Abstract
Christopher P Price and Andrew St John
Washington, USA: AACC Press, 2012
160 pp, Price £45.86
ISBN 978-1-59425-143-6
As the authors state from the outset, this is not a book about point-of-care testing (POCT) technology but an exploration of how POCT can be used to address the challenges of meeting the healthcare needs of the 21st century and, in particular, the delivery of a more patient-centred approach to care. As such it is an extremely useful resource for any healthcare professional involved in the commissioning, planning or delivery of POCT services.
The first chapter provides an interesting discussion about innovation in healthcare and identifies POCT as a ‘disruptive innovation’, i.e. an innovation that disrupts the current system to achieve significant change. In the context of healthcare this type of innovation recognizes the patient as the customer and looks to address his/her needs including better access to care, improved quality of care and better value for money. This is an important change in focus for those of us who have worked within healthcare systems which have traditionally seen the purchaser and provider as the customer.
The authors are careful to highlight that POCT, as the ‘enabling technology’, will not deliver the innovation alone. They advocate a systems approach to understanding the role and benefits of POCT within the process of care as a whole. Using well-written conceptual explanations and a broad range of illustrative examples, they discuss the place of POCT within the often complex care pathway. They describe how POCT can achieve benefit including improved clinical decision making, more productive physician patient interaction and more effective and efficient healthcare. I found the emphasis on a care pathway-based approach to service design, and how this can be developed, for example utilizing the Map of Medicine pathways, informative not only in the context of POCT but also for clinical laboratory services as a whole.
Perhaps the most practically useful chapter in this book is Chapter 3, ‘Achieving Innovation with POCT: Developing the Informed Business Case’. We are all familiar with the difficulties of translating research and innovation into routine service and of generating a comprehensive business case. In this chapter, the authors discuss these barriers and challenges at length. They provide useful guidance on considering the evidence base, describe the use of modelling techniques to assess the effects of the proposed interventions on the care pathway and present a detailed outline of the different approaches to economic evaluation. The final chapter is also of use in this context in providing a systematic approach to assessing whether POCT can be a solution to an unmet need: it includes a number of illustrative case studies which demonstrate the evidence base, the consequent change in the care pathway and the benefits and challenges associated with each example.
Achieving process excellence through Lean thinking techniques and the role of informatics to integrate POCT into the care pathway are also well covered within the book: the latter including such initiatives as the role of decision support systems and the use of telemedicine to help support healthcare professionals and to empower patients by involving them in their own disease management. This leads on to an interesting discussion with regard to the sociotechnical aspects of new technologies and interventions, with the appreciation that, while disruption of existing healthcare practices is the aim, this not only leads to operational changes but also has social and behavioural consequences, e.g. loss of role, that need to be considered when introducing new services.
This is an extremely topical publication which, in my view, has relevance not only to POCT but also to clinical laboratory services in general. The book provides valuable guidance on how to develop services within a changing world of healthcare provision that appropriately puts patients at the centre of service planning and delivery. It is rich in content, easy to read and a valuable resource that I shall undoubtedly return to on a frequent basis.