trained to help me out here? That's a great

question. And you know, remember in medical school when they used to ask us, should we do a spinal tap or not?

And if it crossed your mind, and the old neurologist, the master neurologist in our hospital used to say, if it crossed your mind, you should do one. So I say the same thing with the 12 week. If, if you thought about sending it away for an ovary, send it away. There's a reason that you thought about sending it away.

Over the years, I've had people flown to me in helicopters for normal EKGs, for normal variants of EKGs, and quite the contrary. I've had patients not flown to me for very abnormal, subtle findings of EKGs. the stakes are so high with this, . And if there's, if there's any question especially in females, diabetics previous disease, if it crosses your mind, please send it, you know,

and I think that, again, the ability now to access a board certified cardiologist to read within 15 minutes, your EKG amazing. Just amazing. Thank you.  

Well, thank you so much, Dr. Beto. It's so incredible to hear how your journey into cardiology led to you collaborating with SmartHeart to be able to bring to DPC doctors like myself and Dr. Mutch, who will hear from next the power of the 12 lead EKG.

So with that, I, now I'll turn the mic over to Dr. Much. So Dr. Jake Much has been on the podcast multiple times. For those of you who have not heard him he's been talking about his journey through DPC before he opened year one, year two, and year three.

And so definitely check out the episodes where he's shared his story about his DPC clinic. But in this interview, we're focusing on his role as a DPC doctor who has used the SmartHeart device specifically. So Dr. Matsch, thank you again for joining us on the podcast.

Thanks for having me. This is great. Appreciate it.

So Jake, for those people who have not heard your story, can you just give us a little synopsis about who you are and where your DPC practice is?

Yeah, absolutely. So, Jake much and my wife, Christina and I, we opened up a defiant direct primary care in August of 2020 coming right out of residency, you know, slam dunk in the middle of the pandemic. And we started as a mom and pop shop and we really wanted to emphasize DPC in a micro practice hospitality forward kind of way.

And so a lot of our practice is hinged on making it like many DPCs, making it a better experience actually getting healthcare. So we opened up, we grew for the past couple of years. We started hiring and growing a hospitality. trained team. And then most recently we just brought on another physician.

So lots of big things happening here and and super excited about it.

It's so incredible. And congratulations again on bringing in your third physician to the practice. One thing that you said that really is so pertinent to our talk today is, the option of having a physician take care of a patient where, you know, hospitality is, is the word you use, but also just bringing this feeling to your guys practice that has in part made you so successful that you're bringing accessibility of all sorts to your patients because of the fact that you're a DPC doctor.

And one of those pieces of accessibility is that your patients don't have to get referred down to, you know, the fee for service clinic or get a referral for a cardiologist to then finally get an EKG.

And in your history, this is something that I don't think we've mentioned on the podcast, you have a significant history with being an EKG tech prior to becoming a physician, and your confidence in using EKG technology is definitely different than most of us.

So can you tell us a little bit about your experience there and how you've Incorporated the availability of an EKG device in this case, specifically the smart heart for your patients based on your experience being an EKG tech as well as a physician.

Yeah. Absolutely. So, I started learning or getting excited about EKGs back in I would say exercise phys lab in college.

And this was many, many years ago. And so, this is actually the same lab where I met my wife. And so, we were thinking about medical school, we were becoming interested in kind of, you know, learning more. We ended up you know, doing our little EKGs or what have you in that lab, but not really thinking much of it.

And then we we graduated college and then I landed a job as a dialysis tech, but I was looking to get a variety of clinical experiences. I really wanted to be able to chime in on different perspectives in health care when the time came to be interviewed and so I on my breaks I would actually go off to a diner and I would start reading that, you know, that orange, you know, EKG book.

You know, Dubin's Rapid EKG Interpretation or whatever. Dubin's Rapid EKG! Yeah! And so, I got so interested in this that I broke the book. The bindings started coming apart. I would just go through and try to memorize each page. I started reading about you know, emergency medicine blogs and you know, EKGs, all that stuff.

