The Evolution of Diagnostic Testing: In-House PCR in Urgent Care

Diagnostic testing has not only evolved tremendously over the last century, but in ways that align tightly with the driving ethos of the Urgent Care model itself: a demand for speed, convenience, accuracy, and reliability. Each major breakthrough in testing—cultures, rapid antigen tests, and eventually polymerase chain reaction (PCR) testing—was driven by the need to deliver better outcomes faster. 

Looking back to understand this history can reveal why the most recent achievement of highly-accessible in-house PCR is an innovation uniquely suited to meet the challenges of modern Urgent Cares. Let’s explore the key milestones that laid the foundation for this transformative technology, and what implications this has for Urgent Cares today.  

The Culture Era (1880s-1940s): The Foundation of Pathogen Detection

The fundamental principles of bacterial culture were developed by Louis Pasteur in 1860 and were further refined in following years by his contemporary Robert Koch, who was specifically interested in linking bacteria to infective illnesses.¹ Famously, in 1882, he discovered the tuberculosis pathogen, which led to major advancements in its treatment and prevention.

Whereas cultures were initially used to develop an early and basic framework for understanding infections, they were a limited tool until the 1940s. By this time, improvements in result times, sensitivity, and specificity allowed cultures to be useful for isolating infective pathogens at the individual patient level. Despite improvements, however, cultures remained inherently slow, which forced providers to lean predominantly on syndromic diagnosing to guide empiric treatment at initial encounters.

Rapid Testing and Rapid Treatment Emerges (1970s-1990s): Antigen Tests and Urgent Cares

The first antigen test is typically recognized as the radioimmunoassay developed by Yalow and Berson in 1959.² This was used to isolate a radioactively-labeled insulin protein antigen, and ultimately led to the understanding that humans respond more effectively to human insulin than the cattle insulin that was widely used at the time.

In the decades that followed, further advancements led to the development of truly “Rapid” Antigen Tests (RATs). Rapid strep testing began to be widely available in the 1980s, with rapid flu tests also becoming popular in following years. 

Perhaps it is no coincidence that this is also around the time that the Urgent Care model began to propagate as patients wanted faster solutions for acute, but non-emergent conditions and infections. Unfortunately, while these tests provided near-immediate results in such settings, they did so at the cost of sensitivity and were known for less-than-optimal accuracy.

PCR Becomes Viable (2000s-2010s): The Rise of Real-Time Diagnostics

As Urgent Cares entered their heyday, PCR technology began to see rapid development. Most attribute the origin of PCR to Kary Mullis’ work in 1983,³ but PCR didn’t become a practical diagnostic tool until the 2000s with the advent of real-time PCR (RT-PCR). 

Initially, research was hotly focused on proving its accuracy in clinical settings, which culminated in the COVID-19 pandemic firmly establishing PCR as the gold standard for diagnosing SARS-CoV-2. Here again, PCR's history is closely tied to Urgent Cares, which were predominantly responsible for providing this life-saving testing to the public during the pandemic.

This was a revelatory moment in the healthcare community, where PCR’s reputation for high sensitivity and specificity dramatically widened. However, challenges related to its usage persisted—most PCR was performed through reference labs, which often slowed down results and complicated billing for patients and facilities.

The Current State: Advancements Make In-House PCR Possible

As an answer to these challenges, Urgent Cares saw the opportunity to take PCR and integrate it as an in-house service. While the technology had historically been limited to hospital and reference labs due to a high barrier of entry, PCR’s technological advancements in the 2000s and 2010s made the shift to in-house testing viable.

Machines have become faster and smaller, testing workflows have become more standardized, and hub-and-spoke implementation models have made its integration more straightforward. Today, we are at a turning point where innovative Urgent Cares are seeing the potential of in-house PCR for reshaping the patient experience and gaining a competitive edge.

Building a Better Urgent Care with In-House PCR

Deciding to own your PCR testing is a synergistic choice—several aspects of delivering care to patients can improve, and they are often complementary to each other.

1. Simplified Patient Billing

When tests are sent to a reference lab, this typically results in complicated financials, hidden fees, and surprise billing. This can have a negative impact on patients who believe they have already paid for services related to their care at your facility. Owning your PCR testing allows you to simplify costs, set prices as you deem appropriate, and streamline billing.

2. Improved Patient Experience

In addition to enjoying a simplified billing process, patients can also experience the benefits of faster result turnaround times. While sending tests to a reference lab can mean waiting 2-4 days for a result, Urgent Care PCR labs are often able to consistently process and deliver results within 24 hours. This means providers and patients can rely on shorter turnaround times for treatment-related decision-making. 

Also related to the patient experience, when a provider chooses to withhold antibiotics, difficult discussions can ensue. But patients may be more likely to accept treatment recommendations when results are backed by fast, accurate diagnostics, improving trust and overall satisfaction.

3. Differentiation in The Marketplace

In-house PCR testing is a tool that can set an Urgent Care network apart in an increasingly competitive market. Patients not only appreciate speed and precision—they have come to expect it, especially following the pandemic. By bringing PCR testing on-site, Urgent Cares can can market themselves as leaders in making the most of cutting-edge diagnostic technology.

Let Streamline Scientific Help You Adopt In-House PCR For Your Urgent Care

Evolutions in diagnostic testing have always been about meeting the needs of the moment—speed, accuracy, and patient-centered care. In-house PCR represents the culmination of these efforts, and Urgent Cares who adopt this model can solve persistent challenges in their PCR workflows. 

But while advancements have made it more accessible, navigating its integration into your Urgent Care network still requires domain expertise, a thorough understanding of regulatory requirements, and help with practical matters like establishing protocols and determining equipment/staffing needs. Streamline Scientific has helped set up over 200 labs—use our experience and insight to help you implement in-house PCR for your Urgent Care network.

 

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References

1. Blevins SM, Bronze MS. Robert Koch and the ‘golden age’ of bacteriology. International Journal of Infectious Diseases. 2010;14(9):e744-e751. doi:10.1016/j.ijid.2009.12.003
2. S Pavia C, M Plummer M. The evolution of rapid antigen detection systems and their application for COVID-19 and other serious respiratory infectious diseases. J Microbiol Immunol Infect. 2021 Oct;54(5):776-786. doi: 10.1016/j.jmii.2021.06.003. Epub 2021 Jun 26. PMID: 34272205; PMCID: PMC8234251.
3. Kaunitz JD. The Discovery of PCR: ProCuRement of Divine Power. Dig Dis Sci. 2015 Aug;60(8):2230-1. doi: 10.1007/s10620-015-3747-0. PMID: 26077976; PMCID: PMC4501591.