Point-of-Care Informatics: Past; Present; and Future

Steven Valorz Director of Sales & Marketing Medical Automation Systems Charlottesville, VA

Information Technology Meets Point-of-Care Testing: Forging New Partnerships

The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Google Results
"point of care" "history" 23,000 results "point of care" "future" 37,600 results

Information Technology Meets Point-of-Care Testing: Forging New Partnerships

The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Where it all began 20 years ago?

Information Technology Meets Point-of-Care Testing: Forging New Partnerships

The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

An Early Definition of POCT

Tests done by non-laboratory staff outside
a recognized diagnostic laboratory
This terminology replaces Near Patient Testing (NPT) as
the favored term. Other terminologies include Bedside Testing, Extra-Laboratory Testing and Disseminated Laboratory Testing.

Information Technology Meets Point-of-Care Testing: Forging New Partnerships

The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

POC Evolution
Early 1990s Data Collection Mid-Late 1990s Data Management Early 2000s and Beyond Information Management - Open IT - Wireless - Web - EMR

- Reimbursement - Patient Care - New Entrants - Partnerships - Regulatory Focus - Dawn of Connectivity - POC Testing - Nursing Influence
Information Technology Meets Point-of-Care Testing: Forging New Partnerships
The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Advantages of POCT
Early to mid 1990s Reduce TAT Reduce errors Reduce paper Smaller sample size (microliters vs. milliliters)

Information Technology Meets Point-of-Care Testing: Forging New Partnerships

The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

What were some of the most important tools that you used when you first got involved with POCT?

Information Technology Meets Point-of-Care Testing: Forging New Partnerships

The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

POCT Informatic Tools

Early to mid 1990s Bench-top analyzers Touch screen PCs Results sent to central laboratory for analysis
University of Virginia Health Science Center Original Home of RALS Technology
Information Technology Meets Point-of-Care Testing: Forging New Partnerships
The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Early POC Informatics

Mid to late 1990s Hand-held devices replace bench-top analyzers Laptops to collect device data Led to Sneaker-Net, Armpit-Net and Floppy-Net Proprietary to analyzer or device vendor
Information Technology Meets Point-of-Care Testing: Forging New Partnerships
The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Enter Networks
Alternative to Sneakernet Device docking stations set up Eliminated sneaker-net systems Enhanced patient care Patient tests electronically sent from floors to a central location and ultimately to the LIS
Information Technology Meets Point-of-Care Testing: Forging New Partnerships
The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

The Dawn of Connectivity

Late 1990s
Shift to electronic patient records Incorporating POC results into the hospital DM scheme took on great importance AACC POCT Div. determined connectivity was the biggest issue facing its members CIC formed to set POC standards
Information Technology Meets Point-of-Care Testing: Forging New Partnerships
The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Whats Driving POC Informatics?

Hospital POC growth rate 12% annually to $3.2 billion by 2008 Decentralized patient testing Reducing overall healthcare costs

Information Technology Meets Point-of-Care Testing: Forging New Partnerships

The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

And Whats Being Done About It

Proliferation of POCT devices Getting smarter, doing more Better information management systems Getting flexible Integration into hospital IT Getting involved Links to LIS/HIS Getting to the EMR
Information Technology Meets Point-of-Care Testing: Forging New Partnerships
The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

The Information Revolution

As POCT evolves, needs will include: Instant information Getting more data to the EMR Continuous glucose testing and monitoring Open IT standards RF and web-based communication and connectivity Optimum security
Information Technology Meets Point-of-Care Testing: Forging New Partnerships
The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

POC Information

Information Technology Meets Point-of-Care Testing: Forging New Partnerships

The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Todays POCT Definition

Care at the bedside and anywhere else the patient might be; or where decisions are made by a caregiver, wherever they may be.
It can be near the bedside, but its not always happening where you can run a wire.now, wireless has fueled this idea that clinicians truly are nomadic. Doctors now have tools available 24/7 and the anytime, anywhere network has become a reality.
Health Data Management, December 2003

Information Technology Meets Point-of-Care Testing: Forging New Partnerships

The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Emerging Trends in Point-of-Care and their Impact on Data Management

Information Technology Meets Point-of-Care Testing: Forging New Partnerships

The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Trends
1. Its not just glucose anymore

Information Technology Meets Point-of-Care Testing: Forging New Partnerships

The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

POCT is Not Just for Glucose!