And so, It got to the point where when an opportunity presented itself at a local hospital I, I was fortunate enough to be able to just walk onto the job. I had a little test and filled it out and he said, yeah, you're good. And so that was nice because then I got to spend, you know, 12 hours a day you know, full time looking at talking to cardiologists and being able to ask them questions and getting that 1 on 1 experience and hearing their answers for what to look for.

And so that was. Absolutely wonderful. And so, flash forward a couple of years to grad school. So just before medical school, I got to work with a Dr. Fabiato and he was the guy who discovered calcium induced calcium release. And so huge cardiology guy in the field. He was actually, he was in the room back when Torsad de Pointe was coined as a term back in 66.

I think it was a medical student at the time. And so I got the chance to not only take his EKG course, but ended up teeing it for him. And so it was a wonderful learning experience for me. It was a wonderful chance to practice teaching as well, and really solidified a lot of my interest in, in EKGs.

And so a lot of fun there. It was A wonderful experience. And you know, while I'm certainly not a cardiologist I, I generally, I do enjoy and find I have a special interest in, in EKGs and, and specifically how they can help patients. So yeah, it's, it's been a wild ride so far, but I find myself very frequently using EKGs in the practice.

I'll put it that way.

So I love that you going into even becoming a physician, you had so much experience reading such an important tool that we need as doctors. I want to ask specifically, why did you choose SmartHeart when you opened your clinic? Because there's, you know, different options for EKGs out there. Yeah,

well, I there, there certainly are and I know we looked around and when we were first starting and you know, going straight into building a practice, we wanted to do something that was flexible, that made sense and so specifically, I wanted to have something that I could use on my phone. I want it to be wireless Bluetooth, something like that. I didn't want to have to have a whole bunch of, you know, reading paper. And one of the big, biggest ones is that I looked at a lot of the stuff that was out there and I was not, you know, that impressed.

And so. I don't know if you guys have experienced this. I feel like it's like with weddings and medical stuff, if you put in those terms plus any noun, like it's just ridiculous. The kind of thing you'll see out there and in terms of price. And so one of the things that was important is that I didn't want to have A 5, 000 cart from 1985, you know, with the sticky leads and all that stuff.

It's just a bad experience altogether. This is the modern age and part of what we can show patients is what modern care looks like, even if it has, you know, an old fashioned or hospitality forward twist to it. And so that was important for our. For us as clinicians in the room, but also as someone owning a business and trying to deliver on a brand and a promise.

And so, I would say that, you know, things like having. Sticky leads where basically you're, you know, ripping off hair from waxing somebody's chest. It's not a comfortable or pleasant thing to go through and people are already feeling exposed. And so we want to make sure that it's as comfortable as possible to be in a doctor's office.

And so that has, has been a huge thing for us and a big part of this and and certainly feel that it's. It's really, really important to have one in the office on day one.

Well, I, I agree because, you know, I, I looked back at the date I purchased my smart heart and it was before I officially opened the doors to the clinic because, you know, for me, as you know, I, opened as a telemedicine home visit model practice only.

And so I definitely needed something that was portable so that I could use it in a patient's home or wherever the patient was. And, when I think about how you and I are similar in that case, I also think about the patients that we must have, incredible stories about that really paint

the reason that having a device like the smart heart is so important in our practices. So can you think about like how you've used it in your practice? That has blown not only patients away, but yours and Christina's, minds away that like you were able to do this for your patients without any hassles and without any stickies.

Yeah, absolutely. So there's, especially when we're starting off, there's always. The list, right? It's the what exactly do I need when I start on day one and without any equivocation whatsoever. An EKG is an absolute must have. It is in my mind, just kind of looking back one of the, you know, there are plenty of things to invest in down the road, but an EKG is, is an EKG.

What I would call a day one problem. And the reason is because you never know what's coming in the door. And there are some things where you, you really don't want it to wait and you really want to be right. So, just as an example I, you know, of course, let me put this out here. I have nothing to financially disclose, no relationship with smart heart.

