by Sarah Michaud
Overview of point-of-care testing, technological challenges, and future opportunities.
The DCA Vantage™ system from Siemens Healthcare Diagnostics better manages diabetes patients by enabling quick results and actionable physician-patient conversations at the time of the visit. Point-of-care testing (POCT) technology provides immediate, portable, and convenient medical diagnostics near the site of patient care. POCT's near-instantaneous results allow health care providers to make treatment decisions for their patients in a shorter amount of time compared to traditional laboratory diagnostics. Faster test results translate to rapid treatment for patients—which can save lives in critical care scenarios.
POCT: THEN AND NOW
POCT has been around since the 1980s. Early forms of the technology were mainly used for collecting data, such as measuring blood glucose levels. The clinical and operational benefits of POCT were first evident in the operating room. For the management of cardiovascular surgery patients, POCT technology has been an indispensable aid. The technology has advanced to not only coordinate with financial and reimbursement protocols and inform physician-patient communication, but also to integrate with electronic medical records (EMRs) and wireless and Web technologies.
POCT technology is now used in primary care, emergency department, and intensive care environments. Typical assays include blood glucose testing, blood gas and electrolyte analysis, coagulation testing, cardiac marker diagnostics, drug screening, urine dipsticks, pregnancy testing, fecal occult blood analysis, food pathogen screening, hemoglobin diagnostics, infectious disease testing, and cholesterol screening.1 The most common POCTs used in US hospitals include glucose (99%), coagulation (62%), blood gas (50%), chemistry (36%), hematology (28%), urinalysis (15%), and cardiac (3%) diagnostics.2 In short, POC technology is almost ubiquitous.
POCT systems for detecting pathogens are often easy-to-use, membrane-based test strips enclosed in plastic. Systems for rheumatology diagnostics typically require only a small amount of sample (one drop of blood, rather than an entire vacuutainer), which means no transportation, delay, or preprocessing of the specimen. Thus, POCT minimizes blood drawing from the patient, which makes this process particularly accurate in pediatric and neonatology wards. The lack of sample processing translates to institutional savings.
Benefits of using POCT include rapid decision-making and reduced operating times, postoperative care time, emergency department time, number of outpatient clinic visits, and hospital beds required, ensuring optimal use of health care professional time.
POCT technology may sometimes fall short in accuracy, adaptability to older data management systems, time required to train personnel to use the technology, and high dependence on informational technology support. The following sections address these issues and discuss the potential future of POCT technology.
PERCEIVED POCT BENEFITS
Using POCT streamlines communication between physician and patient, allowing treatment to be started sooner. "I feel that this is the primary advantage of POC testing," says Andrew Schaeffer, senior R&D scientist, Quantimetrix Corp, Redondo Beach, Calif. "The obvious example is use in the hospital emergency room, where decreased disposition time can be expected to lead directly to improved outcome. Hence, the explosion in the use of POC-type cardiac marker testing."
Outcomes can also be improved. "The fundamental value proposition of POC testing is the streamlining of communication and the enabling of improved workflow, patient care, and outcomes," says David Stein, PhD, CEO, Point of Care Business Unit, Siemens Healthcare Diagnostics, Deerfield, Ill. "This includes both hospital scenarios where an improvement in...