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Point-of-Care Informatics: Past; Present; and Future. Steven Valorz Director of Sales & Marketing Medical Automation Systems Charlottesville, VA. Google Results…. "point of care" "history" 23,000 results "point of care" "future" 37,600 results. Where it all began 20 years ago?.

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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

google results
Google Results…

"point of care" "history"

  • 23,000 results

"point of care" "future"

  • 37,600 results
an early definition of poct
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.

poc evolution
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

advantages of poct
Advantages of POCT

Early to mid 1990’s

  • Reduce TAT
  • Reduce errors
  • Reduce paper
  • Smaller sample size(microliters vs. milliliters)
slide7
What were some of

the most important ‘tools’

that you used when you

first got involved

with POCT?

poct informatic tools
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

early poc informatics
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
enter networks
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
the dawn of connectivity
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
what s driving poc informatics
What’s Driving POC Informatics?
  • Hospital POC growth rate
    • 12% annually to $3.2 billion by 2008
  • Decentralized patient testing
  • Reducing overall healthcare costs
and what s being done about it
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
the information revolution
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
today s poct definition

“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.

trends
Trends…

1. It’s not just glucose anymore…

poct is not just for glucose
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%

data management systems
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
trends1
Trends…
  • It’s not just glucose anymore…
  • Goodbye Paper…Hello e-Patient
goodbye paper hello e patient
Goodbye Paper…Hello e-Patient!

It’s a “Paperless” World!

  • EMRs reduce overhead andimprove efficiency
  • EMRs increase revenue
  • EMRs increase patient care
goodbye paper hello e patient1
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
ways to address this need
Ways to Address this Need…
  • Have automatic restart for serial servers
  • Build scalable systems configured to demand
  • Ensure redundancy
  • Develop pro-active monitoring
trends2
Trends…
  • It’s not just glucose anymore…
  • Goodbye Paper… Hello e-Patient
  • Zero Tolerance for Errors!
zero tolerance of medical errors
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
addressing the need
Addressing the Need…

Current technology:

  • QC lock out
  • Operator lock out
  • In unit ADT for patient verification

This isn’t always enough… : (

in the future
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
in the future1
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
trends3
Trends…
  • It’s not just glucose anymore…
  • Goodbye Paper… Hello e-Patient
  • Zero Tolerance for Errors!
  • Where have all the Med Techs gone??
searching for med techs
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

addressing the need1
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
trends4
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!
poct meet it
POCT, Meet IT!
  • IT as Gatekeeper
  • DM systems must be “IT Certified”
  • Security BIG Issue
    • Microsoft patches
    • Remote Access for Support
    • HIPAA
addressing the need2
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
trends5
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!
it s not just qc out of range
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
imagine the possibilities
Imagine the Possibilities…
  • Patient Tracking SystemsMonitoring compliance
  • Cost Tracking SystemsManaging inventory
  • Integrated Lab CorrelationsImproving quality
  • Integration with Pharmacy systems
trends6
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
tight glycemic control monitoring
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

trends7
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…
in a wireless galaxy far beyond
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
poc can now be anywhere
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…

poc closer to home
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
the use of portable coag devices
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
data management at home
Data Management at Home
  • Provides direct oversight by the care provider
  • Eliminates patient transcription errors
  • Allows for timely medication adjustment
  • Improves patient satisfaction
rals hc home care
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
conclusion
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…
poct is about people
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