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POCT Connectivity: 
Opening the Door to a Laboratory Without Walls
American Clinical Laboratory, July 2000, Vol.19, Number 6, p12-13 by Merwyn Taylor, James H. Nichols, and Joel Saltz

The development of point-of-care analyzers over the last 20 years has allowed laboratory testing to be performed at the patient’s bedside. The simplicity and user friendliness of the portable devices combined with the extensive test menu offered have increased their popularity. The POCT market has grown to over 25% of laboratory diagnostics, amounting worldwide to more than $4.9billion annually, and is expected to double within the next 10 years.

However, more than 3000 reports, including 16 deaths have been filed with the U.S. FDA.  With the possibility of hundred of POCT easy-to-use- devices and thousands of operators in a health system, managing the quality assurance of POCT can be challenging. For example, inadequately cleaned blood gas and urinalysis containers have been a source of antibiotic-resistant noscomial infections on the medical unit. Hence, the key to good POCT quality is information management.

The capacity to capture and transmit data from multiple distant devices in a unified fashion provides for review of quality control records, maintenance of operator training/competency records, and monitoring of results for performance improvement will result in continuous quality patient bedside testing. Although different POCT devices have unique ports and connection cables they also have customized data bases that limit access to data from competitive devices and unfortunately, there is no current communication standard for transmission of POCT data. However, CIC (Connectivity Industry Consortium) has been developed to address standardization.

This article discusses one institution’s (Johns Hopkins Medical Institution, JHMI Baltimore, MD) development of a common connectivity for its glucose meters and hemoglobin analyzer. The Johns Hopkins POCT software is a collection of client-server applications designed to transfer multiple analyzer test results to a common central database. The software uses the network connection provided by the HIS computers and thus conserves IP addresses. The server can reside on any Windows-based computer with a full-time Internet connection.

The Johns Hopkins Institution connectivity development has allowed them to eliminate 5 laptop computers required for glucose downloading that also saved 6 full days per download event. Daily result transmission has allowed Hopkins to learn more quickly about problems and attain a new level of quality assurance.

Hopkins’ POCT software currently collects data from 244 glucose meters at 120 locations and 27 hemoglobin analyzers in 17 locations. Also, their system is monitoring over 3400 operators using the Advantage glucose monitor and 360 operators using the HemoCue hemoglobin meter. Operator management and meter management reports are generated from the database

JHMI is now focusing their connectivity attention on remote patient consultation. Plans are to present patient results and educational materials, and coordinate clinical/patient interaction via a Web portal; leverage wireless or fixed digital subscriber line (DSL) or cable modem Internet connectivity to allow remote assessment.

Note: Dr James Nichols, Director of POCT and Associate Director, Clinical Chemistry JHMI is also AACC, Point of Care Testing Division Chair 

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