Defining Medical Diagnosis: What is Point-of-Care Testing?

Medical science makes giant leaps every year, it seems. Diagnostic equipment is upgraded and new tests and evaluations make it easier for doctors to treat patients. One of the new, and rapidly growing, advances is Point-of-Care Testing. These tests provide providers with in-depth results and a more immediate look into the causes of illnesses. In recent years, doctors had to wait days to determine the patient’s problem. With new advances, they now are able to create detailed treatment plans for results, sometimes within minutes. These new timeframes help patients overcome their medical conditions and receive treatment earlier.

Definition: What is Point-of-Care Testing?

Point-of-Care Testing (POCT), more commonly referred to as bedside testing, is a type of advanced medical diagnostic testing at or near the point of care (Louie, Tang, Shelby and Kost). In other words, it is the testing performed at the time and place of patient care that doctors and other medical practitioners use to make a conclusive diagnosis (Louie, Tang, Shelby and Kost). Blood samples and other elements needed for testing are collected at the point of care and tested in the immediate vicinity (Louie, Tang, Shelby and Kost). Most areas of care include the patient’s home, at the scene of an accident, at a nursing home, or other place not typically conducive of laboratory testing (Louie, Tang, Shelby and Kost). Physicians use POTC to make medical diagnosis of patients who cannot travel to a testing site or when it is more convenient. Some doctors use POTC in their home office, rather than send samples to another testing site (Louie, Tang, Shelby and Kost).

Most standard testing practices require samples be sent to another, outside facility, for example hospital or testing laboratories (Louie, Tang, Shelby and Kost). Most testing is or mostly confined to the medical laboratory, which required both provider and patient to wait hours or days to learn the results. POTC procedures prevent patients and doctors from having to “guess” the problem or delay treatment in the case of more acute, serious conditions (Louie, Tang, Shelby and Kost). Most POTCs are simple medical tests that can be performed at the bedside, require little effort, and are effective in determining immediate medical concerns (Louie, Tang, Shelby and Kost). Tests aren’t limited to blood samples. For example, \urine test strips and portable ultrasonography both are used to determine cause of symptoms and rule out serious medical concerns (Louie, Tang, Shelby and Kost).

Laboratory test results are often pivotal to critical care decisions. Testing provides physicians with valuable knowledge about the criticality of the patient so that appropriate therapeutic interventions can be made quickly. The purpose of POCT is to provide immediate information to physicians about the patient’s condition, so that this information can be integrated into appropriate treatment decisions that improve patient outcomes, that is, reduce patients’ criticality, morbidity, and mortality. Point-of-care testing can be performed in different environments, such as in the hospital, at home, or at other locations. (Louie, Tang, Shelby and Kost)

Treatment: How Do Medical Professionals Use Point-of-Care Testing?

Providers are focusing more on prevention and early detection, an unheard of approach two decades ago. With digital advances and new POTC options, providers are abler to detect diseases and chronic conditions before they before serious and life threatening (St. John and Price). POTC gives immediate results in non-laboratory settings to support more patient-centered approaches to healthcare delivery (St. John and Price). 

The need to make healthcare more patient-centered is also a global trend and is based on the premise that healthcare should be organized more around the patient rather than the provider. The growth in self-monitoring of blood glucose, which is by far the largest segment of POCT, is in part a testament to this need for more convenient and, in some cases, more effective care. (St. John and Price)

Sensor technologies are the next generation of POTC. These systems allow doctors to rapidly analyze blood samples for several critical care assays, including blood chemistry, electrolytes, blood gases, and hematology (American Association for Clinical Chemistry (AACC)). Other areas looking to benefit from advanced POTC are the diagnosis and treatment of cancer, stroke, and cardiac patients (AACC).

Another area of benefit is emergency medicine and disaster response. During Hurricane Katrina, providers used POTC to determine the medical needs for thousands of displaced families (Kost, Tran, Tuntideelert, Kulrattanamaneeporn, and Peungposop). Disaster areas face numerous medical concerns, including accidents caused by the disaster, diseases native to certain natural scenarios, and medical conditions victims already face (i.e. diabetes, HIV, etc.) (Kost, et al).

Disaster-related diseases are often acute in nature, with the most serious requiring immediate triage to emergency and critical care facilities. Chronic diseases are also present and may be compounded by the lack of medical facilities. (Kost, et al)

In their report to the American Journal of Clinical Pathology in 2006, Dr. Gerald J. Kost, MD and his colleagues stated “The use of POC testing accelerates triage, but more importantly, facilitates evidence-based practices necessary for the disaster-emergency-critical care continuum” (Kost, et al). 

Pros and Cons: How Does Point-of-Care Testing Affect Patients?

