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Steve and Dr. Tatiana
Episode 21: Revolutionizing Patient Care with Point of Care Ultrasound with Dr. Tatiana Havryliuk
January 25, 2025

In this episode of the Concierge Medical Marketing Podcast, host Steven Schwartz interviews Dr. Tatiana Havryliuk, an emergency physician and founder of Hello Sono. They discuss the transformative role of point of care ultrasound (POCUS) in enhancing patient care, the evolution of ultrasound technology, and the benefits of concierge medicine and direct primary care (DPC). Dr. Havryliuk shares her journey, innovative uses of ultrasound, and real-life stories from her medical practice, emphasizing the importance of building relationships in healthcare and the future of patient-centered care.

Dr. Havryliuk is an emergency physician, formerly ultrasound director at the Brooklyn Hospital, and founder of Hello Sono. She completed residency and Ultrasound Fellowship at Mt. Sinai in New York as well as a Wilderness Medicine fellowship at the University of Colorado. Throughout her 15 years of clinical practice, she has relied on point-of-care ultrasound (POCUS) to make informed clinical decisions whether it was in an urban ED, urgent care, or Everest Base Camp.

Dr. Havryliuk is now on a mission to extend the benefits of POCUS to primary care and urgent care practices by addressing the key barriers: lack of POCUS competency and operational readiness. She and her team at HelloSono offer POCUS training and support with credentialing and implementation to build high-quality, compliant, and profitable POCUS programs.

Steven Schwartz (00:24)
Hello and welcome to the Concierge Medical Marketing Podcast. My name is Steve Schwartz and I’m your host. And today it’s truly a privilege of mine to introduce our guest, Dr. Tatiana Havryliuk. Tatiana, did I say your name right?

Dr. Havryliuk, Hello Sono (00:37)
pretty close. Have a look.

Steven Schwartz (00:39)
So close. Say it one more time for the listeners, please.

Dr. Havryliuk, Hello Sono (00:42)
Tatiana, Havryliuk .

Steven Schwartz (00:44)
Havryliuk Okay, wonderful. Thank you for clarifying. I don’t mean to butcher names. My last name is Schwartz and whenever I mentioned to people, they often say, like the Spaceballs movie. So that’s about cultured as I get. It’s truly my pleasure to have you here on the podcast today. Your company is Hello Sono. Can you first tell us a little bit about yourself, your medical training and…

kind of your story and then how that leads up to where we are today with Hello, Sono.

Dr. Havryliuk, Hello Sono (01:15)
Yeah, of course. And I am super grateful to be here on the podcast with you talking about what I love. That is being point of care ultrasound, not myself, but I will start with myself. I am an emergency physician. I’ve been in practice for about 15 years. I’ve been using point of care ultrasounds all this time, and it has made me a better clinician.

I also have fellowship training in ultrasound and I used to be an ultrasound program director for an emergency medicine residency program at the Brooklyn Hospital in New York. So ultrasound is really my passion and it has touched so many different patients and helped me.

make better clinical decisions. And that’s why I started Hello Sono about two years ago, really with a mission of bringing this amazing tool into outpatient space.

So really helping clinicians figure out, you know, what do you need for compliance? For example, if you medical legal compliance, billing compliance, and also what kind of standards do you need to achieve in terms of your education to be able to make, to do diagnostic ultrasound? So that’s really the point. So what we do is it’s basically a consulting service and education service to ease the adaptation of this tool.

Steven Schwartz (02:44)
Nice. And you told me previously before we started recording that your company does not manufacture sonogram devices themselves, but you can make recommendations, correct?

Dr. Havryliuk, Hello Sono (02:57)
Exactly. Yes. So part of our service is help providers navigate what’s out there because it’s actually super exciting world in the last five years or so there has been just a ton of handheld devices that came out that are a lot more affordable and are super exciting. But it’s also hard to tell, you know, which one is the better device, which one would work for specific applications you have in mind to be using it for.

