The purpose of this article was to review current principles and criteria for obtaining Clinical Laboratory Improvement Amendments of 1988 (CLIA '88) waiver, to identify existing point-of-care (POC) coagulation and hematology technologies, and to analyze regulatory challenges regarding CLIA waiver for those and future devices. The CLIA '88 documentation requires tests performed by laboratories with a certificate of waiver to be so simple that the likelihood of erroneous results by the user is negligible or poses no unreasonable risk of harm to the patient if performed incorrectly as determined by the Secretary of Health and Human Services. 'Simple' means that the test uses unprocessed samples, has a direct readout of test results, does not have specifications for user training, and includes instructions for confirmatory testing when advisable. Currently, the CLIA-waived hematology and coagulation POC devices only test for hemoglobin, hematocrit, and prothrombin time/international normalized ratio. The problem with these devices is the lack of multiplexing. Point-of-care coagulation and hematology devices face challenges for obtaining a waiver. These challenges include lack of clinical needs assessment, 'miniaturized' assays that correct for interfering substances, and assays simple enough to be combined in a multiplex platform. Several scenarios demonstrate how POC coagulation or hematology devices can improve crisis care. Industry should perform needs assessment on clinicians and emergency responders to determine which analytes to incorporate on multiplex POC coagulation and hematology devices and produce devices that address confounding factors.
- Clinical Laboratory Improvement Amendments of 1988 waiver
- clinical needs assessment
- confounding factors
- Food and Drug Administration
ASJC Scopus subject areas