Emerging Technologies And HIMT: Point-Of-Care Testing

Laboratory tests and services have long been a part of medicine. These vital tests can be ordered and processed more quickly than ever before with the advent of electronic health information. Results can be shared with appropriate providers and specialists across interconnected health information exchanges (HIEs) if they are not all already within the same hospital or medical system. Patients can now access their test results remotely via computer or smartphone once they are released onto a secure patient portal. Point-of-care testing (POCT), also called bedside or near patient testing, is any laboratory or diagnostic testing that can be done at the site of care vs. a traditional laboratory. This paper discusses a few of the uses of POCT in the healthcare setting and how Health Information Management Technology (HIMT) fits into the overall scheme of their use. Point of care testing (POCT) is defined as “laboratory testing conducted close to the site of patient care, typically by clinical personnel whose primary training is not in the clinical laboratory sciences, or by patients (self-testing). ”

The Immunoassay handbook POCT is considered a clinical decision support system, as it relates to information technology (IT). The primary goal of point-of-care testing is to determine results more quickly for the correct treatment to begin sooner. Done correctly, it leads to a better clinical outcome at less overall cost. It might surprise you to learn that POC tests done by non-laboratory individuals usually cost more than those sent out to a formal laboratory. Less surprising is that the rate of error for POCT is higher. This is due to not only the training or skill level of the person performing the testing, but can be negatively affected by the conditions the test was taken in. For example, humidity or cleaning agents in a kitchen or bathroom could interfere with a dipstick reagent used for a home test.

These two concerns, perceptions of initial cost and comparative rate of error are listed as two of the reasons that POCT is not as widely used in primary care in the United States as it is in many European countries according to a study by Hardy et al. (2016). Some other reasons given by study participants were lack of personnel to administer the additional testing, no EMR interface to accurately record or report results, and uncertainty about reimbursement for POCT vs. traditional lab testing. Consider point-of-care testing in the primary or specialty care setting for a chronic condition. In 2017, it was estimated that 30. 3 million Americans had diabetes. This included approximately 7. 2 million who were undiagnosed. The 2018 American Diabetes Association (ADA) Standards of Medical Care in Diabetes suggested that the use of point-of-care HbA1c testing may give providers a timelier opportunity to intervene with effective treatment changes for their patients. The HbA1c POC devices must meet or exceed quality measures set by the National Glycohemoglobin Standardization Program (NGSP) for clinical results to be considered reliable and accurate. All other factors adjusted for, a POC HbA1c test is more accurate than a traditional lab test due to the fact there is no delayed processing time and glucose breaks down in a test tube by the hour. POC HbA1c testing has produced productive outcomes in several areas. Where used, it is associated with a notable reduction in HbA1c numbers in both the long and short term. It promotes operational efficiency and cost reduction via fewer tests ordered per patient, less follow up telephone calls and letters, less patient re-visits.

POC test use becomes even more viable in an emergency care setting for acutely ill patients. A patient presenting to the ED with heart attack symptoms is given a blood test to detect a protein called Troponin. This protein is released into the bloodstream when damage to heart muscle has occurred, and the blood test measures the amount, if any, of Troponin protein found. High levels of Troponin indicate damage, and a likely heart attack. POC testing for Troponin in these patients has been shown to be accurate and beneficial in cost and time savings, although the sample size was limited. Acute stroke patients frequently require thrombolysis; IV drug therapy to prevent blood clots and prevent damage or further damage. These medications are blood-thinners and before the standard of care therapy of thrombolysis can safely begin, the patients INR (time for blood to clot) range must be measured, and a certain threshold met. Point-of-care INR testing, with rapid and reliable results, is crucial for these patients since “time is brain”.

HIMT supports point of care testing in an administrative capacity. POC test equipment must maintained and kept up to date and supplied. It must also be inventoried and logged. Because of its very nature, some of the smaller electrical devices would be prone to breakage, loss, or theft. In some cases, equipment may be repaired on site or if not, sent out for repair or re-calibration. Highly specialized equipment will have specific maintenance schedules that must be upheld to maintain certification. HIMT also assists in a personnel capacity. Employees will need training and, in some cases, continuing education or certifications to administer and process certain types of POC tests. This information will also need to be tracked and managed to ensure quality standards and compliance. Additional employees may need to be forecasted and hired to support an increased need for this service. Billing and reimbursement information needs to be current and accurate communication should be forthcoming to ensure that clinic revenue and spirit remain positive.

POCT technology, like so many other medical innovations, can only reach its maximum potential with support from all facets of the healthcare community.