They bring order to many points of care
Jeanne Mumford
Health systems keep growing in size, and so does the volume of point-of-care tests being conducted in their acute- and non-acute-care settings. Needless to say, the management challenges associated with POC testing are growing as well.
For example, who is doing testing in the hospitals and far-flung non-hospital sites? Who is overseeing their qualifications and work for quality control purposes? Is testing equipment monitored for quality purposes? Has anybody tried standardizing test equipment and kits across the system?
Who’s minding the store???
Enter the point of care coordinator (POCC) – an influential person in the health system, and one with whom sales reps should become acquainted.
Jeanne Mumford, MT, is pathology manager at Johns Hopkins Medicine in Baltimore. She has a staff of five point-of-care coordinators, located at two academic hospitals, and oversees quality at three community hospitals, and a physician-office system. She became a medical technologist in 2000, and has been in the Johns Hopkins system since 2010.
Repertoire recently spoke with Mumford about the role of the point-of-care coordinator in today’s hospitals and health systems.
Repertoire: The point of care coordinator: Is this a new position in the industry?
Jeanne Mumford: It’s not new, but given the growth of point-of-care testing, it has become more widely recognized. In the past – and still, to some extent, today – point-of-care testing was overseen by bench techs who wear many hats in the lab. But quality oversight of a well-run POCT is a full-time job. Having other pathology duties in addition to the POCC role is very difficult to maintain.
Repertoire: Describe a typical day in the life of a POC coordinator.
Mumford: One very difficult lesson to learn as a point of care coordinator is that you seldom have a procedure or policy that tells you how to be a POCC – how to work with multidisciplinary teams in clinical settings, or even how to negotiate or work with vendor/industry reps.
Each day brings a unique set of challenges and workload. Adaptation and critical thinking are key skills for this role.
A typical day is spent “putting out fires” or fixing the one hot issue that seems to come up every single day. We inventory our reagents and supplies, and check in with vendors or supply chain for the next shipments and lot number delivery dates. Once we receive new shipments of reagents and supplies, we validate them and distribute to either our central supply folks or straight to the units doing the tests.
We visit our units or satellite sites across the state or region daily, weekly, or on a set month-to-month schedule. With the units and testing personnel, we troubleshoot local issues, communicate changes or updates, and basically check in to see how things are going on a day-to-day basis. Visibility on the units is so important to establishing trust and a relationship with testing personnel.
We also check in and validate new tests and new instruments, which could be replacements for broken ones, and we visit with units that are adding additional instruments. We train and document training and competency on testing personnel – sometimes by the thousands – on the procedures that we write for each test system. We monitor our middleware software for interface errors, manage connectivity, troubleshoot, and work to fix the errors in the system. If we are lucky, this is all done in eight hours a day, 40 hours a week.
Repertoire: In the past five years or so, has the POC coordinator’s job or responsibility been affected by developments in POC testing itself? If so, what POC developments or trends would you point to?
Mumford: Technology advancements do affect the role of the POCC. For the most part, they are positive attributes. Quicker turnaround times, convenience at the patient bedside, smaller instrument foot prints, better methodologies, etc., are characteristics sought after in the point-of-care-testing world just as in the central labs.
Connectivity is the key word here. More and more, point-of-care testing programs across the country are looking to interface their POC tests. In the past, this was an area of IT in which only the central lab instruments fell. One of our new challenges is learning how to work with our hospital and system IT folks to connect and maintain our interfaces with our point-of-care instruments.
Five years ago, across all of Johns Hopkins Medicine, we began implementing a single middleware product, a single laboratory information system, and a single patient medical record. All of our point-of-care instruments are now connected through a single IT platform. This has made my staff’s work much easier than it used to be.
Repertoire: What challenges (or opportunities) are presented to the point-of-care coordinator when the hospital or health system acquires another hospital, long-term-care facility, or a medical group with multiple clinics?
Mumford: Standardization and harmonization are both the blessing and curse when establishing new partnerships.