Steven Schwartz (03:25)
And would you say that a device that you use in the emergency room on a daily basis is the same device you’d recommend to a concierge or direct primary care physician or perhaps recommend something different?

Dr. Havryliuk, Hello Sono (03:38)
I would recommend something different. I mean, in the ER, we traditionally have been using card-based systems that are a lot less affordable, I would say. And now with the handheld devices, it’s something very portable. can bring, if you’re a concierge doc or you’re doing any home visits, you can bring with you, which is amazing. It fits in your pocket. And it also…

is not as costly, so they’re definitely a big difference.

Steven Schwartz (04:07)
You had also mentioned previously that the ultrasound, you typically think from the medical shows, know, there’s free flowing fluid in the abdomen. Let’s get them into surgery right now. This kind of thing that we see on these TV shows all the time. But what are other areas that people don’t typically think about where the sonogram could be used on the human body effectively?

Dr. Havryliuk, Hello Sono (04:31)
yeah, there’s so much. mean, lung is definitely one of my favorites, followed probably by ocular ultrasounds. So anyone who has vision loss or blurry vision or maybe something got into their eye, you can actually look for bleeding behind.

kind of the lens of the eye, or you can look for detachment of the retina with ultrasound and actually diagnose it. You can look for foreign bodies in the eye, so pretty exciting. And then musculoskeletal ultrasound, it’s getting really big. It has become really big, and there are so many different applications for it as well.

Steven Schwartz (05:10)
think I had heard a while back about using or having a person has a stroke and then they can somehow see that in the back of the eye. Is that correct? Or am I hearing that wrong?

Dr. Havryliuk, Hello Sono (05:23)
You can see in the back of the eye what you can see is increased pressure kind of in the brain. So that could be a correlation. But what you can do with stroke patients, you can actually look at the blood flow and the vessels of the brain through here, through like external, just like the little space you have in your temple and you can see a clot. So there is a big clot, you can actually see it.

Steven Schwartz (05:48)
And this is right there at bedside. They don’t need to go in some huge machine down the hall and up two floors, right?

Dr. Havryliuk, Hello Sono (05:56)
Exactly, you can do it at the bedside. I mean, it’s still pretty innovative and not the standard of care. You would still be getting CAT scans on the patients to make the final decision on whether they need thermobalytics, et cetera.

Steven Schwartz (06:13)
Right, but for a triage situation in the emergency room, you can use the handheld device and very quickly be, I’d say, 90 plus percent sure that that’s our problem and now we have a much better direction to go on. Is that safe to say?

Dr. Havryliuk, Hello Sono (06:27)
I

don’t know whether I would do that in the stroke patient necessarily, just because there are protocols already in the hospitals, know, kind of like code stroke type of thing where they will clear out a CAT scan and you get a CAT scan almost instantaneously to make a decision and that would give you more information. But that being said, yeah, if you were a little bit stuck or had delays, ultrasound would be one of the ways to do it.

Steven Schwartz (06:53)
So I love stories. I know that people remember stories so much better. Do you have a story or two that you can share with our listeners about how you have used a Sonogram device and had some great outcome, or you thought it was one thing, you found out it was another? Do you have some story like that that you could share?

Dr. Havryliuk, Hello Sono (07:16)
Yeah, there are a few stories. I told you long ultrasound is one of my favorites. So actually in my former life, I did quite a bit of wilderness medicine and I ended up spending a whole…

three months at Everest Base Camp in Nepal at 17,000 feet, being a volunteer physician there. So we actually had POCAs there, and that was our only kind of diagnostic imaging available. And as you can imagine, you see all kinds of things there, but most of them were related to high altitude. So you can get really sick, you can have…

pulmonary edema from high altitude, you can have cerebral edema. So I actually had a patient there who had kind of undifferentiated shortness of breath. And I was like, I’m sure this is just high altitude pulmonary edema, but I’m going to take a look with ultrasound anyway. And when I did the ultrasound, I didn’t actually see the fluid that I was expecting to see. And it was also…

a patient who flew a long way from Europe to get there. And basically we ended up getting him down to get a CAT scan eventually. And he was diagnosed with pulmonary embolism, which the treatment is vastly different, right? How do you treat altitude pulmonary edema versus how do you treat a PE? So that was like a big case where ultrasound really…

changed what I was thinking completely. You know, and that happens all the time in the ER for sure, or some of my favorites is looking for foreign bodies as well, especially the ones you can’t see with x-rays.

