College of American Pathologists
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Road-testing a connectivity solution

March 2001
Anne Paxton

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William Beaumont Hospital in Royal Oak, Mich., a 929-bed tertiary-care facility with devices from 20 different point-of-care testing vendors, is eager for a comprehensive connectivity solution.

Dr. Frederick Kiechle, Beaumont’s director of clinical laboratories, says the hospital has reached the point of imposing a moratorium on new POC programs. "We just can’t afford to hire more people to do POC testing coordination. We’re overwhelmed with manual checking of results, QC records, maintenance records-all of those things."

The hospital’s POC testing program has been using a connectivity approach from one glucose testing manufacturer, which offers devices that store data, and a laptop to download the data periodically from the individual devices. "The only software we have handles glucose, and it’s done in the traditional format where the machine is docked to a station that simply keeps track of the data," Dr. Kiechle says. "That data is not interfaced or connected to any other device. We walk up with the laptop and download it, and the frequency of downloads depends entirely on the volume of work."

Volume, in fact, was the main problem when Beaumont recently tested a version of Medical Automation Systems’ RALS-Plus connectivity system as part of a pilot project on five of its nursing units. Each nursing unit has one to three computer terminals for Beaumont’s HIS, called Ulticare, and sometimes one terminal per patient room in the ICU. Laboratory test orders may be placed in that computer, which also has special screens for POC testing. "We have screens for everything, even fecal occult blood and a variety of other tests that don’t have a machine with any kind of electronic output," he says.

This system works much better than those at most institutions, Dr. Kiechle believes. "The situation at many other hospitals is total chaos. Many results are recorded in the nursing notes or on random pieces of paper. We’re lucky we have computer screens where you can actually input the data."

However, the computer requires entry of several pieces of data about the POC test before a result can be entered, and the process can take several minutes. "On some floors, our hospital has over 100 percent occupancy, and when that happens they don’t take the time to do [all the data entry]. So now the computer doesn’t have all the POC results.

"In the worst-case scenario, the MD comes in in the morning to do rounds, walks up to the Ulticare terminal in the doctors’ lounge, and downloads all the diabetic patients’ glucoses for the previous day and night. Then he’s walking around with these results, making decisions on how to change therapy, and he may in fact have only 50 percent of the laboratory point-of-care test data," Dr. Kiechle explains. "That’s the problem we’re trying to fix with MAS."

As envisioned, the RALS-Plus system would interface with the HIS’ admission/discharge/transfer program, which tracks where patients are in the hospital, and would check for authorized users and bar-coded patient identification, then download the POC test result via an infrared reader docking station, enter the result in the patient record, and generate an accession number for billing.

In the pilot test, "the operators we trained were very positive, very excited, because it frees up their time, it shortens the complexity, and it makes it possible to really do POC testing with the same kinds of checks and balances we have in the laboratory." But Medical Automation Systems realized it needed to revise the software to handle the high number of POC tests Beaumont conducts.

"We’re still very enthusiastic we’re on the road to the right solution; it’s just that the solution we brought in couldn’t handle the volume of transactions, which was astronomical," Dr. Kiechle says. When the revisions to RALS-Plus are completed, Beaumont expects to be one of the first hospitals to install the software, probably by mid-2001.