The Butterfly Effect: How the Handheld Ultrasound Is Transforming Care Globally

Q&A with Butterfly Network Chief Medical Officer, Dr. John Martin

Disruptive innovation is making waves in the Massachusetts medtech industry. The space is made up of a robust community of innovators who believe in collaboration and collective success in order to improve the lives of patients everywhere. At the rate technology continues to change, it’s important to understand how companies within the medtech field are adapting and evolving advanced technology to enable the practice of better medicine. One such company is Butterfly Network, Inc., a transformational digital health company whose mission is to create access to valuable clinical insights using innovative ultrasound technology, made simple with artificial intelligence, to benefit all patients worldwide. Butterfly developed the world’s first and only single-probe, whole-body handheld device, powered by Ultrasound-on-Chip™technology, making medical imaging more accessible and affordable.

It may be hard to believe, but two thirds of the world has no access to imaging, yet 80% of diagnostic dilemmas can be solved with it. This is where handheld point-of-care ultrasound (POCUS) comes into play. Over the last 12 months, Butterfly has seen substantial uptick achieving adoption globally across key segments including among clinicians, medical schools, hospitals and veterinarians – from populated cities to rural, underserved communities. Like many other digital health companies, Butterfly is constantly evolving technologically to improve patient care, so we caught up with Dr. John Martin, Butterfly Network’s Chief Medical Officer to discuss the world of medtech, how Butterfly continues to innovate and more.

To begin, can you tell us about your personal experience with Butterfly?

For me, point-of-care ultrasound is personal. While working with the Butterfly team to get FDA clearance of our device, I noticed a bit of swelling under the angle of my mandible and initially didn’t think anything of it. I realized that I had an entire imaging system sitting in my hand and thought, why don’t I take a closer look? Lo and behold, I found a very large mass. I immediately sent the images to a friend who is an ENT surgeon and found out quickly that I had a tumor in the back of my throat. I had discovered a metastatic cancer with our device, which makes me patient number one. Through all the treatments and surgeries, I began to understand the importance of time. Butterfly accelerated the time between, “what’s wrong with me?” or “I’m sick” and “I’m on the road to recovery” – for that I am grateful.

Let’s talk medtech. How does being in this industry inspire you and your work at Butterfly?

There is incredible transformation happening in the medtech industry and we are proud to be a part of the fast-paced, innovative community in Massachusetts. The collaboration we have between our technology-focused experts (those across product, hardware, software, design) and medical experts has allowed Butterfly to create a product that can transform care, enabling better decision-making at the bedside and driving to better outcomes. At Butterfly, we are unified by a belief that our probe and integrated ultrasound platform will dramatically elevate care across use cases and care continuums, and we are investing heavily in our people and product development to meaningfully deliver upon this belief and our first mover advantage. And of course, AI plays a key role in our technological advancements, offering guidance and statistics from a vast database of cloud-based medical information—leading to the ease of ultrasound image capture and image interpretation.

At the moment, our ultrasound device is still required to be used by trained healthcare practitioners, but we are working on a roadmap to make it easier for all skill levels to use the device. This will enable and empower, for example, patients with chronic conditions to overtime scan themselves and monitor their condition from the comfort of their home to reduce emergency room visits and hospitalizations as well as improve their quality of life.

Could you give us the brief evolution of medical imaging and how you see it further evolving in the future?

Medical imaging is rapidly changing the way healthcare practitioners deliver care globally. Ultrasound is now used to inform clinical decisions sooner, and this makes way for better decision-making, while increasing access and significantly reducing patient-care costs. If you look back in time, the global ultrasound market has been dominated by traditional cart-based devices. These devices are accessible only to highly specialized, highly trained technicians and are located predominantly in hospitals, imaging centers, and physicians’ offices and cost anywhere between $45,000 to $60,000. Many healthcare institutions throughout the world lack the facilities and capital necessary to buy and maintain such expensive, cart-based ultrasound and simply can’t afford the highly trained individuals required to operate them. Plus, these ultrasounds are made with piezoelectric crystals, which requires different probes to create different frequencies and shapes to scan different parts of the body.

More recently, we have seen the introduction of POCUS and handheld devices, which are much more portable, affordable as well as intuitive. The use of POCUS has been shown to significantly reduce patient imaging costs, including expensive diagnostic tests such as echos, Chest CT and traditional abdominal ultrasounds. As mentioned above, Butterfly had gone beyond this, and put ultrasound on a chip, enabling the practical application of ultrasound information into the clinical workflow. By putting it on a chip, we were able to scan the entire body with a single probe and create linear phased and curved array probes, and a whole range of frequencies. The opportunities for medical imaging in the future are exciting, and we’ll continue to work to make the ultrasound as ubiquitous as the stethoscope across all specialties, species, and care settings.

