How to improve health outcomes with at-home digital health solutions?
Healthcare delivery, as it is today, is not scalable to serve the ever-growing population
At-home digital health solutions can empower patients and decrease the burden to the healthcare system by offering alternate care pathways
The benefit from new digital tools can only be realized if they are used as intended, and not to try to make what we’re already doing faster for the sake of doing more of it
Dr. Andrew BothamCofounder and chief scientific officer of TestCard
How to improve health outcomes with at-home digital health solutions?18 November 2019
Dr. Andrew Botham is the cofounder and chief scientific officer of TestCard – an at-home testing solution that provides immediate results at a low cost by providing a non-invasive urine test kit embedded into a postcard, with an accompanying mobile application that turns a mobile phone’s camera into a clinical grade scanner.
This is part two of our startup series, where we focus on the experiences, challenges, and insights gained from innovative solution seekers who are redefining healthcare.
HT: Before founding TestCard, you gained unique experience from the National Health Service (NHS) in the UK. Could you please share with us a bit more about what you did there and what your responsibilities were?
Andrew Botham: I was the Laboratory Manager for Blood Sciences in Hull and East Yorkshire. I ran the blood sciences service which included biochemistry, hematology, immunology, blood transfusion and point of care testing. So in essence, all of the blood testing for the entire area.
We supported a population of around 700,000 people, which is about 1% of the UK population, so a fairly large service, and we had 165 members of staff within blood sciences – it is a true 24/7 service.
HT: Considering your perspective and insights into the UK healthcare system, did you see any main challenges that you set out to solve when you started TestCard?
Andrew Botham: I had a perspective in terms of where the gaps and problems were, but that wasn’t the start of the journey with TestCard. TestCard happened almost by accident with my cofounder Luke – our kids go to the same school. Our families were having dinner together and Luke and I started to talk about how bad men were in general at engaging in healthcare – men are terrible. Women are so much more engaged in their own health and in looking after themselves.
It became a bigger conversation about healthcare access and what barriers exist to people gaining access. Some of that is due to isolation in the sense of geography and cost in many parts of the world.
But some of it is just a cognitive barrier in terms of people choosing to engage either because they don’t want to take the time off work, they don’t want to admit that something is wrong and hold up their hand and say “I think I might have this”. Or, maybe it’s social isolation around the elderly and frail or mental health.
TestCard was really born out of overcoming the sorts of things that get in the way of people actually engaging in healthcare
Provide multiple care pathways that suits patients’ needs
HT: How do you see digital diagnostics and at-home testing contributing to the realization of personalized healthcare?
Andrew Botham: Point of care testing has been around for a very long time. It can certainly get people onto the right patient pathway sooner, but point of care testing is still done mostly in hospitals, doctor surgeries or clinics. So those people have already got up off their couch and engaged in healthcare. They’ve already said “I want to be treated; I need help” – so they would have ultimately reached that destination anyway.
“We need to not try and have this “one size fits all” for healthcare. We can have multiple paths ending up at the same destination, and at-home digital health allows us to construct those paths.”
I think if we’re going to improve outcomes with point of care testing, it needs to move back into the home. Now, obviously there is a huge difference between the way home users use things and the way professionals use things in terms of expectations and needs. The NHS, for example has been around just over 70 years now. When it first started, there were maybe 2 – 2.5 billion in the world, and now we’re approaching about 8 billion.
We’ve got more people, more tests and more treatments than ever before, but the model for how healthcare is delivered hasn’t changed very much. Someone gets off their couch and they go to their primary care doctor or their general practitioner (GP). It’s not scalable.
There’s nothing wrong with it in the sense that it works for some people, but GPs are under so much stress – they’re workload is huge. They’re reducing the amount of time each appointment lasts and extending the number of hours they’re working for.
Although the destination needs to be standardized and it needs to be correct, we need to not try and have this “one size fits all” for healthcare, because one size doesn’t fit all. We can have multiple paths ending up at the same destination, and what at-home digital health allows us to do is actually construct those paths so that they are complementary to the individual while also maintaining gold standards of care, practice and decision support, which you wouldn’t be able to do any other way.
HT: How do you think at-home digital testing, with the aid of a smartphone app, can improve patient engagement and lead to better health outcomes?
