The Future of POCT: Wireless Connectivity

James H. Nichols, Ph.D., DABCC, FACB

Wireless technology has exploded over the past few years. Telephones, Internet, blue tooth, text messaging, and even home theater speaker systems have become wireless. Currently, there are more than 3 billion subscribers worldwide to mobile cell phones. (1) In mature markets, like Japan, cell phones have over 100 percent market saturation with some consumers subscribing to multiple phone accounts for business and personal use. (2) Nearly 13 percent of U.S. households use cell phones as their only phone service (3), and over 34 percent of United States Internet users logged on using wireless networks mostly through their cell phone or personal digital assistant (PDA). (4) The volume of text messaging traffic doubled in just one year from 9.8 billion messages to 18.7 billion messages between 2005 and 2006. (5)

Healthcare has traditionally lagged behind manufacturing and industry in adoption of new technologies, like automation. However, the demand to reduce medical errors and save healthcare costs is driving the aggressive adoption of smart phones, tablet PCs, and mobile workstations for physician order entry, prescribing and managing electronic medical records. In a 2004 survey, more than 80 percent of healthcare organizations had deployed wireless local networks, and 60 percent were already utilizing or considering implementing wireless information systems, handheld devices, and PDAs in a variety of clinical applications within the year.(6) These numbers indicate a greater acceptance of wireless technologies in healthcare than other industries like banking and manufacturing where only a few specific applications of wireless are being used.

Only point of care testing (POCT) has lagged behind the other wireless markets. However, we can expect to see a rapid demand for wireless POCT connectivity once some of the technical limitations of this application have been resolved. These limitations include battery life, standardizing the communication format, and middleware compatibility.

Wireless communication places a heavy demand for power on batteries. This coupled with the demands of the analytical process have limited the ability of delivering wireless in a lightweight, handheld device. One POCT vendor currently utilizes a carrier to hold the batteries, but the device must remain docked in the carrier to allow wireless communication. The operator must still manually initiate the wireless data communication. Together the carrier, batteries, and meter allow portability of laboratory testing to the patient, and allow the benefits of wireless communication of results to a laboratory or hospital information system. The developments of the laptop industry will certainly benefit POCT in the future with smaller power sources and longer battery life for the shared demands of testing and wireless.

There are a number of different communication formats in the wireless industry. Most popular in the U.S. are 802.11 and Bluetooth, but cell phones utilize a different standard. Each has advantages and disadvantages in terms of range, power, interference with medical devices, and ability to connect through the building materials (concrete, brick, and steel). Since each communication format is mutually exclusive, POCT manufacturers are hesitant to invest too much money in one format over another, should the healthcare industry move towards one standard. Once hospitals have fully deployed their networks, POCT manufacturers will start adopting the industry trend.

All POCT devices require software to manage data and results prior to documenting in the patient’s record and billing. No POCT devices can directly connect to laboratory or hospital information systems, and all devices require periodic updates of operator, reagent and control information to function. Connecting to this middleware (software and data management systems between the device and the laboratory or hospital information system) currently requires docking the device into a holder that is connected to the organization’s intranet. These docking stations can be shared by several devices, although each docking station requires an IP address to identify their location over the network. As POCT devices move to wireless communication, the device must identify itself over the network, so each device must acquire an IP address. Many institutions are limited in the number of available IP addresses, and adding IP addresses to an existing network can be expensive. So, implementing wireless requires advance planning, funding, and budgeting.

Wireless POCT, on the other hand, offers a number of benefits, including real-time availability of test results, reduced medical errors, and potential for improved patient outcomes. The primary disadvantage with current POCT connectivity is the need to dock the device before results and data can be transmitted. Results can sit in a device for several hours, days, or even weeks if staff does not remember to periodically dock the device. This delays the ability of clinicians to view and utilize POCT results in the medical record, and may cause insurance denials from late billings. With wireless connectivity, POCT results will be transmitted as soon as testing is completed. Physicians will be able to view results in real-time and billing will be completed promptly. Wireless connectivity is automatic, without requiring intermittent device docking. This allows the operator to focus on the patient rather than the device.

While POCT data management automates the documentation of test results, a current problem with this data management is the ability of the operator to enter incorrect patient identification into the device. Only after the device is docked and transmits results will the data management system reject and hold those results that do not match an active patient account. The operator can perform the test and there is no means of matching the result to an actual patient, or worse, results could end up in the wrong patient’s chart. Barcoding has reduced but not eliminated these errors, since patient wristbands can be barcoded with the wrong billing episode, inactive accounts, and even different patient’s identification numbers. With wireless technology, a POCT device has the potential to check the admissions and discharge database for each patient, before allowing testing to occur. If the identification matches an active patient, the POCT device can then display the patient’s name and birth date, or medical record number and require the operator to confirm the information before testing. This provides a secondary check on patient identification required by some healthcare accreditation agencies. Outdated account numbers and wrong episodes would flag the operator with an error and require reentry of correct identification before allowing testing. In this manner, wireless can reduce the potential for medical errors.

Once adopted, wireless POCT will open the future to a spectrum of possible applications. Consider the ability to assist operators with troubleshooting during testing, by sending internal error flags to the vendor and displaying corrective action responses tailored to the problem that the operator is encountering. Patients with home glucose and coagulation meters could have their results sent wirelessly to the physician’s office, where the physician can analyze the results and send back a message regarding dosage and other treatment changes. This could occur in real-time by combining the patient results with a computerized treatment or dosage algorithm customized to the individual patient. Proficiency testing results could be wirelessly sent to a regulatory agency where they could be reviewed in real-time and a grade rather than a result sent back to display on the device. When one thinks of how the i-Phone has revolutionized cell phones since its introduction a few months ago, the possibilities of marrying internet with video with POCT devices can bring a new level to individualized patient care in the future. This future certainly looks bright, and we have only to wait for the widespread availability of wireless on POCT devices to realize these benefits.

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