Steven Schwartz (09:00)
The story about working at Everest Base Camp blows my mind. Just what an amazing adventure for you. Did you did you personally end up climbing Everest as well or you just stay at base camp taking care of sick people?

Dr. Havryliuk, Hello Sono (09:10)
Yeah, it was…

I didn’t get to climb Everest. I did get to climb some nearby peaks including Lobuche East, which is still like a 20,000 foot peak. So it was still pretty high up. But yeah, we were actually not allowed to climb Everest because they needed the medical team to be at the base camp taking care of patients. But yeah, it was a wild experience. I learned a ton, got to meet a ton of interesting people as well.

Steven Schwartz (09:26)
Huge.

I’ve heard it’s like a party atmosphere at the base. People are all pumped and so excited about doing it. Is that true or is that just the movies?

Dr. Havryliuk, Hello Sono (09:53)
yes and no. There were some big parties surprisingly. I mean, there are about 2,000 people there at the base camp living on the glacier during the climbing season. So there’s just a ton of people there. I mean, my priority was to figure out where I can get a Kit Kat because not all camps had like good supplies of snacks. So I had, so yeah, so I was just looking for the best candy.

Steven Schwartz (10:15)
Yes, gotta have the best candy, right?

That’s another thing you and I have in common. Whenever it’s Halloween season rolls around, I tell my kids, what are the rules? Dad, we have to give you all of our KitKat and Twix. That’s right. Usually, I get a couple out of it, so that’s a good deal. Cool. Any other stories or anecdotes you’d like to share with our audience about HelloSano and perhaps how you’ve helped different concierge or DPC practices with your service?

or perhaps how it can bring extra value and benefit to them and their practice as well as their patients care.

Dr. Havryliuk, Hello Sono (10:55)
Yeah, I mean, I would love to share some kind of evidence and statistics that are out there in terms of how ultrasound can benefit patients. And really, there’s a ton. One of the things I invite you to think about is the patient experience, right? So patients are using technology right now, and they love it when their providers are using technology. So, you know,

whipping out a part of Carol ultrasound and instead of a status scope and being like, hey, I’m going to actually look at your lung and show it to you. And we are both going to see that there is an ammonia there or there is not an ammonia. It just makes such a big difference. And there have been studies in primary care showing that provide that patients who got Pocus basically reported improved level of service. 95 % of them said that.

And then 65 % of them said that they trusted their physicians more because Pocus was performed. So there’s just this benefit that maybe is not directly clinical, but I think there is huge in terms of adding value to your patient and building that relationship with them. When thinking about concierge and TPC practices,

Most of the time it’s membership based, but I have worked and talked to various providers and sometimes they choose to

maybe charge a fee for additional services like POCUS, so that would be an opportunity to bring additional revenue for those of you who are looking to do that, versus you’re just bringing extra value for your patients. And that justifies having potentially slightly higher monthly subscription costs. So.

Kind of that’s one thing. And then in terms of clinical use, I mean, I think there’s just so much. Either it’s diagnosing pneumonia and avoiding sending people, pay your patients for x-rays, diagnosing a blood clot or ruling out a blood clot and not having the person go to the emergency department on a Friday night and waiting around for seven hours to get that figured out.

and musculoskeletal imaging. I mean, can go on and on and on, but there are just so many use cases in outpatient settings that are really amazing and make a really big difference.