Medical professionals often sing the praise of POCT and its benefits. As mentioned earlier, physicians don’t have to wait hours, or even days, to determine the results of patient’s tests; they are available within a few minutes, while some are accessible immediately (Burns). But time constraints and mobility aren’t the only advantages POCT brig to the medical arena; special devices programmed to record at-home testing and on-the-field exams now make it possible for doctors to examine patient’s results in real time (Burns). Judy Mangion, M.D., a cardiologist at Brigham and Women's Hospital in Boston, Massachusetts, says she uses a specialized, portable ultrasound, VSCAN, developed by GE Healthcare (Burns). VSCAN is just a little larger than a traditional cell phone, but performs many of the same functions as a traditional ultrasound device (Burns). “These devices do allow you to get ultrasound imaging to people and places that might not easily have access. It does improve access substantially,” the doctor said (Burns). On the other hand, she admits the device, like other POCT tools have their limits and physicians should recognize them (Burns).

However, the device is not without its detractors. Battery life is limited, images generated from the VSCAN device cannot be uploaded to the hospital's picture archiving and communication system, and images are less detailed than full echocardiograms, Mangion said. Additionally, there are no standards for appropriate use, which she worries could lead to unnecessary full echocardiograms. (Burns)

This need for speed could cause serious repercussions. Medical facilities already are creating rules to limit POCT and defining protocols for further use (Burns).

Rushing to make a diagnosis scares many providers. Even Dr. Mangion said these tests “open a can of worms” and “may lead to more comprehensive [tests] being requested” (Burns). If further tests are performed at a hospital or suitable clinic, there are no major concerns, but, if physicians use POCT to continue their evaluations, patients may suffer the repercussions of rushed testing and treatment (Burns). New technologies offer physicians faster ways to help patients, but they also pose a risk of missing crucial conditions (Burns). Dov Frankel, MD, assistant medical director at Sinai Hospital of Baltimore’s emergency care department, said time is important when diagnosing emergency medical problems, like stokes, heart attacks, and other acute conditions (Burns). But he also warns doctors about using these same tests when it comes to chronic conditions. POCT “is no replacement for laboratory testing because the range of values the device can test for is more limited than full lab workups. There is as tradeoff between speed and inclusiveness” (Burns).

Conclusion: Where Do We Go From Here? 

While POTC has made headlines and improvements over the last decade, the process still has room to grow. One growth area is mobile devices. Google Play, iTunes, and several app markets have tools designed to help doctors and patients communicate. Some of these tools allow patients to perform basic testing (i.e. blood glucose and blood pressure) with no assistance from medical providers (Lash). 

With the development of miniaturized devices and wireless communication, the way in which doctors care for patients will change dramatically and the role patients take in their own health care will increase. Health care will become more personalized through tailoring of interventions to individual patients. (Lash)

These new apps and devices will make it easier for doctors to treat patients remotely and with little risk to medical care (Lash). “The next decade will bring a new realm of precision and efficiency to the way information is transmitted and interpreted and thus the way medicine is practiced” (Lash).

Works Cited

American Association for Clinical Chemistry (AACC). “Point-of-Care Testing.” Lab Tests Online. 30 Dec. 2015. Web. 15 Aug. 2016. https://labtestsonline.org/understanding/features/point-of-care-testing/.

Burns, Ed. “Clinicians discuss pros and cons of point-of-care testing devices.” Tech Target. Sept. 2012. Web. 15 Aug. 2016. http://searchhealthit.techtarget.com/feature/Clinicians-discuss-pros-and-cons-of-point-of-care-testing-devices.

Kost, Gerald J. MD, , MS, Nam K. Tran, Tuntideelert, Shayanisawa 

Kulrattanamaneeporn MA, and Narisara Peungposop MA. “Katrina, the Tsunami, and Point-of-Care Testing Optimizing Rapid Response Diagnosis in Disasters.” American Journal of Clinical Pathology. 1 Oct. 2006. Web. 15 Aug. 2016. http://ajcp.oxfordjournals.org/content/126/4/513.

Lash, Tiffany Bailey Ph.D. “Point-of-Care Diagnostic Testing.” National Institute of Biomedical 

Imaging and Bioengineering. N.d. Web. 15 Aug. 2016. https://report.nih.gov/nihfactsheets/ViewFactSheet.aspx?csid=112.

Louie, Richard F., Zuping Tang, MD, David G. Shelby, MT, and Gerald J. Kost, MD, PhD. 

“Point-of-Care Testing: Millennium Technology for Critical Care.” Laboratory Medicine, vol. 31, issue 7, July 2000, pp. 402-408. Oxford Journals, http://labmed.oxfordjournals.org/content/labmed/31/7/402.full.pdf.

St. John, Andrew, and Christopher P. Price. “Existing and Emerging Technologies for Point-of-Care Testing.” The Clinical Biochemist Reviews, vol. 35, issue 3, Aug. 2014, pp. 155–167. U.S. National Library of Medicine National Institutes of Health. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4204237/.