By Michael Dalton
An emergency department nurse standing at the bedside of a trauma victim triages his patient’s condition. He runs a comprehensive diagnostic blood gas panel to assess vital bodily functions, including breathing and oxygen transport, and determines the working status of key organs and metabolic processes. Instantly, the patient’s blood gas results are uploaded into the lab’s and hospital’s information systems, enabling the health care team to make rapid, well-informed decisions about diagnosis and treatment without the tedious process of shuffling a paper-based medical chart across the facility.
Simultaneously in the central lab, the laboratory director remains in control of her ED blood gas analyzer. She knows instantly not only the condition of the patient, but also that the nurse operator is properly trained and qualified, and she knows the detailed status and performance of the instrument. She has captured all this data electronically. In short, this lab director has all of the information and documentation required to manage the clinical and regulatory requirements of the point of care (POC) solution.
Sound too good to be true? This is reality for lab directors who have harnessed the advantages of connectivity solutions within point-of-care testing (POCT). It is well known that the right connectivity solution in the POC setting can bring benefits to hospitals in areas such as data management and remote instrument management. However, it’s the less-than-obvious win-win advantages for the central lab and health care professionals that are too often overlooked. Labs in particular gain tremendous benefits from improved workflow, cost savings, and improved regulatory compliance delivered through POC connectivity solutions. It can even be argued that while the lab, health care team, and hospital benefit from the right POC connectivity solution, ultimately it is the patient who gains.
It’s a Control Thing
When considering POC diagnostic systems, lab managers must look at myriad issues. The need for quality control and compliance, appropriate personnel training, ongoing maintenance, reporting capabilities, and rapid workflow are all concerns that influence a lab manager’s decision when implementing a POC program in his or her hospital. All of these important issues make a compelling case for an appropriate solution that empowers the lab director to control the bedside testing process.
Take, for example, the director who implements a POC blood gas testing program. While intrigued by the promise of more efficient workflow for the nursing staff, and better and faster delivery of care, the loss of control over the blood gas analyzers is daunting. Losing control of POC blood gas instruments manifests itself as a huge regulatory compliance headache for the director. The appropriate POC connectivity solution can provide control to the lab, make regulatory compliance a simple task, and improve workflow processes along the way.
Part of the real value in a connectivity solution for the lab manager comes from controlling the day-to-day POC program administration in compliance with rules and guidelines of inspection bodies, while reducing cumbersome paper-based processes. In the example of the POC blood gas program, the ability to lock out individual sensors, analyzers, and operators prevents instruments with performance issues and unqualified operators from generating patient results. For hospitals that cannot afford to deactivate an entire analyzer when only one parameter is not operating properly, the ability to remotely lock out individual sensors is a powerful feature. This can help to ensure that all sensors being used to generate patient results are accurate and within specifications. It also relieves the lab manager or POC coordinator from the prospect of running around the hospital activating or deactivating sensors or entire analyzers.
Lab managers are also able to maintain control of routine maintenance of POC analyzers and local regulatory requirements with help from their connectivity solution. While the traditional method of documenting maintenance actions is using a logbook for each analyzer, these can be difficult to access and read, are subject to loss, and are much more cumbersome to review than reports generated and stored on a connectivity-based solution. Connectivity solutions can track scheduled maintenance, remind supervisors when maintenance is due or overdue, alert when deviations are made from manufacturer’s recommendations, and provide the opportunity for written comments that explain troubleshooting and system restoration actions. Not only are all of these critical points of inspection, but they also help maintain overall control of system performance.
Further time-saving and workflow efficiencies are achieved from POC connectivity solutions that differentiate calibration samples from patient samples. This is important because many hospital LIS systems have a severe limitation by not capturing calibration results. Many POC connectivity solutions allow for differentiation between the two sample types; calibration results are then filed and reviewed separately. This means far less time is spent managing calibration data, and calibration history reports can be kept inspection-ready at all times.
Finally, a POC connectivity solution provides further advantages in that all of these above aspects are integrated into one system. For example, the slight shift in QC values that appear on Levey-Jennings charts can easily be explained by the sensor change recorded in the maintenance section. Facts can be readily tied together by simply clicking a mouse rather than fumbling through volumes of maintenance, calibration and QC logbooks. The right connectivity solution gives health care institutions the necessary boost in efficiency they are trying to achieve, while providing the lab manager with the necessary control to run a successful POC program.
Back in the Black with POC Connectivity
For a lab director, the appropriate POC connectivity solution can transcend the important benefits of controlling remote analyzers and improving workflow processes. Connectivity can also benefit a hospital’s POC program from an economical point of view. As hospital budgets continue to tighten, a properly implemented connectivity and data management system can provide both tangible and intangible financial benefits.
Thinking back to the lab director who implemented a POC blood gas testing program, the appropriate connectivity solution can provide measurable cost savings to that facility realized through data concentration. Lab directors should consider the dollars that can be saved by consolidating all data, regardless of how many blood gas instruments the facility has in use across its system, through one interface enroute to the LIS or HIS. In order to electronically deliver testing results to where they need to be, an interface must be written. Interfaces require software coding/customization and ongoing support from LIS vendors. These interfaces are a valuable source of revenue with LIS vendors, and prices are rising all the time. By using a connectivity system that concentrates data generated by several analyzers, a hospital can establish a single interface into the LIS that has the same performance as one interface for each analyzer. And this is not pocket change; savings can amount to tens of thousands of dollars annually depending on the size of a POCT program.
Beyond cost savings, the appropriate POC connectivity solution helps a health care institution by ensuring the facility properly codes for diagnostic tests and receives appropriate reimbursement. Even in today’s most modern and sophisticated hospitals, in many cases, tests that are fully reimbursable are left unrecorded and unreported simply because no easy and automated way of tracking has been implemented. This means several thousands of dollars are left unnecessarily unclaimed each year. These are dollars that, if collected, would go straight to the hospital’s bottom line.
In addition, the appropriate POC connectivity solution offers a host of less tangible benefits that also impact a hospital financially. Remote troubleshooting and monitoring of analyzers and faster restoration of analyzer faults means staff can spend less time maintaining equipment and more time caring for patients. Reduced transcription and data entry effort and reduced time needed to prepare records for inspections can allow testing supervisors to focus on their many other responsibilities. More time spent on other facets means a hospital’s testing program can be made as efficient and cost-effective as possible.
The Point in POC Connectivity
With limited resources, intensifying cost pressures, decentralized patient information, and increased regulatory scrutiny, health care today is more challenging than ever before. In this complex landscape, lab directors are challenged to put in place diagnostic testing practices that can help alleviate some of these challenges. While POC diagnostic testing may provide the salve for a health care facility’s ailments, lab directors should investigate POC connectivity solutions that help to maintain remote control of analyzers and, in the process, improve quality control and compliance efforts, minimize workflow constraints, and help assuage economic pressures. While it can give a much-needed boost to the bottom line, an appropriate POC connectivity solution can also have far-reaching effects on a hospital’s ability to efficiently provide diagnostic answers. Accomplishing both of these is the point in POCT success.
Michael Dalton is VP of marketing for the Diagnostics Division of Bayer HealthCare LLC.