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Telelaboratory MASSIMO GION

Telelaboratory MASSIMO GION. Tele-laboratory. Goals of National Health System Governance. Improvement of Health Care Cost Containment. Tele-laboratory. Goals of National Health System Governance.

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Telelaboratory MASSIMO GION

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  1. Telelaboratory MASSIMO GION

  2. Tele-laboratory Goals of National Health System Governance • Improvement of Health Care • Cost Containment

  3. Tele-laboratory Goals of National Health System Governance • Control or reduction of inefficiencies in the consumption, production or allocation of health care services that contribute to higher than necessary costs • Inefficiencies in allocation occur when health services could be delivered in less costly settings without loss of quality

  4. Tele-laboratory Control or reduction of inefficiencies in the allocation of health care services • Restrict services delivered in clinical settings to high specialized care health • Share out intermediate or low complexity procedures and medical services

  5. Tele-laboratory • Sharing out intermediate or low complexity procedures and medical services • The possible positions of Laboratory Medicine • Large, centralized, high throughput, clinical laboratories • Decentralized Point Of Care Testing. Also known as: • Near-patient testing, • Alternate-site testing, • Patient-focused testing

  6. Tele-laboratory Large, centralized, high throughput, clinical laboratories • Pros • Mature and highly competitive technology and organization • Cons • Need to move patients or biological samples • TAT increasing with distance • Probably inadequate to critical logistic areas

  7. Tele-laboratory Decentralized Point of Care Testing • Pros • Very short TAT (no need to move patients/samples) • Shorter brain-to-brain time (decision making process) • Reduction of indirect costs • Cons • Relatively early stage of development • It faces many challenges (i.e. technical, regulatory) • Risk of large but opportunistic diffusion, eventually leading to: • decreasing quality • increasing direct costs

  8. Tele-laboratory Risk of large but opportunistic diffusion Theoretical or concrete risk ? • A survey assessing the use of POCT in 484 US hospitals projected that POCT would double within the next 5 years to become a $950 million market and … • … perhaps eventually constitute as much as 40% of all laboratory testing

  9. Tele-laboratory Health Optimum Market Validation of POCT: Objectives • Optimize the use of human resources; • Reduce the cost of this high-volume medical procedure; • Reduce time gaps between tests and the availability of results and their handling by the prescribing doctor; • Avoid deregulation in POCT deployment.

  10. Tele-laboratory Health Optimum Market Validation of POCT: Steps • Setting up of a network for POCT in in-home services and homes for the aged or rest homes • Running the services above over the trial period; • Verifying the acceptance of POCT by the users in the pilot sites; • Measuring the impact of POCT on the quality of the care delivered • Measuring the economic impact on the cost of delivering care

  11. Tele-laboratory Overall description • Both withdrawals and tests are carried out by professional personnel in peripheral sites ; • Exams results are guaranteed with Quality Control and with validation carried out by laboratory specialists; • POCT are managed by a centralized management system driven by laboratories specialists; • POCT data are integrated with the laboratory informatics architecture (data obtained by POCT become an unique gathering with central laboratory LIS)

  12. Tele-laboratory: Home Care Assistance Sites Geographical references – System trial Padova Central Hospital, District No.3, IRA Padova Treviso Ca’ Foncello Hospital , District No.1, Casa Marani RSA Venezia Central Hospital, District No.1, S. Giovanni and Paolo RSA Verona S. Bonifacio Hospital, District No.4, Cologna Veneta RSA

  13. Tele-laboratory: Home Care Assistance Sites Geographical references – System testing Rovigo Central Hospital, Trecenta Hospital Vicenza San Bortolo Hospital Pneumology Department (in-hospital and territorial services)

  14. Tele-laboratory Health Optimum Results

  15. Tele-laboratory Validated Workflow • Needs assessment • Identify patients type to be tested • Gain commitment from laboratory, nursing and medical staff and any other department, including top administration • Select methods and instruments • Develop test procedures • Establish quality assurance procedures • Develop a protocol to integrate POCT data into LIS • Develop risk management protocols • Identify instrument users • Plan and perform users education • Monitor and get feedback (changes and improvements)

