Crowdsourcing Technology Directs Faster Lab Testing

October 20th, 2020

By Anne Tate & Deb Hewett-Smith

(Originally published by TalkingLabs here; republished here with their permission.)

What Is Medical Crowdsourcing Technology?

Most of us don’t really understand crowdsourcing technology, let alone how it could be used in the medical community. We know that crowdsourcing technology can leverage the internet, social media and purpose-built platforms to elicit and receive the knowledge, goods or services, enabling engagement with a broader spectrum of sources than by using conventional routes of engagement. We all have some experience with crowdsourcing on a personal level when we access medical applications such as WebMD or Mayo Clinic to match our symptoms to a possible medical diagnosis. Novel medical crowdsourcing internet sites such as SERMOsolves and CrowdMed try to resolve difficult medical cases through the collation of advice from thousands of physicians matching one-to-many.  But how does crowdsourcing help the collective human community when it comes to identifying, managing disease processes, and finding medical answers?

In healthcare, crowdsourcing has two essential components: 1) group participation and 2) sharing solutions. The key to crowdsourcing is sharing this information through such vehicles as open access digital software applications or in-person forums such as workshops, conventions or other products that promote the ubiquitous dispersion of information. Bryant provides us with interesting examples of medical crowdsourcing ranging from: projects that develop health communication materials to promote HIV testing on a global level;  crowdsourcing resources and feedback to accelerate the advancement of drugs and antibiotics and recruiting study participants through open-source models (Bryant, et. al., 2019).

Currently in the news, crowdsourcing is being used to update the public almost instantaneously about COVID-19 community prevalence and death rates, predictive hot-spots, and even information about which areas are more likely to wear masks. There is a plethora of dashboards available to the public detailing the trajectory of the COVID-19 pandemic that we can access on our phones and devices designed to help us make informed decisions. Publicly available information on how to control the pandemic emerges from every data source of our society: organizations, government entities and the general public.  We could also imagine that when a vaccine is available for COVID-19 crowdsourcing applications will emerge to guide our choices by disseminating key information about the availability and efficacy of the vaccine on patient populations.

How Does The Lab Fit Into Crowdsourcing Technology?

The COVID-19 pandemic fuels the need to source more laboratory testing capacity to meet the burgeoning demand across our country. It is no secret that many labs are overwhelmed with COVID-19 testing volume while other labs have excess capacity to absorb additional volume. Crowdsourcing technology is rising up as a potential answer for matching labs with spare testing capacity to healthcare providers located anywhere in the country. One of these crowdsourcing innovators is Shadowbox. They use this technology to match the turnaround time and service requirements of physician offices, long-term care and nursing facilities, schools, and colleges with labs anywhere in the U.S.

Talking Laboratories recently interviewed the CEO and Co-founder of Shadowbox, Greg Stein, to learn about their solution. “We’ve created an exchange between labs and healthcare providers. Our Shadowbox COVID-19 DX HUB crowdsources testing capacity, across the nation, no matter how large or small the lab, and makes it rapidly available, wherever it’s needed.”

How Shadowbox Matches Labs With Providers

Greg describes the power behind the Shadowbox technology is its unique capability to bring labs together with those medical practices and organizations that need COVID-19 laboratory testing. To quickly access an available lab’s testing capacity, a medical organization or healthcare provider simply signs up with Shadowbox, downloads and installs the Shadowbox HUB and selects an available lab. Shadowbox is the connector through the HUB to initiate the interactions between the provider organization and a laboratory. Once the clinician has vetted the laboratory, the lab confirms the logistics to dispatch the collection kits while the HUB transports the order to the lab and transmits the results back to the provider from the performing laboratory.

The Shadowbox HUB tracks order volume from the provider and coordinates it with an available lab resource to proactively ensure lab capacity is not exceeded. If capacity constraints are detected that could impact the desired service level and turnaround time, the provider is matched with a second laboratory that can meet the provider's criteria. The Shadowbox crowdsourcing technology is capable of monitoring test order volume and lab testing capacity to ensure testing velocity is maintained to meet patient care needs. Integration and automation with the HUB architecture give the provider flexibility to seamlessly switch from one lab to another or add another laboratory without creating a new cost or delay in service. “Our platform is designed to rapidly ramp up to large volumes through scalable servers, load balancers, and state-of-the-art systems. In this way, we can be poised to accommodate critical high COVID-19 testing needs in preparation for the flu season and the anticipated next wave of COVID-19 infections,” says Greg.

