The Association for Pathology Informatics (API) and Sunquest Information Systems presented an interesting webinar yesterday entitled: Consumerism in Diagnostics: Retail Testing and the Future of Providers. The main portion of the presentation was delivered by Dan Kerls who is the Director of Ambulatory Operations for MinuteClinics. Mickey Urdea of Halteres Associates, longtime executive and consultant in the IVD industry, also participated and asked a number of key questions and provided background commentary. Bob McGonnagle, publisher of CAP Today acted as the host. Here is the link to the recording of the session.
Dan Kerls discussed various part of MinuteClinic's POCT strategy. Given the fact that there are 1,126 of these facilities in 33 states, lab testing in walk-in clinics will surely be of interest to all lab professionals. For the purpose of this note, I want to focus on the physical size and staffing of these clinics as a major driver for the company's lab testing strategy. Examining rooms for the MinuteClinics measure 12x9 ft. and are staffed by either a nurse practitioner (NP) or physician assistant (PA).
As Kerls explained, the physical space for the examining rooms contains a refrigerator that is used mainly to store vaccines. There is not much extra room for, say, test reagents. Also, there would not be extra space in the room for multiple POCT devices. The company has also decided to only use finger-stick blood samples for lab testing. There are no dedicated bathrooms for MinuteClinic patients so no urine samples are collected. Urine pregnancy tests are performed with a test strip provided to the patient. Only FDA-approved CLIA-waived tests are offered in the test menu and not all of them. Examples of tests that are performed include: cholesterol, HbA1c, strep B, mononucleosis. hepatitis C, and HIV.
Given that each MinuteClinic is staffed by only an NP or PA and the run-time for a visit is no longer than 15 minutes, the following limitations are placed on POCT testing:
- Lab testing is performed only while the patient is with the provider in the examining room.
- The patient waiting area is unattended. Venipunctures could lead to patients fainting.
- The interpretation of any lab test must be within the scope of practice of the NP or PA. MinuteClinic is the largest employer of NPs in the country.
- Rules governing the scope of practice for NPs and PAs vary from state to state.
For additional information, here is a link to a transcript of an interview of Dan Kerls about POCT testing published in 2017 (see: POINT-OF-CARE DIAGNOSTICS IN CVS' MINUTECLINICS).