Andrew Botham: There is an absolutely awful term called “gamification”, but it’s adopted now so I’m stuck with using it. Imagine having that reinforcing feedback being provided by your smart phone app. Young diabetics, for example, who are really bad engaging with their disease because they don’t want to admit they have it, would for instance have their phone say: “Well done! You’ve done your monitoring three times in a row now, which is great. Your levels are dropping by this amount, which massively reduces your chances of complications along the line”.
The relationship these patients have with their phone – because phones are already so integrated into life – is further enhanced. It starts providing them real-time feedback based on the information they’re providing, rather than going for a blood test, and then waiting for a couple of weeks and then someone eventually ringing them up and largely it being a, “ ya, it’s fine” – or they don’t even call.
It’s like the difference between being pulled over by a policeman and getting caught on the speed camera for speeding. With the speed camera, you get a letter through the post 6 weeks later after you’ve sped. It doesn’t change your driving. Whereas, if someone pulls you over you change the way you are driving because it happens in real-time. It allows behavior modification, which that distance in time and thought don’t.
A personal health record over time is then able to determine a “normal for you”. Any deviation from that normal starts to become more significant. The TestCard app sensitivity and specificity therefore improves as time goes on.
Empower patients to take control of their own health
HT: You mentioned scalability and how the current healthcare system was built for a different time for a different population level – and that you can’t just tell people to do more of the same, but faster to serve more patients. What do you think are some solutions to this challenge?
Andrew Botham: It’s about empowering people and patients. There’s a perception for some patients that healthcare happens to them rather than with them. In some economies, it’s different because people commission their healthcare if they’re able to afford it, so they have a customer relationship. Perhaps they feel that they have more control over that process, but it’s a very disempowering process. It’s very intimidating and scary.
Laboratory and medical things scare people, and that if nothing else is disempowering. But then to also have to go on to share fairly intimate pieces of information about yourself – not even knowing what pieces of information are relevant or important when you’re having that conversation. So, it’s a matter of handing back some of the control to the users, or carers having to advocate for their child or elderly parent.
At-home digital diagnostics create and provide an alternate care pathway – another opportunity for how the patient ends up engaging with the healthcare system. For example, it could be that the GP is aware that a patient has urinary tract infections on a regular basis. They provide a stack of cards to the patient or carer so that, should they feel the need, patients can do the testing themselves and contact the GP to communicate the results on which to prescribe. GP’s can reduce the footfall through their surgeries whilst still providing a better service.
So although ultimately the destination is the same in terms of what treatment they’re going to be getting and how that need for treatment is assessed, the number of paths are greater. They have a greater number of options on how they choose to engage.
Understand where and how along the patient journey a new tool adds value
“The benefit of new digital tools in healthcare comes from using them as they were intended and designed.”
HT: Providing more pathways instead of doing more of the same yet faster is amazing. What do you think is one of the most important collaboration models that can encourage someone in healthcare to say, “Yes, I feel that we should look at new pathways and ways of doing things” – and what does that look like to make happen?
Andrew Botham: It’s a great question. There are a number of different challenges for startups, and one of the biggest problems we have is being heard because there is a lot of noise out there and we have fairly small voices.
Working with organizations such as Creasphere in a pilot as we’ve been able to do, means that our voice gets a little bit louder and we are able to talk to the sort of people that we wouldn’t have been able to otherwise, such as with Roche. The other side of it is that it offers opportunities for us to share partnerships with other companies because we can’t be everything to everyone.
TestCard is a tool, we think it’s a really good tool, but the problem with tools is they’re only as good as they are used. When we have conversations with people, the sort of conversation they want to have sometimes in healthcare is how much money is this going to save us. The answer is that it depends on how you use it.
What you need as an answer is what the pathway looks like, how is it going to be implemented within your healthcare system. Once you have the pathway, we can then work out the healthcare economics fairly quickly by comparing it to the existing model.
If you just try to jam a new tool in and use it in the same way you used the old tools, nothing improves. The benefit comes from using the new tools as they’re supposed to be used, and not trying to make what we’re already doing faster and do more of it.
TestCard successfully participated in Startup Creasphere, a leading digital health accelerator that strives to transform healthcare together with startups.
Dr. Andrew Botham is the chief scientific officer and cofounder of TestCard. Until recently he was also Head of Blood Sciences in Hull and East Yorkshire NHS Trust. Andrew has been a scientist for 20 years gaining experience in the NHS, private pharma, and academic laboratories. TestCard is gaining global traction, winning startup awards in Dubai, London, and the US.