Point-of-care testing (POCT) is designed to place devices at or near the bedside and provide results as quickly as possible. However, the distance of these devices from the lab presents a dilemma for getting results into the patient’s chart as quickly as possible. Various connectivity solutions have evolved to deal with this problem.
Some manufacturers’ software enables the result to pass from the device to the lab information system (LIS) and then into the hospital information system (HIS) or electronic medical record (EMR). There are also vendor-neutral middleware solutions that can connect many POC devices, regardless of manufacturer.
When I worked in POCT, I managed more than 170 devices across seven different campuses. I could not be in two, let alone seven places at once, so such a middleware product became my lifeline. Over time, I worked with both the device manufacturers and the middleware vendor to get all devices connected through the middleware. This not only allowed for management of the results crossing into the LIS/HIS, but it also provided a repository for me to track proficiency results, calibration verification data, quality control results and lots, and finally, competency. This middleware became my one-stop shop. New test requests also warranted a look into connectivity capability for the potential device.
A New Language
Digging into connectivity and interfacing a device can be a daunting task, though. Learning to speak IT-ese is like learning a new language. At the 2021 AACC Annual Scientific Meeting, we hosted our Point-of-Care Coordinators (POCC) Boot Camp to help POCCs learn more about key aspects of managing a POCT program. In our Boot Camp, we put together a glossary of commonly used IT terms to help a new POCC learn the language and better understand what their IT partners are speaking about while implementing a new device.
When implementing a new device and setting up an interface, it is essential to keep the project running smoothly. Oftentimes the POCC ends up being the project manager for this. A savvy POCC needs to find a project or implementation plan that works and sticks to the timeline. They will need to collaborate with both the vendor and their hospital IT department to keep things moving along. POCCs should also work closely with the vendor to learn how the new device is programmed and how any additional pieces work to keep connectivity established. This may only happen initially upon setup, but devices break and need to be replaced eventually. Knowing how to set things up is a key sanity-saver for a POCC.
Transmitting results into the patient chart quickly and accurately is also key. Software has progressed now to the point that patient information can flow from the HIS down to the device. This is known as the Admit-Discharge-Transfer (ADT) feed. This allows for the end user to positively ID the patient being tested at the time of testing. This is a key component for a vendor to have and a much-needed feature for the POCC to prevent misidentified patient tests.
Having software at your fingertips that is accessible from anywhere in your hospital network is also key. Inevitably, a device isn’t transmitting and the POCC needs to go up to the floor—or across town—to work on the issue. Knowing how each device connects and how the various components of the connection work are key. Devices may utilize a lantronix box or dongle to aid in transmission, and those boxes have lights. They blink with a certain frequency and often have multiple colors. As silly as it may sound, knowing the blinking patterns and what lights blink when is also key to keeping one’s sanity. This can often help with troubleshooting if one isn’t on the right campus that day.
Managing competency is also a huge task for a POCC. Often, the POCC is the keeper of the records but has no management say over end users. Often, POCCs will work with education teams to assure that competency requirements are met. Explaining lab regulations to these teams and then working with them to meet the requirements is a best practice. Tracking these competencies, however, can be a daunting task. Utilizing middleware may be a salvation for sanity.
I had approximately 2,500 operators in my system. Some operators used upwards of five devices; others used only one. I worked with my middleware vendors and our hospital eLearning system to set up what we termed an eLearning interface for competency tracking. We used the eLearning system to store annual quizzes that linked to procedures, photos, and PowerPoint slides to aid in learning retention. The system also tracked attendance at our annual competency fair, where end users would demonstrate testing and QC competency on devices. They performed troubleshooting at this fair, too. Each year we would aim to keep topics current—usually based on common errors tracked in the middleware throughout the previous year. Their quiz completion, attendance at the fair, and performance of a patient or QC test all transmitted into the middleware. The middleware automatically renewed competency if the conditions set up were met. This saved countless hours of manual renewal each year.
Connectivity can be a game changer when implemented in conjunction with a POCT program. A savvy POCC should create a network of key contacts throughout their organization that will help keep their program running smoothly and allow for troubleshooting should something go wrong.
Kerstin A Halverson, BA, MS, is a clinical applications manager, Acute Care Diagnostics Division, for Werfen North America. Prior to joining Werfen in 2017, she spent 24 years in the laboratory, 17 in POCT. +Email: [email protected]