Information Technology Meets Point-of-Care Testing: Forging New PartnershipsThe Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

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

Steven ValorzDirector of Sales & MarketingMedical Automation SystemsCharlottesville, VA

Information Technology Meets Point-of-Care Testing: Forging New PartnershipsThe 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 PartnershipsThe 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 PartnershipsThe 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 PartnershipsThe 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…

- POC Testing- Nursing Influence

- Regulatory Focus- Dawn of Connectivity

- New Entrants- Partnerships

- Reimbursement- Patient Care

- Open IT- Wireless- Web- EMR

Early 2000’s and Beyond Information Management

Early 1990’sData Collection Mid-Late 1990’s

Data Management

Information Technology Meets Point-of-Care Testing: Forging New PartnershipsThe 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 1990’s• Reduce TAT• Reduce errors• Reduce paper• Smaller sample size

(microliters vs. milliliters)

Information Technology Meets Point-of-Care Testing: Forging New PartnershipsThe 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 ofthe most important ‘tools’that you used when you

first got involvedwith POCT?

Information Technology Meets Point-of-Care Testing: Forging New PartnershipsThe 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 1990’s• 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 PartnershipsThe 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 1990’s• 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 PartnershipsThe 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 PartnershipsThe 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 1990’s• 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 PartnershipsThe 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’s 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 PartnershipsThe 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 What’s 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 PartnershipsThe 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 PartnershipsThe 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 PartnershipsThe Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

Today’s POCT Definition

Care at the bedside and anywhere else thepatient might be; or where decisions aremade by a caregiver, wherever they may be.

“It can be near the bedside, but it’s 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 PartnershipsThe 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 inPoint-of-Care and theirImpact on Data Management…

Information Technology Meets Point-of-Care Testing: Forging New PartnershipsThe 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. It’s not just glucose anymore…

Information Technology Meets Point-of-Care Testing: Forging New PartnershipsThe 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!

Glucose

Coagulation

Blood Gas

Chemistry

Hematology

Urinalysis

Cardiac Source: Enterprise Analysis Corp. Stamford, CT

1999 (510 Hospitals)2001 (584 Hospitals)

% of Hospitals with POC Devices by Discipline

51%62%

34%50%

14%36%

18%28%

5%15%

1%3%

98%99%

Information Technology Meets Point-of-Care Testing: Forging New PartnershipsThe 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 PartnershipsThe 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. It’s not just glucose anymore… 2. Goodbye Paper…Hello e-Patient

Information Technology Meets Point-of-Care Testing: Forging New PartnershipsThe 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 Paper…Hello e-Patient!

It’s 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 PartnershipsThe 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 Paper…Hello e-Patient!

Downtime Not Allowed…It’s 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 PartnershipsThe 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 PartnershipsThe 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 PartnershipsThe 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. It’s not just glucose anymore… 2. Goodbye Paper… Hello e-Patient3. Zero Tolerance for Errors!

Information Technology Meets Point-of-Care Testing: Forging New PartnershipsThe 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 topatient to test order

• Federal initiative launched to reducemedical errors and improve patient safety

Information Technology Meets Point-of-Care Testing: Forging New PartnershipsThe 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 isn’t always enough… : (

Information Technology Meets Point-of-Care Testing: Forging New PartnershipsThe 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 PartnershipsThe 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 PartnershipsThe 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. It’s not just glucose anymore… 2. Goodbye Paper… Hello e-Patient3. Zero Tolerance for Errors!4. Where have all the Med Techs gone??

Information Technology Meets Point-of-Care Testing: Forging New PartnershipsThe 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 recruitingand 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 positionsSource: Lab Medicine, September 23, 2003

Information Technology Meets Point-of-Care Testing: Forging New PartnershipsThe 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 PartnershipsThe 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. It’s not just glucose anymore… 2. Goodbye Paper… Hello e-Patient3. Zero Tolerance for Errors!4. Where have all the med techs gone??5. POCT… Meet IT!

Information Technology Meets Point-of-Care Testing: Forging New PartnershipsThe 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 PartnershipsThe 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 accessData Protection• Data to/from devices can be encrypted

Information Technology Meets Point-of-Care Testing: Forging New PartnershipsThe 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. It’s not just glucose anymore… 2. Goodbye Paper… Hello e-Patient3. Zero Tolerance for Errors!4. Where have all the med techs gone??5. POCT…. Meet IT!6. It’s not just QC Out of Range anymore!

Information Technology Meets Point-of-Care Testing: Forging New PartnershipsThe Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section The Critical and Point of Care Testing Division American Association of Clinical Chemistry

It’s not just QC Out of Range!

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

Information Technology Meets Point-of-Care Testing: Forging New PartnershipsThe 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 SystemsManaging inventory

• Integrated Lab CorrelationsImproving quality

• Integration with Pharmacy systems

Information Technology Meets Point-of-Care Testing: Forging New PartnershipsThe 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. It’s not just glucose anymore… 2. Goodbye Paper… Hello e-Patient3. Zero Tolerance for Errors!4. Where have all the med techs gone??5. POCT…. Meet IT!6. It’s not just QC Out of Range anymore!7. Tight Glycemic Control Monitoring

Information Technology Meets Point-of-Care Testing: Forging New PartnershipsThe 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 countryThe New England Journal of Medicine, November 2001

Information Technology Meets Point-of-Care Testing: Forging New PartnershipsThe 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. It’s not just glucose anymore… 2. Goodbye Paper… Hello e-Patient3. Zero Tolerance for Errors!4. Where have all the med techs gone??5. POCT…. Meet IT!6. It’s not just QC Out of Range anymore!7. Tight Glycemic Control Monitoring8. “No Strings Attached” POCT…

Information Technology Meets Point-of-Care Testing: Forging New PartnershipsThe 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-glovein health care and use of thenetworks 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 PartnershipsThe 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 mobilehardware, 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 PartnershipsThe 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 Dell’s Attention!

Information Technology Meets Point-of-Care Testing: Forging New PartnershipsThe 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 PartnershipsThe 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 PartnershipsThe 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 PartnershipsThe 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 PartnershipsThe 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 PartnershipsThe 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 PartnershipsThe 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 PartnershipsThe 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:• It’s becoming more ‘attractive’ to nursing

and other healthcare personnel• More tests are being waived• Vendors are continuing to support growth• Technology is continuing to evolveBut…• POCT is more than hardware & software…

Information Technology Meets Point-of-Care Testing: Forging New PartnershipsThe 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 PartnershipsThe 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!