The COVID-19 pandemic has driven tremendous innovation in bringing diagnostics and treatment throughout the care continuum down to patients’ homes – and it is not stopping. It is only getting broader in scope and more advanced.
“The evolving healthcare system includes new delivery models in which primary care physicians and nurses are assuming more significant roles, with the patient more involved in decision-making and self-care,” states the National Institutes of Health (NIH) regarding its Point-of-Care Technologies Research Network (POCTRN). “These changes require the development of inexpensive and easy-to-use medical devices and information sharing tools that provide timely health status information at the point of care (POC).”1
While telehealth applications, home tests for SARS-CoV-2 and remote monitoring of vital signs have become commonplace, new technologies for POC imaging and testing are providing clinicians and patients real-time, in-depth knowledge of various conditions and disease states anytime, anywhere.
POC testing drivers and challenges
A global study of 634 healthcare professionals on the evolution of the POC and rapid testing market published in February 2022 found the following top reasons driving patients to self-administer rapid tests: 2
- 77% fast to get results
- 67% easy to use
- 65% easy to obtain
- 57% confidentiality of test result
- 54% saves travel time
- 51% affordable
- 47% less scary than hospital setting
- Among challenges cited in POC rapid testing: 3
- 47% specificity/sensitivity of tests
- 33% cost of tests
- 33% complexity of sampling
- 32% lack of awareness in POC rapid test among healthcare professionals
- 29% lack of trust from healthcare professionals in POC testing
Another challenge is bringing supplies needed to the POC and storing them, as Midmark describes in its white paper, “Point of Care Inventory Control: A Place for Everything and Everything in its Place.”4
UMass Chan Medical School and UMass Lowell researchers surveyed healthcare professionals before and during COVID-19 to explore whether the pandemic altered their perceptions about the usefulness of point-of-care technologies (POCTs). Their findings were published in the July 2022 Humanities & Social Sciences Communications, a Nature Portfolio journal. Key findings include:
- POCTs are not only useful for diagnosing COVID-19, but healthcare professionals also perceive them as increasingly important for diagnosing other diseases, such as cardiovascular, endocrine, respiratory and metabolic diseases.
- Healthcare professionals also viewed POCTs as “facilitating the humanization of epidemiology” through improved disease management and monitoring, and stronger clinician-patient relationships.
- As the accuracy and integration of these technologies into mainstream healthcare delivery improves, hurdles to their adoption dissipate, which encourages healthcare professionals to use them more frequently.
The researchers state their belief that “technological advances made in POCTs during COVID-19, combined with shifting positive perceptions of their utility by healthcare professionals,” may better prepare healthcare for the next pandemic.5
Examples of where POCT is making a difference
A growing number of U.S. health systems are leveraging POCTs to expand diagnosis and treatment, and in some cases, lowering care costs simultaneously. They are also researching ways to apply POCTs to new patient populations and conditions.
For example, Massachusetts General Hospital (MGH) in Boston performs over 600,000 POCTs annually through blood glucose kits, pregnancy kits, strep tests, and others.6 The MGH POCT program team evaluated its testing with regards to regulatory compliance, quality and costs. They found their approach has reduced inspection citations from 3.17 per testing site to 0.27 citations, with a $1.89 average test cost.7
The Mayo Clinic has successfully leveraged remote patient monitoring (RPM) to reduce hospitalizations in cancer patients with COVID-19. Use of in-home technology to assess symptoms and physiologic data, with centralized nursing and physician oversight, reduced the hospital admission rate by 78%. As the researchers noted, even when patients in the RPM group were hospitalized, they “experienced a shorter length of stay and fewer prolonged hospitalizations, intensive care unit admissions and deaths.”8
The Johns Hopkins Center for Point-of-Care Technologies Research for Sexually Transmitted Diseases has been leading development of accurate, acceptable and optimal implementation of POC tests for sexually transmitted diseases (STDs) in diverse care delivery contexts. Researchers from the Johns Hopkins University School of Medicine reviewed the performance and time to result of POC assays for STIs in the last 10 years.
