The widespread expansion of electronic medical records, mobile technology and big data has led to a sea change in the practice of medicine. Once centralized at hospitals and health systems, diagnostic testing is increasingly done at the point of care, with diagnosis and treatment more rapid than ever thought possible
Point-of-care testing (POCT) is rapidly spreading throughout health systems in the United States, according to Dr. David McClintock, director of Point of Care Testing at the University of Chicago Hospitals. McClintock spoke at the EuroMedLab conference in June, offering attendees a snapshot of the nascent discipline of pathology informatics and its relationship to point-of-care testing.
Breaking down this specialty, McClintock defined informatics as the “application of science of information as data plus meaning to biomedical issues.” It’s a very specialized discipline that requires designing and implementing “novel quantitative and computational methods that solve challenging problems across the spectrum of biology and medicine,” he added.
Turnaround Time Savings
Pathology informatics uses the processed data to provide actionable information. “The main gain for doing lab testing at the bedside or near the patient is the turnaround time savings,” said McClintock. For example, most lab tests sent to central labs STAT take a minimum of 30-90 minutes. This excludes the time it takes from the physician order (electronic, written or oral) to specimen collection to transport to the lab.
“By doing POCT, that time can be drastically shortened, with some tests performed in less than ten minutes,” he explained. Doing a cardiac troponin in an emergency room, or creatinine/eGFR measurement to assess the risk of contrast-induced nephropathy are POCT that improve patient outcomes and save patient time.
Large health systems are streamlining procedures via POCT. For example, McClintock pointed to University of Chicago Medicine’s adoption of a rapid “decision to admit” process that is based on point-of-care-testing to expedite lab and radiology work. This permits emergency room physicians to assess and triage their patients more quickly.
Clinical informatics only became a board-certified medical specialty in 2011. Numerous hurdles need to be overcome before best practices are known. Wireless mobile technologies, electronic health records and mobile devices vary in their capabilities and capacity to interact. In addition, laboratory information systems were designed before the advent of wireless mobile communications. Multiple changes are expected in the years ahead, as pathology informaticists work to maximize functionality, interoperability and actionability at the point of care.
Expanding Array of POC Tests
Many tests are POC-compatible. McClintock mentioned glucose, pregnancy, dipstick urinalysis and PT/INR warfarin monitoring as the most common and important tests likely to provide invaluable immediate feedback. In the infectious disease domain, PCR tests now make it possible to get extremely sensitive and specific results in the office, leading to quicker treatment for patients and less overprescribing of antibiotics when other preliminary test results are negative but the physician suspects lab testing will yield a positive.
Point-of-care testing also proves valuable in providing rapid diagnostics and data in the fight against epidemics, such as Ebola, Zika, chikungunya and dengue. In parts of the world where healthcare infrastructure is especially wanting, wireless mobile testing units are extremely helpful in quarantine and disease control.
Learn more about POC analyzers on MedicalExpo.com