Steven Schwartz (13:31)
It’s funny that as an emergency room physician, almost like encouraging people to not come to the emergency room for so many things that could be handled with a triage elsewhere, easier, quicker, and obviously a lot less cost. It’s unfortunate. So many people with traditional fee for service insurance plans literally don’t want to go to the emergency room because you know you’re going to

It’s going to be at least a thousand or $1,500, whether it’s a five minute actually seeing somebody, even if you’ve sat around for four hours. it’s nothing to not try to talk badly about emergency departments because obviously they need to be there and they do a fantastic job. as a consumer, the last thing we want to do is go to the emergency room if we don’t have to. Right.

Dr. Havryliuk, Hello Sono (14:24)
I would hope so. I don’t know. I don’t know personally a single person who would want to go to the ER if they don’t need to go there. I mean, there are certain patients I’ve encountered that seem to like going there, but I don’t know anyone personally. Yeah.

Steven Schwartz (14:37)
Yeah. But sometimes it’s your last, it’s

your last choice. It’s your last option, you know, like my about a year ago, I had a migraine that came on from a tight neck and the headache and then and then migraine symptoms and then throwing up so bad that I couldn’t stop. I mean, it was horrific. And by throwing up so much, I literally made a herniated disc in my back worse.

And like a week or two later, I had a surgery to correct the herniated disc. So that was the last time I went to the emergency room and it was, you know, in the evening, I had no choice. But man, what an awful situation. But I’m glad that the ER was there to take care of me for for that emergency.

Dr. Havryliuk, Hello Sono (15:25)
That’s a very proper way to use ER in your case. I’m sorry that happened to you. Yeah, I mean, I think ERs need to see higher acuity patients and the more we can do in the outpatient setting, the better it is for the patients that really have.

acute issues that need to be addressed right away. There’s just less of the waiting time. If there are less patients going to the ER, the throughput improves if you weed out the lower acuity patients.

Steven Schwartz (16:01)
Sure. And I think there’s a situation where people on the lower socioeconomic end of the spectrum don’t have insurance and they have the, I guess, encouraged, it’s like, well, you can’t afford insurance, don’t have any, so go to the emergency room for every sniffle or hiccup. And that’s unfortunate. And it slows everything down for people that have really acute issues.

And as I speak with DPC physicians, whose monthly membership, you know, very low. mean, I talked to somebody earlier today and their monthly fee is $80 a month for an adult. And that’s, you know, 24 hour access through email and through phone and telemedicine and the whole deal. I’m like, you know, jeesh, below $80 a month or 20 bucks a week on

coffee or going out to eat a couple of times. And if more people as consumers adopted the DPC model for their own personal primary care, I think that would go a long way to relieving the emergency departments of the overflow. Would you agree?

Dr. Havryliuk, Hello Sono (17:16)
Yeah, I mean, I think a lot of patients just don’t realize that they have access to DPC doctors. I think there’s an automatic, this is concierge medicine. This is for rich people. And that’s where it stops. And yeah, like I think financially it makes sense to especially if you’re in a high deductible plan.

each time you go see any medical provider, you have a copay and you have to mean you’re deductible, right? So it’s like, my God, why am I even paying for this insurance, right? If I still keep paying out of pocket. So it just makes so much more sense to be part of a DPC practice.

Steven Schwartz (17:59)
I think I’d like to look more into options for health insurance for truly catastrophic situations and not have any primary care as part of that plan at all. It’s like, I don’t need it because I’ve got my DPC or my concierge doctor who I have a real relationship with and they know me and if something more urgent comes up, they’re helping me navigate that. And that’s one of things I love about the more personal care.

a touch of a DPC or concierge arrangement.

Dr. Havryliuk, Hello Sono (18:33)
You know, I actually, this reminded me that I was talking to someone and he said it’s so hard for him to make an appointment with his primary care doctor. And every time there is something that comes up, she never has time to address it. So she’ll just send him somewhere else. You know, like, just go see the specialist, go do this and this. But he actually transferred his care to an urgent care.

He’s like, the urgent care knows me better than my primary care doctor. And he’s like the perfect person to be, you know, to have a DPC physician. I’ll reach back out to him and let him know that might be the better way.