Their research, which was published in the August 2021 Sexually Transmitted Diseases journal, found diagnostic technology for POC assays for STIs has achieved high sensitivity and specificity (>90%) using recent molecular advances in past decade. At the time of the journal article’s publication, the FDA had approved three tests for chlamydia and gonorrhea, two for trichomonas and two for syphilis.9 In 2022, The Johns Hopkins Center offered funds toward the development of POCTs that meet or exceed the current clinically accepted STD POCT assays through its participation in the NIH POCTRN.10
Emerging trends and technologies
As the UMass Chan Medical School and UMass Lowell researchers noted in their published article, COVID-19: a gray swan’s impact on the adoption of novel medical technologies, “the technological trajectory and potential usefulness of POCTs is still in its infancy.”11 Here is a sampling of advanced technologies that have been developed to satisfy the need and desire for POC diagnostics and treatment.
Ultrasound anywhere
Use of point-of-care ultrasound (POCUS) has expanded significantly in the past two decades, beyond emergency and critical care medicine to many other subspecialties.12 Recent research has shown its proven success in supporting hospital at home (HAH) programs to “help providers assess, diagnose, and monitor a range of conditions.”13
“Since POCUS can be performed anywhere, from the chaotic trauma bay of a hospital to the side-lines of a football field, it is important that the user select a system that is designed for these settings…easy to move, probes that are easily accessible, and battery power that can last for the duration of several exams,” Seifriedsberger added. “It’s also very important to select a system that is easy to learn and use. Moreover, these systems should be easy to clean with smooth and seamless surfaces to control infection.”
Imaging throughout the care continuum
Computed tomography or CT scanners are critical tools in diagnostics, enabling clinicians to visualize organs, soft tissue, blood vessels, and bones. They can range from fixed scanners positioned in an imaging suite, to mobile scanners that can be moved from room to room.
The next evolution is bringing CT scanning to patients in their communities, which is what Xoran Technologies is in position to do with its TRON mobile, full-body fluoroscopy, CT X-ray system. The company was granted FDA 510(k) clearance for the device in August 2022.
“This compact, mobile, open-bore device is poised to revolutionize global initiatives to democratize access to diagnostic imaging,” said Xoran CEO Misha Rakic. “TRON is uniquely suited to provide safe, ultra-high-resolution, low dose imaging in traditional settings such as the operating room, surgery center, and critical care unit where space is limited and hospital budgets are stretched thin.”
“TRON’s compact size and weight make it truly nimble without any need for bulky motors and batteries,” Rakic continued. “Because TRON scans take less than a minute, and the system is easy-to-use, it can be further mobilized by placing it in small vans, lending TRON to low-dose screening brought to patients and not the other way around. This means that Xoran’s Vehicle-Based Solutions can be used for community health initiatives and in ambulance and military front-line scenarios.”
Remote patient monitoring advancements
According to Kathryn Gray, Sr. Manager, Corporate Strategy & Business Development, McKesson Medical-Surgical, Remote Patient Monitoring (RPM) has experienced a quick rise over the past couple of years because of a variety of factors: it helps reduce emergency room (ER) visits and hospital readmissions; helps support reimbursement for physicians in areas such as remote therapeutic monitoring; provides availability of affordable and easy to use technology; an increase of patients with chronic conditions; and the onset and continuation of the COVID-19 pandemic.
“A couple bigger headwinds are patient access to the internet and provider staffing,” Gray commented. “We are starting to see more equipment options that are cellular enabled allowing for transmissions where the patient does not have internet access. RPM providers, who understand practice workflow recognize the support services required to get patients setup and trained, as well as do some of the monitoring, are keys to success. This is enabling providers to utilize RPM without requiring more time from the staff.”
Cancer care is one area where virtual care is supporting improved patient care. Skin cancer is a common type of cancer, and early diagnosis and treatment are key to successful outcomes. The SkinIO HIPAA-compliant, AI-driven, virtual skin cancer screening platform allows anyone, anywhere to perform a skin exam in just 10 minutes using their smartphone. It helps identify which marks matter and compare changes over time. SkinIO images are reviewed remotely by expert dermatologists, users receive their results by email in just a few days, and then they are connected to care if they require in-person follow-up.
Wound management is another area where RPM can improve outcomes, and lower care costs. Complex wounds are a huge physical burden on patients, significantly impacting their health-related quality of life. They are also a sizable expense in the U.S., with complex wound management costing our health system approximately $25 billion annually.14
Swift Medical provides an AI-powered, digital wound care platform that allows any clinician to easily capture a high precision image of a wound with their mobile phone, autonomously determines wound dimensions and clinical characteristics, enables virtual wound care consultations, and provides real-time, predictive insights to drive enhanced preventive and personalized care. With the company’s latest product, Swift Ray 1, providers can detect a wound before it breaks through the skin, allowing for early intervention and significantly reduced healing time.
