Hospital Point-of-Care: Collection and Integration of Test Results

Abstract

Point-of-care (POC) testing in hospitals continues to expand both in diversity and volume of tests, driven by improved technology, potential care and cost benefits, and pressures from clinicians for immediate results. The variety of diagnostic devices, coupled with their broad dispersion within the hospital, creates a major challenge for laboratories in managing the quality of POC testing, as mandated by accreditation agencies such as CAP and JCAHO. In response to customer demand, vendors are beginning to offer solutions for collecting POC data and integrating it in the hospital host systems. Implementation of these connectivity solutions, however, demands an understanding of the POC data manager, transmission options, and interface requirements as well as the unique environment of the hospital. The number of hospitals performing POC testing has increased substantially according to surveys of more than 500 hospitals conducted in 1999 and 2001 by Enterprise Analysis Corporation (EAC).1 As depicted in F1, the rate of growth differs for the various test disciplines. Blood glucose testing, already pervasive in more than 99% of hospitals and accounting for more than 43% of total POC sales, shows minimal growth (although hospitals are replacing older devices with new technology). Conversely, cardiac markers are new to the POC arena and are installed in only 3% of hospitals, but are expected to achieve a high penetration, per data on intended purchases cited in the EAC 2001 US Hospital Point-of-Care Survey Report.1 The same survey indicates that the average number of POC test disciplines per hospital increased significantly from 2.3 in 1999 to 2.9 in 2001, evidence of the rising acceptance of POC testing. Especially for hospitals with multiple types of POC devices, management of POC testing requires far more than the traditional logging on paper charts or manual downloading to a workstation; it requires the capability to transmit quality control and test results to information systems for review, integration in the patient record, billing, and financial controls. Results show that although the percentage of POC test results transmitted electronically to a laboratory information system (LIS) has doubled since 1999, it is still less than one third of all POC results. Currently, vendors that offer connectivity often design unique, proprietary solutions that force hospitals to deal with the problems and costs of multiple incompatible systems. A few companies (eg, AbbottM, Medical Automation SystemsM, RocheM, and TelcorM) are marketing, or have under development, data management platforms designed to support devices from multiple vendors. A new standard for POC connectivity developed by the Connectivity Industry Consortium (CIC)2 will benefit both vendors in designing connectivity solutions and hospitals in implementing these solutions. The CIC document, to be published as a standard by the National Committee for Clinical Laboratory Standards (NCCLS),3 contains specifications for POC systems to enable interoperability and bi-directional transmission of data between devices, data managers, and information systems, all from a variety of vendors. Thus POC testing will have overcome a major obstacle in aggregating POC data together with laboratory data and making it accessible in the information systems. EAC forecasts that United States hospital spending on POC testing over the next five years will increase at an overall compound growth rate of 12%, varying by discipline. With advanced technologies, new applications, sophisticated data management, and common connectivity standards, POC testing is a viable complement, sometimes even an alternative, to laboratory testing, especially in situations where fast turnaround time and immediate treatment are critical. POC testing compares favorably in assay accuracy as well as in reliability to laboratory testing in most disciplines. The EAC 2001 POC Survey The number of hospitals performing point-of-care testing has increased substantially in the last two years. Technology continues to advance, offering new challenges to data management.