Like Herding Cats – Information Technology Facilitates Management of Point of Care Testing Systems

Nicole Carney1, Robert Dodds2, Katrina Moreau1, Gregory Sharp1,3,*

1Pathology and Laboratory Medicine, 2Information Systems, Fletcher Allen Healthcare, 3Pathology, University of Vermont College of Medicine, Burlington, VT, United States

Introduction: Point of care testing (POCT), is a rapidly increasing component of US healthcare. Despite advances in technology that “employ methodologies that are so simple and accurate as to render the likelihood of erroneous results negligible” (US Federal Regulations), this is laboratory testing. POCT is performed by large numbers of health care providers with little formal training in clinical laboratory procedures, yet is managed by a small group of laboratorians for whom these issues are paramount. This clash of cultures can make the smooth operation of a system with multiple sites, hundreds of devices and thousands of operators difficult.

Objectives: Our goal has been to bring the same level of quality to POCT as is inherent in testing in the main laboratory. Recognizing the cultural differences that are present we used Information Technology (IT) to facilitate this process.

Methods: With about 2700 operators and fewer than 3 technologists managing the program, a “train the trainer approach” was used combined with educational modules, trainee tracking and email communication in eLearn (the local title of a web based product of NetDimensions). In addition to its educational function, IT was also important for auditing performance and controlling operator access.

Results: As a result of this program, error rates in POCT at sites remain low, and we have successfully passed inspections by regulatory agencies including the College of American Pathologists. Relationships between the different cultures of the laboratory and the non laboratorian testers are very good.

Conclusion: Intensive use of IT and a non-punitive collaborative approach enable a small group of laboratorians to manage a large, rapidly changing group of device operators to perform POCT with a quality equivalent to that in the main laboratory. The elements of training, audit, feedback, documentation, and corrective action are important elements for the quality of testing in both areas.

Keywords: Laboratory organization