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

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

2. Google Results… "point of care" "history" • 23,000 results "point of care" "future" • 37,600 results

3. Where it all began 20 years ago?

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

6. Advantages of POCT Early to mid 1990’s • Reduce TAT • Reduce errors • Reduce paper • Smaller sample size(microliters vs. milliliters)

7. What were some of the most important ‘tools’ that you used when you first got involved with POCT?

8. POCT Informatic Tools Early to mid 1990’s • Bench-top analyzers • Touch screen PCs • Results sent to centrallaboratory for analysis University of Virginia Health Science Center – Original Home of RALS Technology

9. 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

10. 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. 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

12. What’s Driving POC Informatics? • Hospital POC growth rate • 12% annually to $3.2 billion by 2008 • Decentralized patient testing • Reducing overall healthcare costs

13. 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

14. 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. POC Information…

16. “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 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.

17. Emerging Trends inPoint-of-Care and theirImpact on Data Management…

18. Trends… 1. It’s not just glucose anymore…

19. POCT is Not Just for Glucose! % of Hospitals with POC Devices by Discipline 98% Glucose 99% 51% Coagulation 62% 34% Blood Gas 50% 14% Chemistry 36% 18% Hematology 28% 5% Urinalysis 1999 (510 Hospitals) 15% 2001 (584 Hospitals) 1% Cardiac Source: Enterprise Analysis Corp. Stamford, CT 3%

20. 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. Trends… • It’s not just glucose anymore… • Goodbye Paper…Hello e-Patient

22. Goodbye Paper…Hello e-Patient! It’s a “Paperless” World! • EMRs reduce overhead andimprove efficiency • EMRs increase revenue • EMRs increase patient care

23. 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

24. Ways to Address this Need… • Have automatic restart for serial servers • Build scalable systems configured to demand • Ensure redundancy • Develop pro-active monitoring

25. Proactive System Monitoring

26. Trends… • It’s not just glucose anymore… • Goodbye Paper… Hello e-Patient • Zero Tolerance for Errors!

27. Zero Tolerance of Medical Errors The Need for Data Management • Total control of POCT Programfrom device to operator topatient to test order • Federal initiative launched to reducemedical errors and improve patient safety

28. Addressing the Need… Current technology: • QC lock out • Operator lock out • In unit ADT for patient verification This isn’t always enough… : (

29. 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. 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. Trends… • It’s not just glucose anymore… • Goodbye Paper… Hello e-Patient • Zero Tolerance for Errors! • Where have all the Med Techs gone??

32. 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. 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. Trends… • 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!

35. POCT, Meet IT! • IT as Gatekeeper • DM systems must be “IT Certified” • Security BIG Issue • Microsoft patches • Remote Access for Support • HIPAA

36. 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. Trends… • 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!

38. 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

39. Imagine the Possibilities… • Patient Tracking SystemsMonitoring compliance • Cost Tracking SystemsManaging inventory • Integrated Lab CorrelationsImproving quality • Integration with Pharmacy systems

40. Trends… • 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

41. 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

42. Trends… • 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…

43. 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

44. 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…

45. POC Has Michael Dell’s Attention!

46. Dell Healthcare Solutions

47. 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

48. 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

49. Data Management at Home • Provides direct oversight by the care provider • Eliminates patient transcription errors • Allows for timely medication adjustment • Improves patient satisfaction

50. 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