At-home testing is not a new concept, but it is evolving. Recently, populations have been getting accustomed to using COVID-19 tests at home, while tech companies have even been offering DNA testing by post. But what will at-home testing look like in 2030?
In this illuminating webinar, Medical Lab Director Dr. Elsie Yu shares the initiatives her organisation has implemented and explores what might shape the future of at-home testing.
The future of at-home testing
Geisinger is a health and wellness organisation in Pennsylvania, USA, with 10 hospitals and around 80 clinics in its service area. It provides care to more than 4 million people in over 47 counties, serving an area approximately the same size as Austria. Some patients live far from the hospitals or clinics, meaning at-home care is of importance to the service.
In this webinar for the Roche Point of Care Academy, Dr. Yu shares details of Geisinger’s existing at-home testing programmes and looks ahead to what might be possible by 2030. The views shared in the webinar have been summarised below.
The current landscape of at-home testing
Well-known at-home tests include pregnancy tests, glucose meters, faecal occult blood testing (FOBT), HIV/STI tests, ovulation tests and drug-abuse cups. Dr. Yu explores some of the devices used by the Geisinger in more depth:
Diabetes patients routinely use these meters to manage their glucose level. What’s more, the monitor can be paired with an insulin pump, which makes it possible to reduce finger sticks (important for type 1 diabetes), while simplifying the management of type 1 diabetes.
Heart failure monitoring
In 2005, Geisinger started remote telemonitoring to track patients’ weight, shortness of breath and ankle oedema. This was then reviewed by clerical staff and escalated to a nurse case manager if required.
- Bluetooth scales: Implemented in 2008 to monitor weight, the scales have resulted in a 38-44% reduction in readmission.
- ReDS vest: Introduced in 2018, the ReDS vest uses monitoring technology to track the lung’s fluid status. The vests reduced readmissions by 75%, but are expensive, so other options are being explored, such as portable ultrasound devices.
Mobile health bus
The health bus is a hybrid between home health and a traditional clinic/hospital care, which was initially focussed on closing the care gap for HbA1c testing during the pandemic. By scheduling a phlebotomist, the bus will now be able to complete overdue lab tests. Services include:
- Wellness measures: height, weight and blood pressure
- Laboratory blood and urine collection
- Retinal scan (for diabetic retinopathy)
- Foot exam (for diabetic patient)
The challenges of at-home testing
There are challenges to using at-home testing, such as who pays for the device, whether a healthcare provider can trust the at-home test result and whether the result can be documented officially.
However, the pandemic has accelerated innovation on this front, for example there are COVID-19 tests for travel purposes that include telehealth video monitoring and provide an official health report.
What might shape the future of at-home testing?
If our goal is to help consumers use at-home tests to improve their overall health, we need to ask the following questions:
- When is testing required?
- Which tests should we use?
- What do the results mean?
- What should one do with the result?
Improving health literacy
According to WHO, health literacy empowers people to make positive choices.
- For patients: It’s about having the ability to make well-informed health decisions based on evidence.
- For organisations: In a world of disinformation, it’s about smarter marketing – communicating complex medical information in common language so that others can be informed. As an example, Dr. Yu highlights testing.com, which has a section for at-home tests and details when a test has limited evidence.
- For governments: It’s about better oversight – making sure the marketing claims for at-home tests are true and that labelling is clear and standardised, just like it is for food products.
- Clear instructions: What’s clear to the lab isn’t always clear to users. For example, at the height of Omicron in the US, a study found 1 in 3 people misinterpreted an at-home COVID-19 test. When an enhanced interpretation guide was used, only 14% of people failed to quarantine – so people can be taught.
- Access to consultation: How can we use our expertise to help the public? After all, not everyone knows a clinical laboratory professional.
What might at-home testing look like in 2030?
Dr. Yu suggests that mobile and telemedicine will become more widely available, and that at-home sample collection will undoubtedly be useful. However, most chemistry tests will still require around 1mL of blood (more than current at-home tests). We will also need to consider sample storage and stability, as well as the biohazard risk of sending samples by mail.
Wearable health devices attract a lot of discussion. Step tracking is currently popular, but we may be able to use smart watch data to predict hydration status or anaemia – further studies are needed in this area. In Singapore, they are using an app combined with a smartwatch to track healthy activity and remind participants to stretch or move. It will be interesting to see if this improves the participants’ health in the long term.