The Present and the Future of At-Home Testing

Chris Wolski:
Welcome to Clinical Lab Chat, part of the MEDQOR Podcast network. I’m Chris Wolski, director of Business Intelligence for CLP, and today I’ll be speaking with Dr. Alex Owens about the reasons for and the implications of the rise in home testing. So we’re very excited to talk about that. This is a big topic I think. Alex is the medical lead at Hurdle, which was founded in 2017 and is dedicated to analyzing biological samples and giving actionable information to help providers and patients make the best healthcare decisions together.

Alex, welcome to Clinical Lab Chat. I’m really excited to have you here. This is an area that I’m really interested in and I think a lot of laboratorians are really interested in today. So I hate to overstate this, but I think this could be a very revolutionizing sort of force in testing and healthcare system as a whole. So let’s get into just chatting about this a little bit. Now there was some at-home testing prior to COVID, but it seems that if there’s one major societal change that resulted from the pandemic is making at-home testing almost ubiquitous or at least in demand.

And we discussed in the pre-interview, I recently had to do some at-home testing myself a couple of times, which was very convenient. And because I had some emergent things that were happening with some family members, so we had to make sure that we were all okay, so is this an oversimplification that or was at-home testing to the level that we could say that it was an inevitability? I mean, were we on that road already and COVID pushed us along or was COVID really to blame in a way for at-home testing?

Dr. Alex Owens:
Well, hello Chris. Great to be with you and thanks for having me on the podcast. It’s a great frame and it’s a great place to start our conversation. I think if you were designing a program of education for people to get comfortable with at-home testing, you couldn’t really have designed one better than the COVID pandemic, which really created this need worldwide as you describe, for people to test at home by a variety of different modalities, whether that was PCR testing or lateral flow testing in order to be able to get back to their activities of daily living and to reenter the workplace, the gym, wherever it is, get back to traveling, whatever it is they wanted to do. Certainly before COVID, at-home testing was a nascent industry and with the move in general towards hybrid models of care, it was something that was up and coming.

But I think we can certainly say that the COVID 19 pandemic really accelerated at-home testing in the eyes of consumers, got them used to testing for COVID and therefore open their minds to, Hey, what else could I test for in the comfort and convenience of my own home, maybe without even going to visit a doctor’s office. So yeah, I think I would say was there before, but very much accelerated by the pandemic and I think we’re going to see increased growth in this sector because people are just so much more comfortable with testing.

Chris Wolski:
For sure. And the convenience factor I think is the big selling point. And then the other kinds of testing, STI testing, I know there’s some good home tests now for STI testing, for some other just general tests. Now we have some multiplex tests for COVID flu that are coming out, which are really exciting. And this kind of leads into my next question. It’s not just convenience, but it’s also access. I mean, there was a big article that came out last year, I think it was last year in the Lancet that discussed how, I think it’s 47% of people in the entire world don’t have access to basic medical testing. We’re not even talking really advanced genetic testing. We’re talking really basic stuff.

So what does that access mean, not only to patients but to the clinical labs. Now walk me through the wins that we get from accessibility that at-home testing promises. You kind of indicated that a little bit. You don’t have to call your doctor, make an appointment for a very simple test, but what are some of the other wins, particularly in the context of say, clinical labs and just the healthcare system in general?

Dr. Alex Owens:
Yeah, I think that’s a great question. What you mentioned, we talked about that value proposition of convenience where people can test on their own schedule in their own homes. There’s also, as you mentioned, discretion. And I think that comes into play particularly when it comes to sexual health testing. It’s often something people want to do in the comfort of their own home. But yes, access and expanding access to diagnostic and screening tests is one of the biggest benefits that we can unlock through at-home testing. And you touched on it, but it’s crucial to understand that a lot of these tests are really not that complex or expensive. They’re just currently not available in the modalities that are conducive to at-home, to people being able to take them at home. But we’re thankfully seeing that change. So what we’re seeing a lot of now is, and at Hurdle, a lot of our focus is on at-home testing using dry blood spot for HbA1c for example, or FIT testing for colorectal cancer screenings.

And the thing about these tests is that a lot of people are just going about their daily lives and people are busy. They may have one annual physical a year, thinking about what you might be at risk of, whether it’s in these examples pre-diabetes or colorectal cancer may not be top of mind for consumers. By making it easy to take that test at home and send it back and just get into that habit of testing regularly, I think that’s how we can expand access to these very readily available technologies and bring that time of diagnosis earlier, which means we can intervene earlier. And in the case for pre-diabetes for example, if we identify someone through an at-home HbA1c test who is in the pre-diabetic range, there are very straightforward lifestyle dietary and exercise interventions they can take to actually go get back into a healthy HbA1c range and avoid progression to type 2 diabetes. So by enabling that access to early testing, early diagnosis and early intervention, there’s a real opportunity there to expand people’s quality and quantity of life.

