It’s all about speed. And convenience.
 
Shrinking reimbursements and rising chronic disease rates are helping drive major changes in healthcare worldwide. Traditional fee-for-service models have long been replaced by value-based plans that aim to enhance treatments, improve patient outcomes, and lower costs. The shift to value-based care has fostered the development of innovation that allows for convenient, timely testing at the point of care; such technological advances have turned smartphones and microchips into mobile laboratories, bringing care to remote or inaccessible populations.
 
POC technologies can significantly improve disease management, particularly in resource-limited settings with weak healthcare infrastructures and poor access to care. POC testing delivers quick results, which in turn, allows for more rapid treatment; these solutions often produce lab-quality results that can automatically be transferred to an information system, a remote caregiver service for consultation, or an electronic medical record.
 
MPO’s June feature story, “Care Points,” provides an in-depth look at the factors driving the global POC market, estimated at $18.09 billion last year and forecast to grow 3.3 percent through 2025, according to industry data. Ian Parfrement, senior vice president, global franchise lead for Point of Care with Centralised and Point of Care Solutions, Roche Diagnostics; and Gillian Hall, international business leader, PoC IT, Solution Integration & Services, Roche Diagnostics; were interviewed for the story. Their input in the following Q&A provides an addendum to the feature.  
 
Michael Barbella: What trends/factors are currently impacting the global point of care (POC) market?
Ian Parfrement: A number of key factors impact on the POC market currently. These include the digital health transformation, exponential technology development, increasing regulatory demands, and global disease management strategies. Areas such as chronic disease management, antimicrobial stewardship, and emergency care challenges all drive demands for appropriate POC solutions. What is also clear is that patient experience increasingly plays a central role in care pathway redesign beyond the typical health economic and outcome assessments.  
 
Barbella: What factors are driving growth in this market? What segment is the growth most prolific—blood glucose testing, cardiovascular testing, blood coagulation testing, infectious disease testing, etc., or is it fairly even across the board? Why are these segments growing more quickly than others?
Parfrement: POC today is the second largest in-vitro diagnostics segment after Serum Work Area (SWA) and is globally relevant across many different sub-segments.¹ Further growth comes from two major trends: The continued drive of centralization of diagnostics’ testing to achieve greater levels of efficiency is in turn increasing the demand for decentralized solutions either to deliver urgent results in critical care situations or to support efficient care pathways by enabling you to have your result at the time of your visit to the doctor. The second major driver is the desire to treat patients away from relatively expensive secondary care settings and to move care closer to the patient. The market segments that grow the quickest are those where there is clear medical value and tangible health economic benefits, coupled with actionable lab-like results produced by simple and reliable platforms.
 
Barbella: What are end-users/customers requesting from their POC devices, and how has Roche Diagnostics met/meeting these demands?
Parfrement: Reliable, simple, connected solutions that deliver actionable results. Roche has a long history of product developments that have met these requirements in highly innovative ways, including a future pipeline that will ensure we remain at the forefront of POC technology both in terms of platforms, IT software, and disease management solutions.
Gillian Hall: Ease of use is key for caregiver using the POC device. Integration capabilities are key for those who are governing the POC testing service, eg. the Point of Care Coordinator (POCCs). So it is always important to think about the total solution—the device and the software from which a POCC will manage the device. At Roche, we have a suite of software solutions which form our Roche Digital Diagnostics offering, including the cobas infinity POC solution which is focused on making the life of the POCC in the hospital easier.
As the interface between the laboratory and the wards, POCCs perform much of their work while out in different hospital locations. This can be challenging when managing important tasks that require a desktop PC, like performing remote troubleshooting tasks, arranging operator training, checking the status of a device or replacing an instrument. The cobas infinity POC was designed from the outset with the POCC in mind. We commissioned a workflow analysis study to really understand the day-to-day tasks and needs of POCC. The cobas infinity POC enables POCCs to complete all these tasks across desktop, tablet or smartphone, no matter where they are—saving them valuable time and increasing their productivity. The software is a fully open system, which means it connects Roche and non-Roche POC devices so that our customers can manage their service from a single portal in the hospital setting.
 
Barbella: How has wearable technology, connectivity, lab-on-a-chip technology, and smartphones impacted the development of POC solutions? How will these technologies help the market evolve in the future?
Parfrement: All of these technologies have the potential to contribute towards effective healthcare and the explosion of digital products creates endless possibilities. The key with all of these developments is to keep focused on value creation and understand when combining solutions can increase overall benefit rather than just create a highly complex ecosystem.
Hall: For the POCC being mobile is key, as mentioned above our cobas infinity POC solution enables POCCs to move and work. They can access the application across tablets and smartphones, enabling them to manage their POC program while out of the office.
 
Barbella: What challenges face companies operating in this market? How has Roche Diagnostics overcome these challenges?
Parfrement: POC can be incorrectly viewed as being a relatively simple in-vitro diagnostics (IVD) segment as the platforms are often small and run a limited menu. The reality is that to meet the whole spectrum of customer and regulatory demands in a non lab, remote environment takes a huge amount of skill, expertise and understanding of the customer. Roche leverages its extensive experience in this segment and combines our POC solutions with our Lab portfolio to provide Integrated Diagnostic Solutions that can be deployed right across a lab network, as well as across the patient pathway.

Barbella: What impact, if any, is value-based healthcare having on the development of POC technologies?
Parfrement: Undoubtedly value-based healthcare is an opportunity for POC; the essence is that the broader benefits of any solution are taken into account and this is where POC contributes greatly. At this point in time, we do see countries and regions that are leading the way with this type of approach. However it should be noted that a lot of traditional tendering still exists and this is much less focused on overall value to patients or the healthcare system.
 
Barbella: How has Roche contributed to the evolution of POC technologies? (an opportunity to discuss some of the company’s innovations)
Parfrement: Roche has a long history of highly innovative POC technology developments such as the first connected hospital glucose systems or CoaguChek for remote and patient INR testing. Today the cobas LIAT continues this trend delivering molecular lab-like performance in a true POC platform.
Hall: Roche has also been at the forefront of software across the years and we plan to launch our latest digital innovation to support POC integration outside of the lab and hospital setting, later this year.

Barbella: Can you provide some examples of innovative solutions the company developed or helped customers develop to meet customer/market demand or requests for POC technologies?
Hall: As briefly mentioned above, a new member will soon join our Roche Digital Diagnostics family. This cloud-based offering will leverage microsoft's IoT (internet of things) technology stack, to enable POC devices to communicate securely across the internet and integrate test results into the patient electronic medical record (EMR). Why is this important? As discussed earlier there are two key trends within the POC market—on the one hand there is a need to provide care closer to the patient—this is important as it not only reduces the number of costly visits to secondary care, but is also provides a better patient experience and in more convenient locations. On the other hand there is an  increased focus on regulatory requirements. This is important to ensure testing is delivered safely by trained individuals. These two trends pose a challenge for the POCCs who tended in the past to have a focus on hospital based POC testing. Increasing they are seeing their responsibilities expand to primary care sites, but how can they be everywhere at once? Without having to spend their days travelling to each site our latest innovation will enable them to place devices outside of their hospital IT network, without compromising data security and enabling them to oversee and manage the devices just as though they within the hospital walls. We are very excited to bring this to market later this year.

Barbella: How do you expect the POC market to evolve over the next half decade?
Parfrement: The POC market will continue to grow strongly due to the market and technology developments previously discussed. The key will be to integrate these solutions into the overall diagnosis and healthcare context to provide integrated diagnostic solutions and disease management solutions respectively as this is where the greatest overall value will be achieved.