Wireless glucose results—the latest
  in real-time data

October 2007
Feature Story

Anne Ford

More than a decade after tight glycemic control made its debut in the early 1990s, numerous studies, and recommendations from organizations such as the American Association of Clinical Endocrinologists and the American Diabetes Association, have affirmed its ability to decrease everything from mortality and comorbidity to the risk of heart failure and organ damage. But from a point-of-care testing coordinator's point of view, tight glycemic control increases a few things, too.

A few? Make that 1,000—the approximate number of glucose results that point-of-care staff at University of North Carolina Hospitals, Chapel Hill, manage every day. After UNC implemented a TGC protocol a few years ago, "the first thing that I noticed as a point-of-care person was that it required more glucose meters and testing strips, and more data was being generated," says Beverly Robertson, MPH, MT (ASCP), until recently UNC's point-of-care testing coordinator and now a technical service representative for Somerset, NJ-based in Ventiv Health and an authorized installer of LifeScan equipment. In addition to reviewing and charting a greatly increased number of glucose results, the new TGC protocol meant that Robertson was faced with managing more frequent data downloads and data flow bottlenecks. Not only were there more results to deal with, but "all those results were being hand-charted," Robertson says. "And the only way that physicians could review them was to be physically at the nursing locations." In a large institution like UNC, which has 750 beds, 100 units, and nine ICUs, that meant relying on what Connie Bishop, MT (ASCP) SH, UNC assistant administrative director of core laboratories and point-of-care testing, laughingly terms the "sneaker network."

"The travel distance in our institution is huge," she says.

As Robertson discussed in a press conference held by LifeScan at the American Association for Clinical Chemistry meeting in July, UNC addressed these and other TGC-sparked data-management issues earlier this year by implementing an innovative technological solution: a combination of Telcor's Quick-Linc interface product with LifeScan's OneTouch DataLink wireless system. The Quick-Linc/DataLink combination allows UNC staff to access, measure, and track blood glucose results on clinical workstations and laboratory IT systems in near real time. But that's not all. "Keep in mind, once you get those results into an electronic chart, then they can be reviewed by any type of device," Robertson says. "The clinicians can review them in the hospital on the computer equipment—or, in many cases, on a PDA. That data is not only real-time; it's also something that's easy for them to view." In other words, no more sneaker network.

LifeScan marketing manager Theresa Vaughan explains how the system works. A LifeScan product called MeterLink, she says, "manages the raw information sent from the glucose meters to get that information sent into DataLink. And then it's stuck there unless you have some sort of middleware that can take that data and send it to your LIS. Ours happens to be Telcor [Quick-Linc]. In our case, once it's in Telcor, then we have another transfer interface that reviews those results, and after reviewing and matching them, sends it on to our LIS."

Being paired with DataLink, says Telcor executive vice president Becky Clarke, enhances Quick-Linc's already considerable functionality. "We enable the electronic charting, the electronic documentation, the electronic billing. All of those things are triggered by the interface through Telcor," she says. Adding the wireless component "allows them [UNC] to move data from point A to point C—that is, the LIS—in a real-time, seamless manner. Without wireless, nothing is real-time, because you have to walk the glucose device over to a docking station and dock it."

Robertson and her team began implementing the Quick-Linc/ DataLink system in March, beginning with selected nursing services. "Then we just brought on several more nursing services each week until by the end of April we had the entire house—100 units—implemented," she says. Was it a smooth transition? "It appeared smooth to most people. It was a little rocky from the laboratory perspective because our patients are not bar coded, and so we had some patient identification issues that we had to deal with." Those concerns aside, she describes the staff training as "very simple," consisting largely of distributing educational materials from LifeScan.

One issue that arose early on: the need to work closely with the institution's information technology staff. "We have learned that it requires very close coordination with our IT department," Bishop says. "We're now a big user of their systems, and if they make changes in the wireless network, they need to coordinate with us, or else they take us down. They've been very supportive—it's just that we had to make sure we were on the call list when wireless systems were being affected."

"You really need to get the IT department on your team," Vaughan agrees, "because you're limited by their availability. When we work with our customers, we make sure that the person we're working with, whether it be the point-of-care coordinator or the nursing director, involves the IT department early in the process."

Real-time data delivery offers more benefits than just saving clinicians some shoe leather, as Robertson points out. "We have critical values set on all of our laboratory results," she says. "The physician is alerted—by e-mail, by PDA, by whatever their choice has been—if any of the values that the glucose meters are reporting out are within those critical levels." LifeScan U.S. informatics marketing manager Jose Castanon says, "This is something that is actually very exciting, because this level of information continuity and problem response just didn't exist before you had the capability of delivering results in a real-time way."

The Quick-Linc/DataLink system has also resulted in greater staffing efficiency. "We probably would be looking at additional support to the program if we had not implemented" the wireless system, Bishop says. One example: "We interface to a nursing system called eChart, and they [nursing staff] used to have to manually enter all of these results into that system. Now they are electronically transmitted. It's given us a little bit of a reprieve in adding additional FTEs."

Robertson and Bishop know of few other institutions of UNC's size that have wireless capabilities for glucose. "I know a lot of institutions are implementing wireless IV pumps, wireless phones for the nursing staff," and the like, Robertson says, but "the glucose is really cutting-edge." Vaughan adds, "Many hospitals are not actually 'wired' for wireless," so "implementation is really limited by the capabilities of the hospital."

But no one seems to doubt that more and more hospitals will eventually follow UNC's lead. "As more tests are performed at the point of care, the expansion and proliferation of wireless technologies, not only for glucose but for other point-of-care devices, is inevitable," Castanon says. "Traditional modem and network [nonwireless] connectivity solutions rely on fixed docking stations, and there's a real need to improve the rate at which data transfers from the meter to the laboratory information system and beyond."

Wireless technologies are not new, of course, but they're new to point-of-care glucose testing. "This is definitely the future," Vaughan says.