The most efficient and, in most cases, effective method of collecting data about a patient’s care or health condition is at the location where care is delivered. Point of Care (POC) Technology is the system of interconnected computing hardware and software and the communications modalities used to enter, retrieve, store, and transmit information from the location where patient care is rendered. This definition leads to the understanding that POC technology is not one single software application, a new piece of hardware, or a new telecom modality but, rather, a combination of devices and programs and infrastructures that enable care providers to achieve the following benefits:

• Decrease the amount of time it takes to document care
• Decrease the use of highly skilled labor to collect data (versus verifying data and acting on information)
• Decrease or eliminate inaccurate and duplicate collection of data
• Increase recording of results
• Improve availability of data in a rapid manner
• Improve the ability to make the best decisions for care

In previous blogs we discussed the integration of data from bedside medical devices such as physiological monitors or ventilators with electronic health records as one aspect of point of care technology. This blog addresses Point of Care Testing (PoCT), defined as a diagnostic medical test performed at or near the site of patient care. PoCT is accomplished through the use of transportable, portable, and handheld instruments (e.g., blood glucose meter) and test kits (e.g., HIV salivary assay). The increasing clinical demands for more rapid tests as well as advances in technology have made it easier to perform diagnostic procedures in settings other than the traditional core clinical laboratory. Benefits include simpler sample collection, some pre-processing of data to reduce time between collection and final analysis and more timely delivery of better care due to more rapid turnaround of results.

When considering a PoCT deployment, these advantages should be weighed against some potential issues, not the least of which is a lack of expertise with diagnostic testing procedures by non-laboratory personnel and quality control processes. There are also costs associated with nursing workload impacts and the higher cost of PoCT devices and reagents. One additional cost, sometimes overlooked, is the data integration component. When examining PoCT, systems integration issues become very important. In most cases, POCT is interfaced through a laboratory information system (LIS) that then sends data to the hospital’s electronic health record (EHR) system; or, device data may be passed to an interface engine to feed an EHR application. Important considerations in this analysis are the mechanism for docking the devices and uploading data, how results data will be associated with the proper patient ID and how to manage “unsolicited results” (results with no associated order).

In addition to having a robust interface engine and integration analyst expertise with HL7, LOINC and other data mapping and interface protocols, a successful PoCT integration project includes clinical workflow specialists, LIS and EHR application analysts, data mappers and a project manager who can manage all the moving parts of such a project both with internal as well as vendor resources. As per one frequently cited publication on this process (AACB reference), any POCT project should have the following:

• A detailed workflow specification
• Analysis of costs and benefits including eligibility for reimbursement
• A literature search for evaluations of appropriate instruments for clinical purposes
• Verification of electronic capture of results and a detailed data flow analysis
• Availability of IT/ technical support
• Availability of all necessary testing equipment
• A user manual and training/certification program for all PoCT users
• Documentation of how to perform all quality control procedures
• Policies and procedures for problem resolution and corrective actions
• Regular audits of all processes and any actions taken

When considering a PoCT program, it is important to remember to conduct it within a strong framework of quality standards equal to that which would be attained in a traditional clinical laboratory. And, to always have a patient centric approach to technology acquisition and deployment, including collaboration between healthcare providers, IT services and technical vendors. Santa Rosa has experienced resources with demonstrated success managing PoCT integration with hospital information systems. Let us know if we can help.