Steven Schwartz (19:04)
Ouch. Ouch, that hurts.

I would agree.

You know, it’s funny that you mentioned

that because I had that same experience before with a doctor I had a few years ago and, you know, going in for my yearly checkup, well physical, he’d literally spend a half an hour, 45 minutes with me. I was really kind of impressed. Like, wow, he’s really taking the time to do this. I really dig in and we’re really talking, you know, did the miscellaneous tests and blood work before it was just, a great deal. but then during the course of the year, if something came up and said, well, we can’t really see you for, you know, a couple of weeks.

It’s like, I’ve got to migrate. I need help right now. Yeah, go to an urgent care. And it’s like, But that’s what I had to do. And it’s funny is that at some point, his wife, who is also a primary care doctor, left that practice, started her own concierge practice, got full nice and quick with her panel.

Dr. Havryliuk, Hello Sono (19:55)
Yeah, I mean our…

Steven Schwartz (20:13)
And then a couple of years later, he joined his wife in her practice. And so now they’re both focused on Concierge DPC style and doing great. More time per patient and less visitors per day.

Dr. Havryliuk, Hello Sono (20:30)
Yeah, that’s amazing. you know, when you do have more time per patient, that’s also an opportunity to do POCUS. So one of the kind of pushbacks I get from primary care physicians that are trapped and just seeing as many patients as possible per hour is their question is like, well, how can I fit in POCUS? It seems like even like taking two to five extra minutes to do it is too much.

Steven Schwartz (20:31)
Happy.

Dr. Havryliuk, Hello Sono (20:57)
And it just blows my mind. was like, but you can literally see their pneumonia and tell them and not need to go to order a chest x-ray. And it’s just like, doesn’t fit into their, like the way it’s structured right now. So I think for TPC docs, it’s really a perfect tool.

Steven Schwartz (21:17)
I think we’re in the midst of truly a trend of revolutionizing American health care, at least our country to start with, that there truly is a better way to do this. And people just need to be educated on it because once they’re educated on it, they can shift some money around and say, you know what, I spend $150 a month to get my grass mowed or for my pool being cleaned.

Wouldn’t I be willing to spend $80 per month or $200 or whatever per month for my health, my wellness, you know, and making sure my diet is correct based on my health issues. And one physician I spoke with at the Concierge Medical Forum a couple of months ago, she said, at our practice, we haven’t had a patient with a single heart attack.

And why is that? Because we did all the proper testing and whatnot on the intake with these two and three hour intake appointments that anybody who had any potential for heart attack was handled with medication and additional stuff so that again, 100 % no heart attacks for her patients. I mean, how cool is that?

Dr. Havryliuk, Hello Sono (22:35)
That’s pretty awesome. Sign me up. I want to be her patient.

Steven Schwartz (22:37)
So.

Exactly.

Yeah, she is a wonderful lady. And so just through that, I think that we’re seeing where we are now. I’ve heard within the next five years that this industry of concierge and DPC is going to go from essentially $6 billion industry to over 13 and a half billion by 2030. So it’s more than doubling. And in order to that happen, people need to really open their eyes and see that, wow, there’s a different and a better way.

of getting care for my physical body. And through that, obviously, emotional health and minimizing stress and whatnot, there’s a better way of doing healthcare for primary care situations. And for folks who have more intense medical issues, their doctor can help them navigate that with the other specialists that need to be involved. So I really think this is great. The industry itself is truly improving.

this whole situation for our country. Would you agree?

Dr. Havryliuk, Hello Sono (23:39)
I would say so. Yeah, yeah, no, I agree. I think I’m not surprised that this, you know, DPC, the size of it would be doubling by 2030. Totally makes sense. I mean, there’s definitely benefit. And I think most of the patients will appreciate the relationship that they are building with their physicians and also

kind of knowing that the physician is not going to drop the ball, right, because they are so overwhelmed with all these other patients they are seeing. Like even right now I have an excellent physician, but she doesn’t check in on me. I have to remember to like go and make do my appointment and then hopefully she’ll do all the standard things that need to be checked, you know, annually. But it’s like I have to maintain that relationship, not vice versa. So I think

TBC just makes it so much easier for physicians to be connected with our patients.