% of Hospitals with POC Devices by Discipline
Glucose
Coagulation Blood Gas Chemistry
14% 36% 18% 28% 5% 15% 1% 3% 34% 50% 51% 62% 98% 99%

Hematology
Urinalysis Cardiac

1999 (510 Hospitals) 2001 (584 Hospitals)

Source: Enterprise Analysis Corp. Stamford, CT

Information Technology Meets Point-of-Care Testing: Forging New Partnerships

The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Data Management Systems

Must quickly and effectively handle New devices in the market for existing applications Constant upgrades to device firmware Devices which are not CIC compliant Devices for new POC applications Interfacing with LIS and HIS
Information Technology Meets Point-of-Care Testing: Forging New Partnerships
The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Trends
1. Its not just glucose anymore 2. Goodbye PaperHello e-Patient

Information Technology Meets Point-of-Care Testing: Forging New Partnerships

The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Goodbye PaperHello e-Patient!

Its a Paperless World! EMRs reduce overhead and improve efficiency EMRs increase revenue EMRs increase patient care

Information Technology Meets Point-of-Care Testing: Forging New Partnerships

The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Goodbye PaperHello e-Patient!

Downtime Not AllowedIts that simple! Download stations must always down load Servers must always be on the network Connections to host systems (LIS/ HIS) never lost

Information Technology Meets Point-of-Care Testing: Forging New Partnerships

The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Ways to Address this Need

Have automatic restart for serial servers Build scalable systems configured to demand Ensure redundancy Develop pro-active monitoring

Information Technology Meets Point-of-Care Testing: Forging New Partnerships

The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Proactive System Monitoring

Information Technology Meets Point-of-Care Testing: Forging New Partnerships

The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Trends
1. Its not just glucose anymore 2. Goodbye Paper Hello e-Patient 3. Zero Tolerance for Errors!

Information Technology Meets Point-of-Care Testing: Forging New Partnerships

The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Zero Tolerance of Medical Errors

The Need for Data Management Total control of POCT Program from device to operator to patient to test order Federal initiative launched to reduce medical errors and improve patient safety

Information Technology Meets Point-of-Care Testing: Forging New Partnerships

The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Addressing the Need

Current technology: QC lock out Operator lock out In unit ADT for patient verification
This isnt always enough : (

Information Technology Meets Point-of-Care Testing: Forging New Partnerships

The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

In the Future.
Look for technology which will: Have real time, dynamic patient verification at the device level Provide integration of CPOE into data management systems Offer automatic validation routines checking and flagging suspicious results
Information Technology Meets Point-of-Care Testing: Forging New Partnerships
The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

In the Future.
Look for more patient outcome data Statistics to validate quality New reports to allow users to sort data on various criteria such as nursing unit, patient, result, etc. POCT as a separate laboratory department
Information Technology Meets Point-of-Care Testing: Forging New Partnerships
The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Trends
1. 2. 3. 4. Its not just glucose anymore Goodbye Paper Hello e-Patient Zero Tolerance for Errors! Where have all the Med Techs gone??

Information Technology Meets Point-of-Care Testing: Forging New Partnerships

The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Searching for Med Techs

50% of labs have difficulty in recruiting and hiring clinical laboratory workers 91% had difficulty hiring for at least one shift Night shifts were most difficult to fill (82%) for MT positions Evening shifts were most difficult to fill (72%) for MLT positions
Source: Lab Medicine, September 23, 2003 Information Technology Meets Point-of-Care Testing: Forging New Partnerships
The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Addressing the Need

Web-based solutions Allows fewer people to do more Viewing and maintaining operator lists Viewing and correcting results records Conducting and certifying initial training on specific information Monitoring and re-certifying competencies
Information Technology Meets Point-of-Care Testing: Forging New Partnerships
The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Trends
1. 2. 3. 4. 5. Its not just glucose anymore Goodbye Paper Hello e-Patient Zero Tolerance for Errors! Where have all the med techs gone?? POCT Meet IT!

Information Technology Meets Point-of-Care Testing: Forging New Partnerships

The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

POCT, Meet IT!

IT as Gatekeeper DM systems must be IT Certified Security BIG Issue Microsoft patches Remote Access for Support HIPAA

Information Technology Meets Point-of-Care Testing: Forging New Partnerships

The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Addressing the Need

Security Access All system components secured with passwords DB server goes into the IT center to secure access Data Protection Data to/from devices can be encrypted

Information Technology Meets Point-of-Care Testing: Forging New Partnerships

The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Trends
1. 2. 3. 4. 5. 6. Its not just glucose anymore Goodbye Paper Hello e-Patient Zero Tolerance for Errors! Where have all the med techs gone?? POCT. Meet IT! Its not just QC Out of Range anymore!