Chris Wolski:
And to back up a little bit in terms of also in a slightly different way, this is years and years ago, I actually had a really bad case of flu and I got delayed getting into my doctor and by the time I got there, first thing they did was they gave me a chest x-ray because they thought I had bacterial pneumonia. It was really serious. I’m wondering too, also at-home testing, it also helps for those general practitioners and other specialists to help to triage a little bit as well say, “Hey, I took a home test and for flu or COVID, I came up positive. I feel really bad, these are my symptoms.” They might say, “okay, get in. We’ll make room for you right away.” So do you think it also helps with maybe the continuum of care?

We always talk about the continuum of care sometimes I hate to say it, I don’t know if we honor that as much as we should, but do you think that helps too? It’s not just accessibility, but also as you were talking about with the HbA1c side of things, you get into treatment faster, you get it resolved faster before it turns into something extremely serious. You have to go to the hospital, you’re using up those resources. It’s expensive for the consumer and for the healthcare enterprise itself, do you see some of the benefits there? Is that another win that we’re seeing?

Dr. Alex Owens:
Yeah, and I’m really glad you brought that up because something we think about a lot at Hurdle is how can we build tests which fit seamlessly in with the clinical workflow? Because I think the real pitfall of digital health more generally, but specifically diagnostic testing is when things are developed, I guess in silos or seen as oppositional to existing clinical workflows. What we would really emphasize is that we want to be just another tool in the arsenal of a primary care physician or a specialty doctor who wants to make their workflow more efficient, use their time and their patient’s time more efficiently.

And so to your example, taking that flu test or combination flu COVID test before visiting the practice might help that physician or clinician to triage what that patient is going to likely need. Decide, hey, actually we need to do a physical examination or some further diagnostic imaging here to make the decision. Or maybe with the information we have to hand, we can make the best care decision for this patient right now and get them the treatment they need more quickly than we could in the absence of that diagnostic testing. So absolutely, I think we need to be working together to figure out how do these diagnostics fit in with existing clinical workflows to make everyone’s life and workflow more efficient.

Chris Wolski:
Right. And this leads me into, so recently we talked a little bit about this on the pre-interview and recently there was a comment on something I put on LinkedIn about at-home and point of care testing and someone wrote in a comment that said that they thought point of care testing in particular, and I think probably by implication at-home testing as well, had a potential to really undercut labs. We talked about this in the pre-interview. You really disagreed with this point and you had a really interesting answer about why you disagree with this and how actually this might be more of an opportunity for labs. So if you could maybe recollect what we talked about then and you can explain why you think that this is more of an opportunity and not something labs should be afraid of.

Dr. Alex Owens:
Absolutely. Well, I think it’s an interesting comment, and I certainly think upfront we need to make a distinction between point of care testing and then at-home self collect testing. The distinction being that there are some technologies which enable that point of care testing. For example, we’re all very familiar with COVID lateral flow tests, which are sent to the consumer. They take the test, they’re able to interpret the test themselves, and then they have an answer. And those tests are very helpful. We also have at-home self-collect tests which are sent to the consumer. They take the test, ship it all back to the lab, and then the lab analyzes it and then that result is sent to the patient. Clearly, in this latter scenario, the lab remains absolutely central to the analysis of that sample and a very important stakeholder in the process.

And that’s where I think at Hurdle, we’re very focused on working with labs to actually just expand their ability to offer those services, whether that’s partnering with us to send those labs directly to the consumer partnering with us and our business to business partners. So whether that’s payers, insurers, large health plans or telemedicine organizations. And the way and the way we think about that is really it’s a win-win because the lab is, as I said, a central stakeholder who is actually just doing a higher volume of testing by making it available through our platform or through our partners platforms. So I think that news of the labs death in this scenario is greatly exaggerated. I certainly think that labs have a very central role and shouldn’t be threatened at all by the growth in this at-home diagnostic sector.

Chris Wolski:
And in many cases with the at-home test, and particularly in the early days of COVID, fortunately I had COVID, I took an at-home test, it came up positive it, I wasn’t very sick, I just was a good citizen, stayed home for a week and another case I was exposed, et cetera. But in this case, it’s still just indicative, I mean, even if I had symptoms that were severe and I needed to go see my primary, at-home testing also isn’t an end all in many cases it’s more indicative. I mean, that’s the other thing we always have to keep in mind that just because I have a positive COVID test, I don’t have symptoms. That doesn’t mean I have it. That just means that the test said it could be a false positive.

I could be positive. I don’t think this is the case or it could be negative and have symptoms that’s not the case. They both have to line up obviously. And that doesn’t mean it’s more indicative, again, it could be a false positive. You could have something else maybe, I don’t know. I’m not a medical person, so I can’t really speak to that. But that’s my understanding is that a lot of the at-home tests are more indicative. I think if I call up my doctor knowing him, he would say, “yeah, come on in. We need to do another test,” is probably what it would happen.

Dr. Alex Owens:
For sure. And that actually is where, coming back to that point of working together or working within existing clinical workflows, you’re exactly right. A lot of the tests that we’re doing at home by self collection and capillary draw are. So some of them actually, yes, they are diagnostic and we can prescribe an antibiotic or a course of treatment off the back of that test, but other tests, to your point, are more indicative and they’re more intended for screening purposes. And we would suggest doing further diagnostic confirmatory testing before proceeding with a particular course of action.