Steven Schwartz (24:40)
I think relationship is the number one key word in what you just said, is that when you can truly have a relationship with your physician and they have the time to be able to focus on you and not one of 3,000 patients in their panel, it makes all the difference and you can really have better outcomes because of that. My arm of my business of Concierge Medical Marketing, we have three programs. One is transitioning.

existing patients to the concierge or DPC practice. The second is growth, where a business wants to grow to get to their full desired panel size. And the third is nurture. And nurture is exactly what you were just talking about, is using digital marketing techniques and methods to keep your medical practice in the minds of your patients who are your member subscribers. So whether that may be monthly

email newsletters or text messages or, you know, quarterly get togethers for, you know, wine and cheese and shrimp parties and learn about a new medical topic or something along those lines. That relationship nurturing those relationships can help your patients stay with your practice for years and years to come. And it’s always easier to continue serving a wonderful patient.

than having to go back and find somebody new as far as growing a business, right? And so through our company Arm of Marketing, those are the three programs that we offer. But you can see how different practices, no matter where they are in their own journey, need to think about what they need to do or what needs to be done for them to hit their panel size goals. And obviously, that relates to their financial goals, right?

Speaking about all of this kind of marketing stuff, I just want to put in a quick plug. I wrote a book called The Definitive Guide to Winning with Digital Marketing for Concierge Medical Practices. And I’d like to offer this book for anyone listening to the podcast totally free of charge. Simply go to our website, conciergemd.marketing, and scroll down on the home page. There’s a picture of the book. All you have to do is put in your email address and click the Submit button.

The system will send you an email with a link where you can download the PDF documents, about 100 pages, chock full of great information, actionable information that you can use to grow your practice, whether it’s transitioning, whether it’s growth, or whether it’s nurture, it’s all in there. And of course, if you have any questions about that whatsoever, something doesn’t make sense, or how do you actually do this, I’m always available for a quick phone call or a strategy session, discussion, whatever you want to do.

You can literally give me a call, 772-304-2420. And let’s talk and see if we can help figure out what you need to do or if you need our help. We’re happy to help, of course. And Tatiana, for you, I know you’ve got this amazing business. Could you please share with our listeners how they can get in touch with you to discuss what you offer?

Dr. Havryliuk, Hello Sono (27:59)
Yeah, of course. mean, the easiest way would be to email us and it’s [email protected] H e l l o. I said too many else, I think H e l l o s o n o. And same thing for the website. You can check out the website. We have a pretty extensive blog on there and also

just some more information on the services we offer. And I really, I am a firm believer that every DPC doc should have Pocus and be doing it for their patients. I mean, it’s really the future when people talk about replacing stethoscopes with Pocus. I mean, it’s already here, the time is here. So yeah, and please reach out. Even same thing, if you just want to discuss, you know,

what potentially could be compliance issues or requirements for you in your DPC practice regarding POCUS. Yeah, let me know. Reach out. I’d be happy to chat.

Steven Schwartz (29:03)
Wonderful. So [email protected] or the website hellosono.com. It’s a way to reach you. Dr. Tatiana, thank you for your time today. This has truly been a pleasure. I’ve learned so much. I mean, literally the story of working at Basecamp Mount Everest, that is cool. What a neat, neat experience for you.

Dr. Havryliuk, Hello Sono (29:23)
Yeah, well, I’m glad you enjoyed it and I enjoyed my time here with you, Steve. Thank you so much.

Steven Schwartz (29:29)
Truly my pleasure. Well, this is Steve Schwartz with the Concierge Medical Marketing Podcast signing off for today and looking forward to seeing you all on another future episode. Take care, everyone.

Dr. Havryliuk, Hello Sono (29:39)
Bye bye.