  16. Tele-laboratory Scenario: In-home services (ADI) Indicator: Turn around time between lab test order and availability of results (TAT)

  17. Tele-laboratory Scenario: Homes for the aged (RSA) Indicator: Turn around time between lab test order and availability of results (TAT)

  18. Tele-laboratory Health Optimum Market Validation of POCT: Steps Health Optimum Market Validation of POCT: Conclusions • Setting up of a network for POCT in in-home services and homes for the aged or rest homes • Running the services above over the trial period; • Verifying the acceptance of POCT by the users in the pilot sites; • Measuring the impact of POCT on the quality of the care delivered • Measuring the economic impact on the cost of delivering care • Eight pilot POCT units have been activated in 4 in-home services and 4 homes for the aged • The POCT services have operated over the trial period • The compliance with POCT by the users was excellent (education plans improved both skill and acceptance) • A substantial shortening of turnaround time was obtained using POCT. This is expected to have a positive impact on both the quality of care and cost of delivering care

  19. Tele-laboratory Contacts Dr. Massimo Gion Clinical Chemistry Laboratories Director ULSS 12 Veneziana Tel. + 39 041 5294260 massimo.gion@ulss12.ve.it

  20. Back up

  21. Tele-laboratory Agenda • Overall description • Objectives • Test panel • Geographical references • Conclusions • Situation in Veneto Region • Back-up

  22. Tele-laboratory Point-of-Care Testing (POCT) • It brings laboratory testing to the site of the patients rather than obtaining a specimen and sending it to the laboratory • It is used in a variety of settings such as: • Emergency department, • Operating suites • Phisicians offices • Nursing homes

  23. Tele-laboratory Information Systems • Guidelines • IHE recommendations for tele-laboratory applications; • HL7 v.2.5 messages; • logical actors defined in the workflow: • ADT: It is the system that manages modifications in patients’ personal data, considering access to healthcare structures (i.e. Central Registry system, Laboratory Registry system…). Each Healthcare Unit has to define the system involved in the workflow • Order Placer (O.P.): this system manages the “orders”: it creates them and sends them to their departments; • Order Filler (O.F.): this is a departmental information system that manages orders incoming from Order Placer • POCDM: Point of Care Data Manager.

  24. VENEZIA LIDO Tele-laboratory Demo ~140 km ~2h

  25. Tele-laboratory Health Optimum Market Validation phase of POCT includes the following steps : • Eight pilot POCT units have been activated in 4 in-home services and 4 homes for the aged • The POCT services have operated over the trial period • The compliance with POCT by the users was excellent (education plans improved both skill and acceptance) • A substantial shortening of turnaround time was obtained using POCT. This is expected to have a positive impact on both the quality of care and cost of delivering care

  26. Tele-laboratory Veneto Region: state of advancement • Functional and technical specifications have been defined with consensus agreement; • Suppliers are working to develop standards and specifications; • In order to develop a protocol to integrate POCT data with the LIS architecture, a technical team work is defining specifications for Electronic Health Record.

  27. Tele-laboratory Overall descripion (2) • Results are immediately available for therapeutic choices (no lead time is due to bring biological samples to the central laboratory); • POCTs are managed (QA, result validation) from the central laboratories; • Specialists can use both data from POCT and available historical data from LIS for decision making

  28. Tele-laboratory Point-of-Care Testing (POCT) • A POCT program MUST involve the laboratory in: • development • maintenance • decision-making process

  29. Tele-laboratory Test Panel: • blood urea nitrogen (BUN) • creatinine • glucose • potassium • sodium • prothrombin time (PT) • hemoglobin

  30. Tele-laboratory Where are intermediate or low complexity procedures and medical services provided ? • Extended Care Facility • Alternative Delivery System • Intermediate Care Facilities

  31. Tele-laboratory 3. Extended Care Facility • It is a skilled nursing facility that provides post hospital services

  32. Tele-laboratory 2. Alternative Delivery System • Provision of health services in settings that are more cost-effective than an acute-care hospital, such as: • Skilled and intermediate nursing facilities • Hospice programs • In-home services

  33. Tele-laboratory 3. Intermediate Care Facility • Provision of maintenance services in such facilities as: • Homes for the aged • Rest homes

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