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Information Technology Meets Point-of-Care Testing: Forging New Partnerships The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section.

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Presentation on theme: "Information Technology Meets Point-of-Care Testing: Forging New Partnerships The Baltimore-Chesapeake Bay Point-of-Care Coordinators and The Capital Section."— Presentation transcript:

1 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 Point-of-Care Informatics: Past; Present; and Future Steven Valorz Director of Sales & Marketing Medical Automation Systems Charlottesville, VA

2 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

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 Where it all began 20 years ago?

4 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.

5 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… - POC Testing - Nursing Influence - Regulatory Focus - Dawn of Connectivity - New Entrants - Partnerships - Reimbursement - Patient Care - Open IT - Wireless - Web - EMR Early 2000s and Beyond Information Management Early 1990s Data Collection Mid-Late 1990s Data Management

6 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)

7 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?

8 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

9 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

10 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

11 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

12 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

13 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

14 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

15 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…

16 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

17 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…

18 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…

19 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! 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%

20 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

21 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

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

23 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…Its that simple! Download stations must always down load Servers must always be on the network Connections to host systems (LIS/ HIS) never lost

24 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

25 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

26 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!

27 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

28 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… : (

29 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

30 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

31 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! 4.Where have all the Med Techs gone??

32 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

33 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

34 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! 4.Where have all the med techs gone?? 5.POCT… Meet IT!

35 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

36 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

37 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! 4.Where have all the med techs gone?? 5.POCT…. Meet IT! 6.Its not just QC Out of Range anymore!

38 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

39 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

40 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! 4.Where have all the med techs gone?? 5.POCT…. Meet IT! 6.Its not just QC Out of Range anymore! 7.Tight Glycemic Control Monitoring

41 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 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

42 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 TGC and POC Informatics POC data management can provide sequential, graphical patient reporting Reports of TGC can be generated by unit Benchmarking for diabetes best practice The lowdown on hospital blood sugars, April 2004, CAP Today cover story

43 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! 4.Where have all the med techs gone?? 5.POCT…. Meet IT! 6.Its not just QC Out of Range anymore! 7.Tight Glycemic Control Monitoring 8.No Strings Attached POCT…

44 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 % in 2004

45 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…

46 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!

47 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

48 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 - 22 nd most common drug 1,100 Clinics growing at 20% a year Indications –Atrial fibrillation –Heart Valve replacement –Stroke

49 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

50 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

51 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

52 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

53 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

54 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…

55 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

56 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!


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