And I think that’s where that collaboration with existing clinical workflows and clinicians becomes most important. Because when clinicians trust at baseline, the at-home testing that has been done, and you see the value of expanding access and expanding the number of people we’re able to screen by making it more convenient, discreet, and cost effective for them to test, we can view that as a positive when those tests come back and are appropriately dealt with by those physicians and further confirmatory testing is done, speeding up that patient’s journey to getting the treatment that they need. So I think, yeah.

Chris Wolski:
All right. Great. All right. Well, tell me a little bit about Hurdle. I mentioned it a little bit at the beginning of the recording. What do you offer and what’s on the horizon for you in terms of at-home testing?

Dr. Alex Owens:
Sure. So Hurdle was founded, as you mentioned, 2017, and our co-founders, their research area of interest is epigenetic testing. And so really understanding the impact of the environment on our genes and how those genes are expressed and how then we can measure the expression of those genes to understand very in depth what our risk for certain conditions is or how we’re reacting and how we may be able to change our environment to improve our quality or quantity of life. So that’s our kind of core founding interest. But as you mentioned, we’ve expanded since then to incorporate at home diagnostics across a range of categories. So our first product was a saliva based COVID test, which was the first of its kind. And we’ve since expanded through sexual health, men’s health, women’s health general wellness to really serve across the full gamut of clinical need.

As I mentioned, some of our areas of greatest focus align with some of the greatest burdens of disease, so HbA1c testing for diabetes, FIT testing for colorectal cancer risk, as well as sexual health testing, which we view as one of the primary use cases for at-home diagnostics as well. And I suppose what differentiates Hurdle and what excites, I guess the partners who we work with is that we view ourselves very much as the platform that delivers these diagnostics in a white labeled plug and play manner for every partner who wants to work with us.

We integrate with labs nationwide across the United States, which means that a lot of the issues that people face, whether it’s regulatory or shipping or logistics, all of that is handled on our platform and we’re able to really get going day one, and really expand, as we were saying, access to at-home diagnostic testing for those partners who we work with.

And I suppose that’s in a nutshell how I would describe what we’re doing. I know you did ask about what is next? We are always working to expand our network of labs to make more epigenetic testing available, pharmacogenomic testing available, genetic testing. So all of those are on our roadmap on things that we’re excited about at the moment.

Chris Wolski:
Well, great. You sound like you have a full compliment that you’re working with for sure. So we know that there’s high interest in at-home testing now, that’s what we were talking about for the last 20 minutes or so. But what does five years from now look like? So let’s polish off that crystal ball a little bit. Look in your tea leaves, however you look at the future. What do you expect the two of us will be speaking about in five years about at-home testing?

Dr. Alex Owens:
Yeah, it’s a fun question, and I think this actually comes back to this comment that you saw about labs and the role of labs or is at-home testing a threat labs, some of the most compelling tests remain beyond the reach of at-home self-collect testing today. So when we think about a complete metabolic panel or a complete blood count, the reality is that by at-home self-collect capillary blood testing, we just can’t get the volume that we need right now to be able to run those assays.

And I think what we’re going to see is real innovation in that space. Where’s that innovation going to be happening? It’s the R&D that’s happening in the lab to make those tests possible to do. And so I think in five years time, we’re going to be talking about how primary care physicians, hospital clinicians, how they’re going to be able to proactively screen and test their patients in advance of any in-person or hybrid or telehealth visit, test their patients for not just the current suite of tests that are commonly available, HbA1c et cetera, but they’re actually going to be able to monitor those patients’ complex conditions using assays like complete blood count or complete metabolic panel on an ongoing basis.

And it’ll be seamlessly integrated with the clinical workflow, which I think is huge ability to improve those clinicians lives, but more importantly, improve the lives of patients. Particularly when you think, Chris, about those patients who have chronic medical conditions, which bring them in and out of their doctors and healthcare professionals very regularly. Think about how much time and energy and expense that would save those patients if their monitoring needs were able to be done by them in the comfort of their own home. I think we’ll be excitedly talking about that in five years time.

Chris Wolski:
Yeah, and I think it would also improve healthcare in general. That goes back to what we were talking about access. People doing it. I can’t get to the doctor because my daughter couldn’t bring me in today. I missed the bus. Whatever the case, I’m too sick to go, but I’m well enough, I could take a sample or a family member could take that sample for me or what have you. So yeah, I think you and I probably have a very interesting conversation in about five years.

I think you’re right on that, and I hope you’re right. Let’s put it that way. So unfortunately, with that, we’ve come to the end of our time. Alex, thanks again for taking the time to speak with me today about at-home testing. I think we probably could revisit this topic again in the future. I hope you’d be willing to come back at some point. I also want to thank you the laboratory audience for listening. Look for more episodes of Clinical Lab Chat in the near future and visit us online at clpmag.com and on all the major social media platforms. So until then.