For a variety of reasons, many health system laboratories have opposed the expansion of point-of-care testing (POCT). POCT, some labs have argued, poses a threat to their very existence, primarily because they believe it could reduce their revenue as more and more testing occurs outside of their core facility. The methods used in POCT have also been characterized by some laboratory leaders as inferior to those employed in controlled and centralized environments; and the non-lab clinicians who provide POCT have often been perceived as unqualified to do so.
And finally, many labs have pushed back against POCT because they see its adoption as a losing business proposition. Most organizations with POCT, they note, ask laboratory leaders to provide oversight of such testing, including training, quality-control monitoring, and troubleshooting as needed. That work only benefits nurses and physicians, the laboratorians argue, and draws valuable resources away from the core lab.
These and other arguments against POCT are receiving a lot of attention in the industry lately. POCT expert Nam Tran, Ph.D., director of clinical chemistry and POCT at UC Davis Health System in California, sheds some light on the other side of the POCT debate.
In Dr. Tran's opinion, laboratory leaders need to accept that POCT's time has come. POCT demand is increasing all the time; if labs ignore that fact and resist supporting POC services, or if they wait for the “POC mandate" to arrive, they risk being seen as late to the game, he explains. “If you're not ready to implement a test that clinicians need, that feeds back into the notion that your laboratory is slow."
Similarly, Dr. Tran notes, labs that delay the introduction of POCT will likely be “forced to implement quickly" in the end, which could wind up delaying other important projects. “A proactive approach is key. Being proactive and working with providers creates confidence that the laboratory knows what they're doing and are leaders for medical testing, including POCT."
Whether your lab likes it or not, POCT “is moving quickly," Tran says. “In the last few years alone, we have seen the FDA approval of CLIA-waived [Clinical Laboratory Improvement Amendments of 1988] POC molecular diagnostics and the push for several challenging and controversial requirements to improve the performance of POCT." Two good examples, he says, are the reclassification of flu testing and the critical care claim for glucose meters. “Many hospitals waited until the last minute to change—and some still haven't changed—delaying their chances to become compliant and also delaying measures that would improve quality of care." It's better to “get ahead," Tran says, “than to be reactionary to POCT."
Last, Dr. Tran notes, it's important to remember that POCT is the laboratory's responsibility as defined by CLIA. Those who oppose it are free to do so, but they're fighting a losing battle given the current trends. “If you don't keep an eye on the future," he says, “your lab will fall behind and lose its perceived medical-testing expertise."
POCT in clinical microbiology may be a pathway to better patient care
By Glen T. Hansen
In 1900, speaking about the clinical and ward laboratory, William Osler, physician-in-chief at Johns Hopkins from 1889 to 1905 said, “They [lab tests] are to the physician just as the knife and scalpel are to the surgeon.”
The pros and cons of point-of-care testing vs laboratory testing
By Lisa-Jean Clifford
Consolidation among hospitals and laboratories can sometimes seem like too massive a tide for independent and hospital-based laboratories to effectively resist. What are the advantages that large size provides to a hospital system or national lab in a competitive marketplace? And will there be any space left in which smaller laboratories can survive?