Transcript Point-of-Care Informatics: Past, Present and Future

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 1990’s
Data Collection
Mid-Late 1990’s
Data Management
Early 2000’s and Beyond
Information Management
- 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
- Open IT
- Wireless
- Web
- EMR
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 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 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 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 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 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 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 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’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 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 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 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
Today’s 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 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 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. It’s 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
98%
99%
Glucose
51%
Coagulation
62%
34%
Blood Gas
50%
14%
Chemistry
36%
18%
Hematology
Urinalysis
Cardiac
28%
5%
15%
1%
3%
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
1999 (510 Hospitals)
2001 (584 Hospitals)
Source: Enterprise Analysis Corp.
Stamford, CT
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. It’s not just glucose anymore…
2. Goodbye Paper…Hello 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 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 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 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 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. It’s 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 isn’t 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.
It’s 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.
It’s 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.
It’s not just glucose anymore…
Goodbye Paper… Hello e-Patient
Zero Tolerance for Errors!
Where have all the med techs gone??
POCT…. Meet IT!
It’s 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
It’s 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.
It’s not just glucose anymore…
Goodbye Paper… Hello e-Patient
Zero Tolerance for Errors!
Where have all the med techs gone??
POCT…. Meet IT!
It’s 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.
It’s not just glucose anymore…
Goodbye Paper… Hello e-Patient
Zero Tolerance for Errors!
Where have all the med techs gone??
POCT…. Meet IT!
It’s 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 Dell’s 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:
• 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 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