Bridging the divide: Harmonizing polarized clinical laboratory medicine practices

In today's healthcare, clinical laboratory medicine stands as a cornerstone of patient care, providing vital diagnostic insights that inform decisions in disease management. Yet, within this crucial field, a dichotomy persists between two predominant models of laboratory testing to support clinical practice: point-of-care testing (PoCT) and central laboratory testing [1]. This schism, while born of practical necessity and evolving technology, presents both opportunities and challenges that warrant closer examination. Point-of-care testing, characterized by its immediacy and accessibility, offers rapid results at or near the patient's location, facilitating swift clinical interventions and enhancing patient satisfaction [2]. Devices used for PoCT are often compact and portable, enabling testing in diverse settings, from emergency departments to remote clinics [3]. This model provides healthcare providers with real-time data to make timely care decision, as a result of reducing the time to diagnosis and treatment initiation. Conversely, central laboratory testing operates on a larger scale, often in dedicated facilities equipped with advanced instrumentation and automation. Central clinical laboratories boast a wide menu of tests, offering comprehensive diagnostic capabilities that encompass a spectrum of medical specialties. Standardization and quality control measures are rigorously enforced, ensuring the sensitivity, reliability, and accuracy of test results. Furthermore, central laboratories facilitate economies of scale, driving down costs and promoting efficiency in resource utilization. However, this division between PoCT and central laboratory testing has fostered challenges in interoperability, data management, and standardization. Integration of PoCT results into electronic health records (EHR) remains a significant hurdle, limiting the seamless exchange of clinical data across different care settings [4]. In addition, differences in testing methods and quality assurance protocols between PoCT devices and central laboratory assays may introduce discrepancies in results and interpretation of results, posing risks to patient safety and clinical decision-making. Yet, amidst these challenges, there exists a growing recognition of the need for synergy between PoCT and central laboratory testing. Collaborative efforts are underway to bridge the gap, leveraging technological innovations to enhance connectivity, streamlining data exchange, and harmonizing testing methods across different care settings. Interoperable EHR systems and middleware solutions are facilitating the seamless integration of PoCT results into central laboratory databases and EHR, fostering an integrated approach to patient care. Furthermore, advancements in point-of-care technologies, such as lab-on-a-chip devices, hand-held devices, and mobile phone applications, hold promise in expanding the scope and capabilities of PoCT while maintaining the rigor and reliability of central laboratory testing [5]. These innovations empower patients to actively participate in their healthcare journey, promoting self-monitoring and facilitating early intervention in chronic medical conditions. Speed versus Accuracy: PoCT offers rapid results, typically within an hour, making it invaluable in settings where immediate care decisions are necessary, such as emergency departments or outpatient clinics. Central laboratory tests, on the other hand, may take several hours to days but often provide more comprehensive, sensitive, and accurate results due to their sophisticated equipment and assay methods. Accessibility and Convenience: PoCT devices are often portable and can be deployed in various healthcare settings, including remote or resource-limited areas, enabling timely diagnosis and treatment initiation. Central laboratory tests require specialized equipment and trained personnel, limiting their use to larger healthcare facilities. Reliability and Quality Control: Central laboratory tests often are subjected to rigorous quality control measures and are performed by highly trained laboratory professionals to ensure consistency and reliability of test results. PoCT devices, while convenient, may vary in quality, leading to potential discrepancies in results, if the devices are not properly maintained and calibrated. Cost and Resource Allocation: PoCT devices may have lower upfront costs and reduced infrastructure requirements compared to central laboratory tests. However, ongoing costs associated with consumables, maintenance, and quality control must be considered. Central laboratory tests may require significant initial investment but can process a higher number of tests and specimens efficiently, thereby reducing overall costs per test. Integration and Standardization: Harmonizing PoCT and central laboratory tests involves aligning protocols, result reporting formats, and quality assurance measures to ensure consistency across different testing platforms. Standardization facilitates seamless integration of test results into EHR and enables effective communication among healthcare providers involved in the care of the patient. In the context of respiratory viral pathogen testing, harmonizing PoCT and central laboratory tests is crucial for optimizing patient care [8]. PoCT can provide rapid results for immediate clinical decision-making, while central laboratory tests offer comprehensive diagnostics and quality assurance. By integrating and standardizing these testing modalities, healthcare systems can leverage the strengths of each approach to enhance diagnostic accuracy, accessibility, and patient outcomes. In conclusion, while the dichotomy between PoCT and central laboratory testing in clinical laboratory medicine may present inherent challenges, it also provides opportunities for innovation and collaboration. By embracing an integrated approach that transcends traditional boundaries, healthcare stakeholders can harness the strengths of both testing approaches to deliver optimal patient care. Through continued collaboration, standardization, and technological advancement, we can pave the way toward a more integrated and patient-centric future in clinical laboratory medicine. Yi-Wei Tang: Conceptualization (lead); writing – original draft (lead); writing – review & editing (equal). Joseph D. Yao: Conceptualization (supporting); writing – original draft (supporting); writing – review & editing (equal). Not applicable. The authors declare no conflicts of interest. Not applicable. Data sharing is not applicable to this article as no new data were created or analyzed in this study.