NIH Discusses Future of Point-of-Care Research
More than 250 scientists, clinicians and engineers convened recently to discuss current developments and future research challenges in the area of point-of-care (POC) technologies—be it at a bedside in a remote village or on a battlefield. The meeting was co-hosted by NIH and the Institute of Electrical and Electronics Engineers.
Point-of-care technologies encompass a broad range of diagnostic tests and treatment tools, some of which are already ubiquitous. Primary care physicians use quick-Strep tests and other rapid bacteria tests before prescribing antibiotics. Women have been using over-the-counter pregnancy tests for years and diabetics prick their fingers to monitor blood sugar levels instantly.
With the widespread use of smartphones and the advanced computing power they afford, a growing number of complex technologies are already being developed, from a solar-powered PCR machine that can detect HIV, to smart apps that can communicate patient information directly to a doctor many miles away.
“The conference was designed to map out a research plan for the future by bringing stakeholders from various backgrounds in health care, government, academia, small business, large businesses and non-profits together,” said Dr. Tiffani Lash, program director of sensors and telehealth at the National Institute of Biomedical Imaging and Bioengineering and conference co-chair.
Speakers included many investigators in the NIBIB-funded Point-of-Care Research Network, a group including Boston University, Johns Hopkins University and Massachusetts General Hospital. They discussed the latest advances in POC research including rapid HIV testing, a microscope that can diagnose the beginning stages of cervical cancer and a clinical trial in Baltimore where patients conduct at-home gonorrhea and chlamydia tests and mail in their sample to find out the results.
Dr. Rebecca Richards-Kortum, an investigator from Rice University, made clear the urgent need for more point-of-care diagnostics in Malawi, where the risk of a woman getting cervical cancer is 7.4 percent, the highest in the world, and 5.2 percent of women die from it. Pap smear, the traditional form of cervical cancer screening, cannot be conducted in rural areas since it requires a laboratory and trained technicians. Richards-Kortum described an interaction with a clinic director on a recent trip to the country.
“I asked him, ‘What can we develop that would help you combat this disease?’” she said. “He pulled out a jar of liquid morphine and told me, ‘We have many women dying from cervical cancer so we leave them bottles of morphine. But at night, they cannot see very well in the dark and often make mistakes when pouring out their dosages. Do you think that you could make something that would make sure they get the proper dosage?’ It was very humbling and shows the desperate need for better POC cervical cancer diagnosis.”
The conference also gave attendees the chance to discuss challenges the field is facing and how best to gain patient and physician acceptance of new point-of-care devices. The challenges are not trivial—new devices must be inexpensive and small, fast but accurate and require ease in sample acquisition and training.
“This was very much a working conference, where speakers and attendees will build high-value connections, strategic alliances and partnerships that will help create lifesaving new technologies and make a massive impact in clinical care,” said Dr. Atam Dhawan, vice provost for research and distinguished professor, New Jersey Institute of Technology and conference co-chair. “At the end of the conference, a task force was formed to develop a white paper on future strategic direction for POC technologies.”
Dr. Jim Gallarda, senior program officer at the Bill and Melinda Gates Foundation, summed up the conference: “What we came to realize from the multitude of stakeholder perspectives is that to move forward we can, and must, collectively co-create the future. This will happen when all of us, from diagnostics innovators to health care professionals in both developed and developing countries, work together to respond with effective POC solutions capable of addressing global health care needs.”