College of American Pathologists
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Spectrum of connectibility
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February 2002
Anne Paxton

Looking at the full range of point-of-care devices, Christopher Fetters divides them into four levels of electronic sophistication. The first and most basic group includes manual testing that is visually read, with no batteries or electronics.

"Level 2 is marginally connectible devices," Fetters explains. "They may have a plug in the back of the instrument, often attached to a simple printer or simple download. So you may get results, and a couple of pieces of information off the devices, but the problem is there is not enough to complete the patient record—no date and time, no indication of whether QC was done, no operator or patient ID." This category may require results to be entered manually, or it may simply print results out on a strip that somebody tapes into the patient record.

Many of the glucose meters, and some blood gas and coagulation instruments, have arrived at Level 3, crossing the threshold into electronic record-keeping. They’re able to collect all the information making up a full patient record: patient ID, comment code, result, operator ID, date, time, quality control—"anything needed for a legal result." These devices need connectivity, but are primarily batch-download devices that have a certain amount of memory and transmit data from several patient episodes when they are hooked up to the LIS.

"Level 4 includes continuously connected devices, which collect all the information necessary and send the result to the laboratory right away. The big blood gas meters are capable of this," Fetters says. "But I don't necessarily think Level 4 is optimum as it stands today, because typically the devices are larger and it only makes sense to keep them connected all the time. We don't carry them around." There are no glucose devices now that can be at the patient's bedside and still be continuously connected, he says—"but for the wireless glucose meters of tomorrow, that would be the best of both worlds."