I just love their stuff. And so, after the. birth of my first child. This is in 2021. I was covering for my wife who's, you know, in practice with me. And so, I got a call from an elderly patient and this was on a late afternoon. And you know, there was just kind of a vague history of the phone, some questionable fatigue, you know, some symptoms that were very nonspecific.

So I said, you know, let's, let's just get you in. We'll take a look. And so I saw her that day and she looked okay. But her vitals were just like a little borderline you know, not quite a hundred percent. And so I said, you know what, let's, let's just get an EKG. And and we, so we get the whole thing on her.

We, you know, strap it on real quick. And, you know, it basically connects up very very easily. And yeah, and, and sure enough, when we got the EKG, I'm sitting there. looking for the interpretation comes up on my phone. And you know, sure enough in the those early pre cordial leads of you want to be to she's got what looks like byphasic T waves.

And I say, Oh, that's, that's not so good. And, and so I say to her, you know, I know we're. In the middle of COVID and but I really think that you need to go to the hospital for this one because I, I'm afraid that this might be something called Wellen's syndrome. And you know, this kind of suggests you know, an impending LAD occlusion.

And so I was During this whole conversation, I'm sitting with her, I'm kind of like wringing my hands a little bit because, you know, I'm, I'm going to send this poor old lady in the, you know, the middle of a pandemic over to the the epicenter of COVID in our area and just hope that it's really worth the risk based on one line that I read from a slide, you know, in a medical textbook 10 years ago, like really trying to assess the risk here of what's most important.

And so, you know, I, I called the physician at the, the ed told her, you know, told him, Hey, here's, what's coming up. I'm sending her over and and they begin the workup. And so, the tropes were negative, the EKG looked a little bit better, but they agreed that something just didn't quite look right.

And so they actually ended up getting a, a CTA on her. And sure enough she had bilateral PEs sitting right there. And so what Look like Wellen's syndrome in retrospect was actually something called pseudo Wellen's syndrome, which was portending a DVT PE. And so, that, you know, this was a late afternoon.

We weren't getting into a cardiologist's office, anything like that and having the EKG on hand made a huge difference because it completely changed her management at the point of care. And so I would have I mean, it would have been great to have an overread. At, at that point as well to add some confidence in this.

But at that point it was a matter of being able to just look at it and, and kinda go with my, my gut here and, and try to do what's right. But there was, there was a question in my mind and so, I am very, very glad to have had the the EKG on hand because everything else was kind of wishy-washy and it really helped at least make sure that she got definitive care in the correct place.

So, I'm very, you know, grateful for having a, a smart heart in the

office. I know that, you know, we talk all the time on the podcast about what do you really need to open your clinic? And technically, yes, like you only need your abilities as a physician to open up your DBC. However, with regards to tools, I totally agree that. The reason to have an EKG is unlimited, and there are so many use cases where you can roll in or you can roll out because you have the device in your hands at the moment you need it.

You know, I just, I get, I get very moved when I hear that because You know, if she hadn't had anything like I had a person who was very concerned that she was having a cardiac event, went to her house, did an EKG on my smart heart was able to look up her EKG in comparison to her old EKG right there on my app on the same screen.

I wasn't going between screens. And I was able to say look I'm going to provide you with reassurance versus sending you for an unnecessary visit to the ER, especially when you talk about your patient during COVID times and especially an older patient. You know, I remember, and we all do those stories about people who were terrified, like they would rather die at home than risk going to the hospital for COVID.

Now, when you talk about you wish you would have had an overrate at the time you know, hearing what Dr.

Beto had shared that is a thing now, like 24, seven, you can have a cardiologist do an overread of your EKG through the smart heart device. Bring us to, Jake Much who was not yet a physician in those early days when you were learning about EKGs and, and doing them and, and having, something like this device available to you now as a physician, can you just reflect on, , In a bird's eye view about like how important it is to have a backup available if needed.

If you don't have the confidence that you do because you've done so many EKG reads even before opening DPC.

Yeah, I, I think that it is extremely helpful. And whether one of the, what are the kind of exciting things that I like about DPC is that it's changing the relationship that we have with our specialists and with our technology and in turn with our patients.