Information Technology Meets Point-of-Care Testing: Forging New Partnerships

The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Its not just QC Out of Range!

DM Systems will have to provide value end users in at least three forms: Improving Patient Outcomes Reducing Cost Generating Revenue

Information Technology Meets Point-of-Care Testing: Forging New Partnerships

The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Imagine the Possibilities

Patient Tracking Systems Monitoring compliance Cost Tracking Systems Managing inventory Integrated Lab Correlations Improving quality Integration with Pharmacy systems
Information Technology Meets Point-of-Care Testing: Forging New Partnerships
The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Trends
1. 2. 3. 4. 5. 6. 7. Its not just glucose anymore Goodbye Paper Hello e-Patient Zero Tolerance for Errors! Where have all the med techs gone?? POCT. Meet IT! Its not just QC Out of Range anymore! Tight Glycemic Control Monitoring

Information Technology Meets Point-of-Care Testing: Forging New Partnerships

The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Tight Glycemic Control Monitoring

Advantages of POC Testing Studies show maintaining ICU patient glucoses between 80-100 mg/dl, enabled with hourly or more frequent POC glucose testing, significantly reduce mortality rates in the ICU (and ultimately the entire hospital) TGC being adopted at hospitals across the country
The New England Journal of Medicine, November 2001
Information Technology Meets Point-of-Care Testing: Forging New Partnerships
The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Trends
1. 2. 3. 4. 5. 6. 7. 8. Its not just glucose anymore Goodbye Paper Hello e-Patient Zero Tolerance for Errors! Where have all the med techs gone?? POCT. Meet IT! Its not just QC Out of Range anymore! Tight Glycemic Control Monitoring No Strings Attached POCT

Information Technology Meets Point-of-Care Testing: Forging New Partnerships

The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

In a Wireless Galaxy Far Beyond

Point-of-care technology and wireless networks fit hand-in-glove in health care and use of the networks is poised for growth
Wireless networks topped technology wish list 54% in 2002 -- 76% in 2004
Information Technology Meets Point-of-Care Testing: Forging New Partnerships
The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

POC Can Now Be Anywhere

Wireless networks and mobile hardware, provide clinicians with broader access to patient data;
Technology advances could be challenging the definition of point of care.
Instead of clinicians going where data is, data is now going where the clinician is
Information Technology Meets Point-of-Care Testing: Forging New Partnerships
The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

POC Has Michael Dells Attention!

Information Technology Meets Point-of-Care Testing: Forging New Partnerships

The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Dell Healthcare Solutions

Information Technology Meets Point-of-Care Testing: Forging New Partnerships

The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

POC Closer to Home

2 million+ on Anti-Coagulation therapy Warfarin - 22nd most common drug 1,100 Clinics growing at 20% a year Indications Atrial fibrillation Heart Valve replacement Stroke

Information Technology Meets Point-of-Care Testing: Forging New Partnerships

The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

The Use of Portable Coag Devices

Bedside testing enables: Home health providers to make immediate changes in coagulation therapy if necessary Frequent testing = Fewer complications Home testing with data communication = improved patient management
Information Technology Meets Point-of-Care Testing: Forging New Partnerships
The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Data Management at Home

Provides direct oversight by the care provider Eliminates patient transcription errors Allows for timely medication adjustment Improves patient satisfaction

Information Technology Meets Point-of-Care Testing: Forging New Partnerships

The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

RALS-HC (Home Care)

Data management software Captures lab test results from all sources Allows automatic medication calculation and adjustment Allows tracking of patient medication, test results and complications Improves efficiency of clinic and staff Provides data for outcomes research
Information Technology Meets Point-of-Care Testing: Forging New Partnerships
The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Information Technology Meets Point-of-Care Testing: Forging New Partnerships

The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Information Technology Meets Point-of-Care Testing: Forging New Partnerships

The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Conclusion
POCT is here to stay and is growing because: Its becoming more attractive to nursing and other healthcare personnel More tests are being waived Vendors are continuing to support growth Technology is continuing to evolve But POCT is more than hardware & software
Information Technology Meets Point-of-Care Testing: Forging New Partnerships
The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

POCT is About People!

In 2005 MAS is planning a POC Leadership Series Focus will be on motivation, team building and more Available to all POC groups throughout the country
Information Technology Meets Point-of-Care Testing: Forging New Partnerships
The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Thank you!

Information Technology Meets Point-of-Care Testing: Forging New Partnerships

The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry