The next frontier of point-of-care testing

Increasingly, lab professionals are being called on to support appropriate testing in environments that extend beyond traditional clinical settings. On Tuesday afternoon, an ADLM 2026 session, “Addressing scientific gaps in POCT,” moderated by Nicole Tolan, PhD, DABCC, will advise attendees on how labs can address clinical needs across pediatric, rural, remote, and home-based care populations in the point-of-care testing (POCT) context.

Much of the daily work centers on maintaining competency across a large and diverse group of testing personnel, while also supporting the infrastructure required for accessible, interoperable, and clinically impactful POCT.

As healthcare delivery evolves, new testing environments are bringing analytical, regulatory, operational, and environmental concerns to the surface. This raises important questions about where POCT fits, how it should be implemented, and what challenges must be addressed by the laboratory medicine community.

Anyone who oversees pediatric testing knows that product inserts, including their revisions, must be carefully reviewed to identify limitations that may affect results in our smallest patients. The lack of pediatric-specific reference intervals is often the first challenge. Other limitations may involve specimen type (cord or capillary), age, or sample volume requirements that are difficult to meet in pediatric populations.

Dennis Dietzen, PhD, DABCC, FADLM, from Phoenix Children's Hospital, will discuss his experience providing POCT in pediatric settings and the issues that still need to be addressed by the field.  

Distance is a commonly overlooked health equity issue, leading to poorer health outcomes for patients in rural and remote communities. For laboratory medicine, distance has always been a difficult barrier to overcome.

Julie Shaw, PhD, will discuss current POCT offerings in resource-limited and remote locations, along with the gaps that remain. In particular, she will focus on variations in quality between POCT methods and testing performed in the main laboratory.

These differences can have real clinical consequences. For example, how does a remote emergency-department provider manage N-acetylcysteine (NAC) dosing for acetaminophen toxicity when liver enzyme testing is limited and acetaminophen measurements are unavailable? What happens when traceable POCT methods are lacking for diagnosing and monitoring long-term conditions such as chronic kidney disease or diabetes? Drawing on her experience in rural areas of Eastern Ontario, Canada, Shaw will explore these challenges and others related to mobile and remote testing.  

Another evolving area for POCT is home-based healthcare —including hospital-at-home programs and virtual care — which raises additional questions: How should reagent storage be managed? How can connectivity remain secure and compliant? How portable does testing need to be, and what are the analytical tradeoffs?  

Tolan will discuss how she dealt with some of these concerns while working on an inpatient-at-home virtual hospital model during the COVID-19 pandemic.

In that setting, clinicians needed to navigate between main laboratory test results and POCT results during the same patient encounter. Tolan will share her work examining pre-analytical and analytical differences between these testing modalities and how they may affect clinical interpretation.

The continued push to bring testing closer to where patients are reflects real clinical need, but current POCT offerings do not always fully address the rigorous demands for high quality care.