Can you speak to the importance of time in a healthcare setting as it relates to Butterfly?

In many care decisions, time is of the essence, and having the ability to drastically reduce the time it takes to make a better clinical decision is critical. Traditionally, the healthcare system followed the path of ‘history, physical, pause,’ and thereafter a clinician decides whether a patient should get imaging. This involves long periods of waiting, sometimes weeks at a time, leading to heightened anxiety and frustration.

Putting a handheld ultrasound device in the hand or pocket of every clinician at the initial assessment enables a faster diagnosis and clinical decision, shortening the wait time for patients, and improving the patient/doctor relationship. Our cloud technology also securely captures, transports, and stores diagnostics from clinicians even hundreds of miles away, so POCUS can easily deliver key imaging data to existing infrastructures housing patient data, enabling more thorough analysis across stakeholders.

If a physician is contemplating what exactly is wrong, approximately 80% of the time, simple imaging can answer the question. Consider these questions: Do you have kidney stones? Do you have congestive heart failure? Do you have gallstones? Are you pregnant? Those simple decisions can be answered with a handheld ultrasound device at the time you have that first physical examination. Care teams can now transition to ‘history, physical, Butterfly exam’ to provide the right information, make better decisions and provide rapid care.

There is so much information and data available today. How can Butterfly hone this data with the use of AI to make a real impact on patients?

The work we are doing with AI is remarkable. At Butterfly, we think about AI in a couple of ways. First, we want medical imaging to be broadly available and valuable, and to ensure this is possible, we need people to be able to learn how to facilitate a scan and interpret the scan to make better decisions. Ultrasound training has historically been intimidating. With AI, however, we can now drive the expertise into the probe and application itself. The AI drives ultrasound simplicity, allowing the journey to ultrasound competence to be shorter than usual.

With the infinite amount of data available today, it’s important to ask the question, what piece of information can guide my clinical decision now in order to know how to proceed? Artificial intelligence is and will continue to be an integral part of this process. Take congestive heart failure for example: there are 550,000 congestive heart failure patients diagnosed each year. If patients can assess their status at home via AI-guided lung scans with their clinician or care team remotely, they can often avoid unnecessary and costly hospital visits. This will provide patients with more timely intervention, improve quality of care, and their quality of life.

Just last year we entered into a strategic partnership with Caption Health to implement Caption AI, AI-guided ultrasound software to enhance cardiac assessment by improving the ease of image capture and image interpretation in a variety of care settings including the hospital, clinic, and home. We are continuing to improve our software by harnessing AI with a goal to drive ease-of-use for image acquisition, improve analysis, guide and educate practitioners, and provide quality control.

At the start, you mentioned a commitment to create access to valuable clinical insights using innovative ultrasound technology. To close out, can you speak to Butterfly’s work in the area of global health equity?

At Butterfly, we’ve made great strides in improving worldwide access to medical imaging and thus advancing our work in global health equity across communities in the US and abroad. We continue to work towards improving the quality of care and eliminating the inequality of care as you look across healthcare systems.

Many places in the world, especially low- and middle-income countries, are diagnostic deserts, leaving practitioners with virtually no imaging capabilities to aid in the diagnosis and treatment of patients. Improving worldwide access to medical imaging can transform care and improve clinical outcomes. Our TeleGuidance capabilities allows an experienced sonographer to remotely guide and train less-experienced clinicians from anywhere in the world. Innovators are bringing transformative care and disruptive technology like this to the most remote villages and rural, underserved communities, to improve healthcare outcomes. Midwives with no prior training in sonography, for example, armed with a pocket-sized Butterfly probe and a smartphone can assess gestational age as accurately as a certified sonographer using an expensive machine. This has the potential to revolutionize the delivery of obstetric care in low-resourced settings around the world.

Outside of our core commercial geographies, Butterfly iQ+ is also being utilized in over 70 low resource settings around the world, where we have partnerships with non-governmental organizations like the Bill & Melinda Gates Foundation to deliver our technology to underserved communities. Currently, we have over 100 NGOs and global health partnerships in place with organizations that align with our mission to improve the quality of care while reducing disparities in care around the world.