Turnaround time is another. “A turnaround time of 15 to 20 minutes is very different from a turnaround time of 90 minutes,” which is “not workable in an outpatient setting,” he said. Even a 15- to 20-minute wait can be problematic, depending on the platform. “If your cartridge is running at 15 to 20 minutes, and you only have one machine, then you need to be switching that out every single time.” Purchasing more machines, though, isn’t a cure-all. “If we’re going to have five machines running side by side, you’re going to have to hire one person whose FTE is just to put out samples and be able to enter this and integrate this into the EHR.” Thus, there’s more to this than a great test with a good turnaround time, he said.
“These are conversations we’ve had with our clinical leadership. These are such great platforms that we can utilize. But the rub is, how do we implement this?”
Scaling up point-of-care testing will require collaboration.
“Often we’re working in silos,” Dr. Hazra said. “The clinicians have their own needs and barriers and their own priorities that may match or be a mismatch with the lab’s priorities.” All the same, “we have shared goals. We’re all looking for timely diagnoses, equity, and data behind what we are doing,” he said.
“Clinicians, labs, and overall health systems must align to address these barriers and opportunities for maximal impact,” he added.
At the University of Chicago, Dr. Hazra and others established a workflow in which patients who present to the ED for sexual health needs are transferred to the Sexual Wellness Clinic, a collaboration of the ED and the infectious diseases section that provides same-day care, regardless of insurance status, for ED patients whose primary complaint is related to STIs (see “At ADLM, sessions on race, equity, and litigation,” CAP TODAY, June 2025, www.captodayonline.com). “That would be another location where point-of-care testing might play a role,” he said.
“So many patients are relying on our emergency department for sexual health needs,” he said, “but that’s not the best place to get sexual health care, for many reasons.”
Even in systems where the laboratory can get the result to the ED in 90 minutes, ED physicians may not wait, instead treating patients empirically. “In the ER, things are done by an algorithm or workflow. You quickly go down an algorithm to figure out if this patient needs treatment, and you treat them right there.” That culture, he said, would have to be broken for ED physicians to wait 90 minutes for a test result before treating.
Though he acknowledges a 90-minute test is considered a point-of-care test, he doesn’t see it as clinically feasible. “But I think a 15- or 20- or even 30-minute test can put a break into the [ED] algorithm,” he said. Still, stakeholders in the ED have to be aligned. “This can’t be a lab-directed workflow. It can’t be an ID-directed workflow. You need to have stakeholders in the ER who care about this and understand that it will benefit not only their patients but also their overall workflow.”
Importantly, the tests need to be free for patients, Dr. Hazra said.
“We’ve been able to do that for HIV point-of-care testing,” he said. “We need to get to a point where we can provide that same cost—or lack thereof—for STI screening.”
In a world without barriers, cost or otherwise, point-of-care assays for STIs would not have age restrictions, Dr. Hazra said. (Many now are not FDA cleared for patients at the young ages at which some are sexually active.) There would not be restrictions by specimen type, and there would be no restrictions on how specimens are collected, allowing patients to self-collect for all specimen types. Ideally, patients would be able to self-test in the home, too.
“In a perfect world, I would have access to these point-of-care tests for any person who needs this testing done,” he said.
Charna Albert is CAP TODAY senior editor.