So that is to say that it's The, the ways, whether it's from, you know, electronic consults through EMRs or through other services, we can now get answers for our patients a lot quicker than what they are used to. And so, for some people, that's hey, I don't know if this is an abscess or if it's just cellulitis, let me put an ultrasound on it, see what happens.

You know, I don't know if this is cancer, let me put a dermatoscope on it, see what happens. And now we have that ability. With an EKG as well, too. It's, it's not some sort of, you know, crazy large cart with a whole bunch of things and maybe you have one in the office and maybe you don't. It's, you know, this is another quick thing that I can just pull out of the drawer and we can slap on and we'll, we'll know very quickly what's going on.

And so that is it. It's extremely helpful and it also serves as, you know, we all go through medicine. We're all, you know, this is, it's a, it's art as a science, the practice, like we're all growing as, as learners, as teachers. And so it's really nice to be able to use the knowledge and use the expertise. of people around the world you know, of people who are around our area as well, who are world class, you know, having a world class cardiologist in your pocket is a wonderful thing to have, or being able to, you know, talk to a dermatologist because your patients get that benefit too.

And so it's nice because there's this collegial atmosphere where you can Get additional learning points and you can continue to grow as a clinician. And I think that that's extremely meaningful in your, in your patients get to benefit from it too. So, so yes, whether regardless of what modality is being used and in particular, I would say certainly the smart heart, it's really nice that you can lean on your colleagues a little bit and be able to get that extra push in the right direction.

It's fantastic.

When we talk about DPC and those people who are like, well, but you know, it's, it's an extra fee, you know, beyond insurance. I know you and I have patients who are like, yeah, but because they have a DPC doctor who has the ability to talk to cardiologists, dermatologists, whatever it is, or like whip out their smart heart or whip out their point of care ultrasound.

I didn't have to wait six months and, you know, have syncopal episodes in the meantime or let this cancer of mine grow on my skin, you know, it's like they were able to diagnose it and treat it right away. I mean, like I had a patient who had a hematoma that eventually went to you know, infection, opening up the entire skin down to her on the leg, down to the ankle, multiple surgeries.

And it's If you had had a DPC doctor, one option could have been evacuating that hematoma right away and compressing it and not having all of those complications. So, you know, when we think about how useful, again, identification of acute cardiovascular diseases, it affects every single person in this country, whether it be today or tomorrow, you know, or down the road.

Now I want to go into the technical aspect of your practice like and how you and Christine and your new physician use the device in terms of you mentioned, you know, there's no stickies, there's no paper, there's no, I ran out of paper issues, you know, there's no Oh, gosh, it's not.

It hasn't been plugged in. Like I can't, I can't use it. There's none of those issues from the past. So when you have the device in your in your clinic, what's the workflow that you have for your device in terms of you know, can you just walk us through for those people who are like, Whoa, I didn't even know that smart heart exists.

Like, how do you, you know? Prep to use EKG, any tips and tools from a DPC doctor's perspective as to how to actively use the smart heart in your clinic. Yeah,

absolutely. So if we're in the middle of a patient encounter, and I think we've all, you know, had that experience where, you know, an incidental chest pain disclosure comes out, or, you know, somebody says, Hey, I've got these types of symptoms.

What do you make of that? Then we say, okay, let's definitely take a look. And so we wrap up the first part of the visit or whatever we were covering, you know, it may have been, You know, several different problems, but we say, you know what we've got a preliminary plan here, but I would like to get an EKG today for you, if you don't mind.

And so they say, if they say yes, that's perfect. And so we take them. My assistant is in the room. She's describing the encounters with us. And what she does is she takes them into the adjacent procedure room and starts running the water to get it from cold to, you know, body temperature warm.

And so in the meantime, she'll give them like a nice robe as well. And so have them change into it. And so it will by that time the you know, the water will be warm and she'll pull out the EKG case, which is about the size of a small violin case, something like that, probably a little bit smaller.

