More than a decade after tight glycemic control made
its debut in the early 1990s, numerous studies, and recommendations from
organizations such as the American Association of Clinical Endocrinologists
and the American Diabetes Association, have affirmed its ability to decrease
everything from mortality and comorbidity to the risk of heart failure
and organ damage. But from a point-of-care testing coordinator's point
of view, tight glycemic control increases a few things, too.
A few? Make that 1,000—the approximate number
of glucose results that point-of-care staff at University of North Carolina
Hospitals, Chapel Hill, manage every day. After UNC implemented a TGC
protocol a few years ago, "the first thing that I noticed as a point-of-care
person was that it required more glucose meters and testing strips, and
more data was being generated," says Beverly Robertson, MPH, MT (ASCP),
until recently UNC's point-of-care testing coordinator and now a technical
service representative for Somerset, NJ-based in Ventiv Health and an
authorized installer of LifeScan equipment. In addition to reviewing and
charting a greatly increased number of glucose results, the new TGC protocol
meant that Robertson was faced with managing more frequent data downloads
and data flow bottlenecks. Not only were there more results to deal with,
but "all those results were being hand-charted," Robertson says. "And
the only way that physicians could review them was to be physically at
the nursing locations." In a large institution like UNC, which has 750
beds, 100 units, and nine ICUs, that meant relying on what Connie Bishop,
MT (ASCP) SH, UNC assistant administrative director of core laboratories
and point-of-care testing, laughingly terms the "sneaker network."
"The travel distance in our institution is huge,"
As Robertson discussed in a press conference held by
LifeScan at the American Association for Clinical Chemistry meeting in
July, UNC addressed these and other TGC-sparked data-management issues
earlier this year by implementing an innovative technological solution:
a combination of Telcor's Quick-Linc interface product with LifeScan's
OneTouch DataLink wireless system. The Quick-Linc/DataLink combination
allows UNC staff to access, measure, and track blood glucose results on
clinical workstations and laboratory IT systems in near real time. But
that's not all. "Keep in mind, once you get those results into an electronic
chart, then they can be reviewed by any type of device," Robertson says.
"The clinicians can review them in the hospital on the computer equipment—or,
in many cases, on a PDA. That data is not only real-time; it's also something
that's easy for them to view." In other words, no more sneaker network.
LifeScan marketing manager Theresa Vaughan explains
how the system works. A LifeScan product called MeterLink, she says, "manages
the raw information sent from the glucose meters to get that information
sent into DataLink. And then it's stuck there unless you have some sort
of middleware that can take that data and send it to your LIS. Ours happens
to be Telcor [Quick-Linc]. In our case, once it's in Telcor, then we have
another transfer interface that reviews those results, and after reviewing
and matching them, sends it on to our LIS."
Being paired with DataLink, says Telcor executive vice
president Becky Clarke, enhances Quick-Linc's already considerable functionality.
"We enable the electronic charting, the electronic documentation, the
electronic billing. All of those things are triggered by the interface
through Telcor," she says. Adding the wireless component "allows them
[UNC] to move data from point A to point C—that is, the LIS—in
a real-time, seamless manner. Without wireless, nothing is real-time,
because you have to walk the glucose device over to a docking station
and dock it."
Robertson and her team began implementing the Quick-Linc/
DataLink system in March, beginning with selected nursing services. "Then
we just brought on several more nursing services each week until by the
end of April we had the entire house—100 units—implemented,"
she says. Was it a smooth transition? "It appeared smooth to most people.
It was a little rocky from the laboratory perspective because our patients
are not bar coded, and so we had some patient identification issues that
we had to deal with." Those concerns aside, she describes the staff training
as "very simple," consisting largely of distributing educational materials
One issue that arose early on: the need to work closely
with the institution's information technology staff. "We have learned
that it requires very close coordination with our IT department," Bishop
says. "We're now a big user of their systems, and if they make changes
in the wireless network, they need to coordinate with us, or else they
take us down. They've been very supportive—it's just that we had
to make sure we were on the call list when wireless systems were being
"You really need to get the IT department on
your team," Vaughan agrees, "because you're limited by their availability.
When we work with our customers, we make sure that the person we're working
with, whether it be the point-of-care coordinator or the nursing director,
involves the IT department early in the process."
Real-time data delivery offers more benefits than just
saving clinicians some shoe leather, as Robertson points out. "We have
critical values set on all of our laboratory results," she says. "The
physician is alerted—by e-mail, by PDA, by whatever their choice
has been—if any of the values that the glucose meters are reporting
out are within those critical levels." LifeScan U.S. informatics marketing
manager Jose Castanon says, "This is something that is actually very exciting,
because this level of information continuity and problem response just
didn't exist before you had the capability of delivering results in a
The Quick-Linc/DataLink system has also resulted in
greater staffing efficiency. "We probably would be looking at additional
support to the program if we had not implemented" the wireless system,
Bishop says. One example: "We interface to a nursing system called eChart,
and they [nursing staff] used to have to manually enter all of these results
into that system. Now they are electronically transmitted. It's given
us a little bit of a reprieve in adding additional FTEs."
Robertson and Bishop know of few other institutions
of UNC's size that have wireless capabilities for glucose. "I know a lot
of institutions are implementing wireless IV pumps, wireless phones for
the nursing staff," and the like, Robertson says, but "the glucose is
really cutting-edge." Vaughan adds, "Many hospitals are not actually 'wired'
for wireless," so "implementation is really limited by the capabilities
of the hospital."
But no one seems to doubt that more and more hospitals
will eventually follow UNC's lead. "As more tests are performed at the
point of care, the expansion and proliferation of wireless technologies,
not only for glucose but for other point-of-care devices, is inevitable,"
Castanon says. "Traditional modem and network [nonwireless] connectivity
solutions rely on fixed docking stations, and there's a real need to improve
the rate at which data transfers from the meter to the laboratory information
system and beyond."
Wireless technologies are not new, of course, but they're
new to point-of-care glucose testing. "This is definitely the future,"
Anne Ford is a writer in Chicago.