At first glance, the need for centralized connectivity of point-of-care (POC) instruments may seem conceptually at odds with the primary benefit these devices provide. Indeed, caregivers generate results and may well have acted on them by the time POC staff can view test data on their middleware server.
Nonetheless, the value of POC connectivity has risen steadily in concert with the growing importance of informatics in care delivery. Connectivity not only facilitates dissemination of clinical data to caregivers across the house but also provides numerous advantages to laboratorians under the broad heading of compliance management.
POC connectivity enables labs to keep central oversight of quality control (QC), device management, and user database and competency management, while also supporting automated billing. Put simply, POC connectivity enhances POC staff productivity and helps manage a growing POC program without the need to increase staff.
Unlike hospital laboratories where all employees involved in testing report to a lab manager, individuals who perform POC testing are dispersed throughout facilities—nursing staff on care units, anesthesia personnel in operating rooms, respiratory therapists, radiology technologists, and physicians. None of these caregivers actually answer to any lab personnel, making compliance a formidable challenge.
Managing how these end users interface with POC instruments is a key objective of POC connectivity. By using devices’ operator lockout features, POC coordinators effectively limit instrument access to staff who are current with their mandatory competency assessments. Connectivity also enables timely reporting of results. Each result flows automatically to patients’ electronic medical records, giving the entire care team rapid access to POC data.
In addition, POC connectivity makes possible automated billing for all POC tests. Connectivity also enhances lab staff’s ability to pull quality management reports, review QC in a timely manner, and efficiently manage the instruments. Finally, POC connectivity promotes overall improved documentation for compliance management with minimal paper files.
Here at Duke University Hospital, I currently oversee eight instrument types and 655 instruments connected to our POC data management system, versus 90 glucose meters connected to a server located in the POC office when I started in 2001. Based on my experiences in this POC connectivity journey, I recommend that labs seeking better POC connectivity first research the available options, a somewhat daunting prospect given that POC middleware solutions are constantly changing. It helps to establish connectivity goals and identify the best scalable solution to accommodate the program’s growth projections.
Another crucial step is to gather key players and discuss POC connectivity goals. This early support and buy-in is an essential ingredient for success, as the connectivity journey isn’t a 400-yard sprint, but rather a marathon that may take years to fully implement with commitment and coordination of financial, technical, and information technology resources.
Armed with a clear understanding of the program’s needs and institutional support, key stakeholders acting as a committee should assess connectivity systems and determine their top two or three choices. I recommend visiting similar-sized institutions to see what they like and dislike about their software and how they use it in live production.
After signing on the dotted line, the next step is to build a test system exactly as the production system will be expected to function. There are many considerations at this juncture, such as whether instruments are shared between units and whether operators float among different units.
This also is the time to decide if operator competency will be managed within or outside of the new system and to determine whether any renovations, including more outlets and ports, are needed. Finally, the design phase is when the system’s evaluation criteria, alert values, and instrument comments should be addressed.
Once the test system is duly configured, put it through its paces by operating a POC instrument as if it were in a production environment. And this is no joke: Try to beat the system by thinking like an operator. Skip steps or use shortcuts to speed through the recommended workflow. Finding these vulnerable spots during testing will enable the evaluating team to configure the system to avoid them, and also to ensure the system works only as intended.
After testing ends, I strongly recommend a phased go-live. This helps identify unforeseen issues and, if necessary, enables the system to be taken down with minimal impact. Adding additional instruments will become a progressively faster and smoother process as implementation moves forward.
There’s no question, the journey to full POC connectivity is long and arduous and puts a lot on POC staff in developing a plan, maintaining momentum, and reaching project milestones on schedule while also adhering to current program standards. Yet by celebrating victories along the way—no matter how small—the team will keep its eyes on the prize, as each represents an incremental improvement in quality and/or patient safety and will sustain the group through many months of effort.
Christiane Nooney, MHA/MBA, MT(AMT), is a POC specialist and laboratory supervisor with Duke University Hospital’s POC testing program. +Email: [email protected]