Standardization is the act of switching all the laboratory/POC instruments and test kits to the same instrument/system. It involves upgrading everyone to one centralized IT platform. From the patient medical record, to the laboratory interface, to the POC middleware, the entire infrastructure should, ideally, be rebuilt to a single platform. The same goes for the central laboratory systems. They, too, should be standardized to one vendor/methodology for financial and clinical efficiency.
Harmonization refers to policies and procedures that cover all facilities under one document or manual. For instance, as we standardize to a single glucometer, we are working to have a single procedure in a manual for all of the hospitals and medical groups. Harmonization also refers to harmonizing all of the laboratory tests.
Another challenge for expanding health systems is finding best practices for workflow, instrumentation, procedures and IT structure. Walking into these institutions and saying, “Switch to our instruments, policies, and workflow,” doesn’t work. It breeds discontent. It is prudent to sit down with all of the business owners and find out what is working and what isn’t working within the current systems. Then, work with purchasing or supply chain and find the right pricing model for your system. Sometimes the right price beats the best technology when it comes to decision-making for acquisitions and new instrumentation.
Repertoire: How involved is the POC coordinator in evaluating and selecting new point-of-care testing systems.
Mumford: In my particular setting – a large academic health system – our point-of-care coordinators are fully engaged in evaluating new POC testing systems. We work with our central laboratory and medical directors to evaluate the analytics of new point-of-care systems. We also work with research units or clinical teams when they perform clinical evaluations on new technologies. For coordinators who lack these resources to evaluate new technologies, networking with POCCs who can offer their data and feedback can help them to stay up to date on new tests.
In a well-organized and well-maintained POCT program, sales representatives approach the pathology department with new technology before “selling” it to the doctors. Our point-of-care coordinators and medical directors test new technologies in real world settings which go far beyond what the CLIA regulations and FDA 510(k) standards call for. Having a symbiotic relationship with manufacturers is the key to unlocking the potential in all technologies. Manufacturers who work with point-of-care coordinators as experts of the products or systems in which they are used can develop instruments and technologies that meet all the needs of the POCT program, current and future.
Repertoire: What are the two or three most challenging “people-related” issues the POC coordinator has to deal with in today’s multihospital system?
Mumford: One challenge is learning how to communicate in a blame-free and meaningful way. It takes time and practice. Also challenging is learning how to help testing personnel from clinical teams understand the regulations that must be followed when performing laboratory tests – as well as the consequences we all face when these requirements are not met.
Clinical teams don’t necessarily “speak the language” of the lab; nor do point-of-care coordinators “speak the language” of patient care teams. (We jokingly refer to these two languages as “nurse-ese” and “lab-ese.”) For example, when we write procedures for the lab tests, we tend to use terms that we understand in the lab and that are in line with our regulatory bodies. But clinical teams, such as nursing, don’t comprehend laboratory lingo, despite their science-based field of study. Conversely, point-of-care coordinators don’t know nursing teaching models. The best outcomes revolve around capturing the most meaningful communication tools to mix the laboratory’s regulatory needs with the nursing/clinical needs.
Clinical teams want to treat patients; they don’t want to do laboratory testing. We try really hard to have relationships with our clinical teams that allow them the time they need to take care of their patients.
Another challenge is the fact that in many POCT programs, lab staff seldom meet with clinical teams on a regular basis to hash out challenges, celebrate successes, and prepare for upcoming changes. Lab staff have their scheduled team meetings, and the clinical teams have theirs. Learning how to schedule time together without filling everyone’s calendars with needless meetings is a real challenge.
Also, point-of-care coordinators lack authority to discipline testing personnel who don’t follow procedures. This goes back to communication skills and how to help testing personnel understand why and how to perform certain tasks. The misconception about POCT is that you put a sample into a device or instrument, you get a result, and you move on with your day. That is just a very small portion of what is done to maintain a point-of-care testing program according to regulations.
One more challenge comes to mind: Disseminating information from the POCT program to all three shifts of testing personnel in every single unit that does point-of-care testing. Some of our programs are so large, and testing personnel can number in the thousands. What’s more, geographic distribution can cover an entire state.