Mobile Unit with POCT

We have a CT scan mobile unit that rotates within several hospital and clinics within our organization. As part of their protocol of care, this mobile unit check their patient's creatinine prior to the CT scan. 
Once stationed at any of our hospital/clinics, the mobile unit gets connected to that location's LIS via hardwired, so the lab orders and results are bidirectionally interfaced between the two sites.
This CT scan mobile unit is staffed by nurses from one of the main hospitals, therefore, all the quality assurance of the testing performed at this mobile unit is managed by lab POCT staff from the same facility under the same CLIA certificate. Additionally, to facilitate compliance monitoring, lab orders and results are also routed to the same hospital, regardless of where the CT mobile is located at a given time. 
Let me know if you have any questions about this process. It will be interesting to know what other sites are doing to manage these mobile units.

Pedro, how interesting. We've only used mobile CT scan mobile units post hurricane but that experience meant the CT scan mobile was 'self-contained' while in the parking lot of the ambulatory/clinic. The POC creatinines were manually ordered/resulted. I'm admiring the operation set up. What State are you in (wondering in terms of which State CLIA office accepted the CLIA Certificate application ;-)). NIFTY! 

Hi Angie! As mentioned to Pedro, we have very limited experience with POC on mobiles (there was a possibility during the pandemic of using a mobile, which included performing POCT, related to population health (outreach) but that did not go forward). Since the POC on the mobiles was only POC Creatinines, and the mobile unit self-contained, we did have concerns about CLIA Certificate # if the Radiology staff used a permanent/facility's downloading capability.
Sorry, only thing to contribute and it's old news (before the day cellular may be viable depending on the POCT). Good Luck!

Hi Peggy and Angie, granted that this mobile unit performs only POC waived test, there is a CLIA Multisite Certificate of Waiver that you can apply for this type of scenarios (at least here in Minnesota), and the application requires that you enter a main office address that will be managing the regulatory and quality assurance of the POCT perform at this unit. 
Since our CT scan mobile unit is staffed by nurses from our main hospital, the test results are routed to this hospital's LIS, and POCT staff from the same hospital manages the quality assurance of this test, I think we are in compliance with this type of CLIA certificate regulations.

We have a mobile CLIA we oversee - it is a team that is handled by Virtual Care and is deployed if needed.  This is staffed by EMT's and Paramedics.  They have POC equipment that they take to the home.  We just figured out how to get the ISTAT interfaced by using a Meracki device that hooks to their laptop while in a hotspot.  Other equipment or manual tests are entered in a software program to post to the patient EMR.   They could do that when back at the home base or in the moment if in their hotspot connection and had time. They also had a way to use a program called Haiku that was used to post results through a picture from a secured device so a physician could see that information in the moment while the EMT/Paramedic was there.  We have Telcor QML and Epic.

Hi Miranda, this is sure interesting. I know I've heard use if Haiku here but I personally am not involved so not sure 'how' it's used by providers.
Does your oversight of the mobile's CLIA, with the team handled by Virtual Care, include doing all the training and annual training?

Thanks.

Jumping in with a couple of random other questions regarding mobile units.  We use EPOC on transports from outlying hospitals . These then are updated after the patient is admitted to our hospital.  The results cross to EPIC and charges drop.  This causes billing problems as the testing is done prior to admission. 
How do you get the results on the chart and do you bill the patient for testing on transport.  Does anyone monitor the temperature on the truck for compliance with reagents.  The EPOC itself will not work but how would I show the cartridges were maintained at room temperature?

Yes Peggy!  Answering above.  We handle all the initial training and will do recertifications if they do not have anyone that qualifies to sign off.  We are pretty involved with the area.  They have ISTAT Chem8 and CG4, Sofia Flu/Covid, Nova glucometer, Occult Blood, and visual urinalysis dipstick.
I haven't seen Haiku in use, we don't have access to it as lab coworkers.  I believe they use a secure phone on our network in a hotspot.  Not 100% on that.

We have a mobile unit that comes through every Monday and does our facility so they perform their glucoses all day and dock it at then end of the day.  I have a reminder to look in my middleware and push through any results that didn't upload due to a timing issue.  Since it is only a screen before testing, the delay doesn't affect patient care etc.