The essential role of information management in point-of-care/critical care testing

Laboratory medicine is undergoing tremendous change in recent years driven primarily by technology, regulations, reimbursement, and market forces. In this paradigm shift, the laboratory is under tremendous pressure to adapt t o new requirements for critical care testing. Indeed, laboratories have ent ered the information age where chemical data is being extracted from specim ens in totally automated fashion. In the past, laboratory data has played a more historical role in the care of critically ill patients, arriving at t he bedside too late to be of significant use in the active, ongoing care of the patient. However, today's physicians taking care of critically ill pat ients now require that laboratory results are made available in real-time a nd, if possible, at the patient's point-of-care. Many new testing point-of- care testing (POCT) devices have been developed to address this need howeve r often laboratories implement such distributed devices with little or no a ttention to the information technology requirements. In fact, as little as 10% of point-of-care testing is actually managed by the central laboratory computer hence critically importance results are not found on the patient's electronic medical record. In addition, the billing and management data fo r point-of-care testing is often handled manually with no plans to interfac e point-of-care devices to the laboratory billing and management systems. B ecause of recent improvements of information handling and interface capabil ity, such shortcomings in data management are no longer acceptable. Indeed, the demands for laboratories to utilize information technology are such th at those laboratories with no overall plan for data management of critical care testing will probably not survive this market-driven paradigm. We pres ent a discussion of the various approaches to computerization of point-of-c are testing including the advantages and the disadvantages of each approach . (C) 2001 Elsevier Science B.V. All rights reserved.