“This kind of care at home is not a replacement for a doctor visit,” cautions Gray. “It allows monitoring between visits so intervention can be provided at the point where it is needed – not next month in an office visit or next week in the ER.”
Gray comments on the future of RPM, stating: “Centers for Medicare and Medicaid Services continues to expand reimbursement for remote care. To support this, we expect to see innovation in areas like medication monitoring and chronic pain management over the next couple of years, along with new innovations that don’t require patients to perform the measurement.”
References:
1. Point-of-Care Technologies Research Network (POCTRN), National Institutes of Health, https://www.nibib.nih.gov/research-program/point-care-technologies-research-network
2. FUTURE OF POINT OF CARE & RAPID TESTING, A GLOBAL STUDY AMONG GPs, HOSPITAL DOCTORS & PHARMACISTS, US, EU, CHINA February 2022, https://www.ipsos.com/sites/default/files/ct/news/documents/2022-03/Ipsos_Future%20of%20POC%20and%20Rapid%20Testing_March%202022.pdf
3. FUTURE OF POINT OF CARE & RAPID TESTING, A GLOBAL STUDY AMONG GPs, HOSPITAL DOCTORS & PHARMACISTS, US, EU, CHINA February 2022, https://www.ipsos.com/sites/default/files/ct/news/documents/2022-03/Ipsos_Future%20of%20POC%20and%20Rapid%20Testing_March%202022.pdf
4. Point of Care Inventory Control: A Place for Everything and Everything in its Place, MidMark, https://cdn.baseplatform.io/files/base/ebm/hpn/document/2022/09/007_10435_00_HPN_Inventory_Control_Cabinetry_Mobile_Carts_Workstations_White_Paper_FINAL.633319deafca3.pdf
5. Dunlap, D.R., Santos, R.S., Lilly, C.M. et al. COVID-19: a gray swan’s impact on the adoption of novel medical technologies. Humanit Soc Sci Commun 9, 232 (2022). https://doi.org/10.1057/s41599-022-01247-9
6. Point of Care Testing, Massachusetts General Hospital, https://www.massgeneral.org/pathology/services/point-of-care-testing
7. Lewandrowski EL, Gregory K, Le J, Goldstein L, Lewandrowski K. Description of a point-of-care testing program in a large urban academic medical center: Technologies, management and program cost. Clin Chim Acta. 2021 Nov;522:127-131. doi: 10.1016/j.cca.2021.08.021. Epub 2021 Aug 19. PMID: 34419463
8. Pritchett JC, Borah BJ, Desai AP, Xie Z, Saliba AN, Leventakos K, Coffey JD, Pearson KK, Speicher LL, Orenstein R, Virk A, Ganesh R, Paludo J, Halfdanarson TR, Haddad TC. Association of a Remote Patient Monitoring (RPM) Program With Reduced Hospitalizations in Cancer Patients With COVID-19. JCO Oncol Pract. 2021 Sep;17(9):e1293-e1302. doi: 10.1200/OP.21.00307. Epub 2021 Jun 4. PMID: 34085535; PMCID: PMC8457804
9. Gaydos CA, Manabe YC, Melendez JH. A Narrative Review of Where We Are With Point-of-Care Sexually Transmitted Infection Testing in the United States. Sex Transm Dis. 2021 Aug 1;48(8S):S71-S77. doi: 10.1097/OLQ.0000000000001457. PMID: 34110728; PMCID: PMC8284360
10. Improvements to Rapid Simple Point-of-Care Tests (POCT) for Sexually Transmitted Diseases (STDs), Johns Hopkins Medicine, https://www.poctrn.org/web/jhu/solicitations
11. Dunlap, D.R., Santos, R.S., Lilly, C.M. et al. COVID-19: a gray swan’s impact on the adoption of novel medical technologies. Humanit Soc Sci Commun 9, 232 (2022). https://doi.org/10.1057/s41599-022-01247-9
12. Lee L, DeCara JM. Point-of-Care Ultrasound. Curr Cardiol Rep. 2020 Sep 17;22(11):149. doi: 10.1007/s11886-020-01394-y. PMID: 32944835; PMCID: PMC7498117
13. How Point-of-Care Ultrasound May Improve At-Home Hospital Care, AJMC, September 3, 2022. https://www.ajmc.com/view/how-point-of-care-ultrasound-may-improve-at-home-hospital-care
14. Labib AM, Winters R. Complex Wound Management. [Updated 2022 Jul 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK576385/