And so, she opens that up and kind of turns it on. There's this little iron man button that you push in the middle and things turn blue. And so, she gets that ready and then opens up the the app. And so with that, she gives the patient instructions on, on how to push that. And if they need assistance, she's certainly there for them, but basically it's like one of those you can remember the, I guess.

Endurance or marathon athletes with heart monitors. It kind of looks like that. There's a, this cube that goes in the, in the front, this little flat panel, and then around is an elastic band that hooks into the other side. And then in addition to that, there's there's a specific wire, just a few of them, but instead of being attached via stickies, instead, it's a metal that's kind of held and clamped under the arm and under the left waistband.

And so that gives you the whole lead system, both pre cordially as well as in the clock face plane. And so, Once we get that ready and they've got, we kind of wet the area with that water that's running. We use like a gauze and put it onto the patient's skin and on the metal leads. And you know, we secure that around them, kind of tighten it up just a little bit and then run the app.

And there's an ability to test the lead connections to make sure that you're getting a you know, there's not a whole lot of interference going on and you can get a prelim EKG read. And so, just to make sure that, that there isn't too much artifact. And so we run that and then. My assistant knows how to troubleshoot that and kind of move things around because you know where the leads are and once she's got a good one, she'll put record and then show me on her phone or on a laptop what those readings look like and I say, Yep, that's a good one.

We can go ahead and use that and then she'll download or she'll upload that into the chart, which I'll then. Take a look at a little bit more detail and then I will go into the procedure room with the patient or I'll have them join me back in the office, in which case I'll talk to them about what each of the leads meet and what we can conclude from that and how that changes what the workup shall be.

So it's a, it's a fairly streamlined process and then literally they can just. Unhook by opening their, their arms, unhooking the the right side of that chest monitor and then placing it, you know, right on the exam table. And then we go back and, and kind of take care of the rest of that for them.

So, super, super simple again, we're not pulling off leads and, you know, having to do anything with their, their chest at all. It's it's very straightforward. It's not very intrusive. And it's, it allows us to get a really reliable, quick read very very smoothly. So love it.

Yeah, I'm here shaking my head as I'm sure listeners are with regards to like, how many faxes have we got that have been faxed or copied or whatever and we're like, what does that actually say?

I can't read that because it's so grainy or you know, whatever it is and it's you know, the ability to have a digital version that you can zoom in on. text to a person on a HIPAA compliant text, texting platform, put in an EMR so that, you know, a patient can say Oh, that's, that's fine. If you didn't get the facts from my doctor, do you want the CKG that I just opened up in my patient portal or whatever it is like, there's so many use cases for that.

And. Reflecting on the time from when the smart heart is on to the end, how long does that process take for you guys in terms of going from like they're already positioned to getting the full EKG done?

Yeah. Assuming that there's no having to reposition because every now and then something like that just just happens logistically.

But I would say that that's rare and oftentimes we're talking in, you know, I would say if I had to ballpark it somewhere in the two to three minute mark, like really to, to bring somebody back to have them. And the thing that takes the most time is, is having them like disrobe and give them the instructions when you actually put it on their chest, wrap it around, put everything, you know, armpit, armpit, waist, and then.

Run it. I mean, that, that takes. seconds when you're, when you're smoothing, you know what you're doing. So it's a, it's a very smooth operation.

With that, thank you so much, Dr. Mutch and Dr. Beto for joining us today.

It was great. Really appreciate the opportunity.


for having. So if after hearing what Dr. Much has shared and Dr. Beto has shared, you're interested in getting the smart heart for your office, definitely check out the link in the show notes and register for the prospective users course that's coming December 13th.

Not only can you access the 99 per month pricing, but you'll also get the enrollment fee waived for your smart heart device. .

  So join me and the SmartHeart team virtually on December 13th, 9 a. m. Pacific, for a Prospective Users course to learn even more about what SmartHeart can do for you and your patients. I'll be there to answer questions at the end of the presentation. When you attend the Prospective Users course, you'll get your onboarding fee waived.

Sign up today at SmartHeartPro. com or check out the link in the show notes. Hope to see you there!

*generated by AI, so please excuse errors.

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