Shadowbox believes that the use of new technologies to match clinical laboratories with providers for COVID-19 testing is a game-changer for lab testing. As Greg explains, “any provider anywhere can download and install our COVID-19 HUB and select an available lab to quickly access that lab's capacity. We think providers and labs are looking for solutions like this that are simple to use and easy to implement. It’s a solution that really evens out the ‘patient access’ playing field and expedites lab testing to where it is needed the most, including rural and under-served communities.”

Shadowbox shared with us the key functionality they designed to bring COVID-19 testing to the right place at the right time:

  • Infrastructure – Turnkey implementation via a commercially available browser that wraps around the EHR/EMR to intelligently identify patient data, and then securely transfers the data from the order form through the browser layer. The FTP can be installed and implemented in less than a day.

  • Automation- Once the FTP is established with the Shadowbox HUB and the provider, a laboratory can be selected that meets the provider needs in test type, turnaround time expectations, and locality. The orders are automatically transferred from the provider to the laboratory with the appropriate test order and patient data. Results once available are then transmitted back to the provider through the Shadowbox HUB.

  • Security & Compliance – The Shadowbox technology utilizes a zero-trust HIPAA compliant browser wrapping around the underlying applications eliminating the potential for the introduction of malware or viruses through the application interface. Shadowbox maintains the application security protocol with multiple layers of security checks such as multi-factor authentication and login-lock outs to protect ePHI disclosure.

Building An Adaptive Marketplace Network

Using multiple send-out labs for testing is not new. Relying on outside labs to meet capacity is equally not new. What is new with the technology Shadowbox proposes is a way to share capacity and the need for that capacity on a much broader scale. The use of crowdsourcing technology-based services holds the potential for giving healthcare providers and organizations a ready-made network of laboratories across the U.S. without necessarily committing to contractual volumes or building expensive point-to-point integrations. We know by watching COVID-19 hot spots emerge across the country that the demand and supply of COVID-19 testing may not always be able to be fulfilled locally or by the typical reference lab channels. Closing the gap between buyers and sellers, irrespective of location presents an intriguing opportunity for a ‘many-to-many’ network that opens the doors to greater access to available testing resources.

Impact on You. New technologies can help providers and labs better serve their communities during a crisis or a pandemic like COVID-19. One of the keys to fighting diseases is to identify effective strategies that help you better pivot during these urgent times when the way forward or path is not clear. Becoming a part of a nationwide infrastructure platform like Shadowbox that connects testing suppliers with providers could help you mitigate risks during uncertain times.

Reference

Tucker JD, Day S, Tang W, Bayus B. 2019. Crowdsourcing in medical research: concepts and applications. PeerJ 7:e6762 https://doi.org/10.7717/peerj.6762


Is Your COVID Test Legit?

 

October 9th, 2020

By Beth Crocker

 

Back in late March, just a few weeks after several states went into lockdown to prevent the spread of COVID 19, the FDA gave emergency approval for rapid coronavirus testing that would deliver results in less than an hour.  Rapid tests present some clear benefits, among them portability, ease of use, and fast results. The introduction of an instant test seemed almost too good to be true, especially considering the test result bottleneck that many experienced in the early days of COVID.

But are these rapid tests reliable? Perhaps the conventional wisdom is correct – if it seems too good to be true, it usually is.

The spread of the novel coronavirus at the White House, the Pentagon, and several college campuses, offers a cautionary tale about the merits of rapid COVID testing.  Just a few months after their release, New York University and Columbia University both reported that rapid tests are highly prone to false negatives. NYU suggested that these tests could be missing close to half of positive cases. Columbia University researchers found that rapid tests identified only 74% of infectious samples.   These tests lack the high sensitivity required to discover the presence of coronavirus until a person has a substantial viral load.

What this means is that a person can become infectious days before they register as positive on a rapid test, and potentially infect others under the false assumption that they themselves are not infected. With the need for expedient, cost-effective COVID testing urgent, the allure of inexpensive, rapid tests is apparent.  That said, the combination of high false negatives and the false sense of security that a negative result offers may render these tests more dangerous than helpful.

Now for the scary part.

Rapid tests are about to be delivered en masse to countries, schools, and businesses.  The World Health Organization in partnership with at least two rapid test providers has plans to sell 120 million tests to low- and middle-income countries.  One provider offers testing technology that is accompanied by a smartphone app that allows the user to share their test results instantly.  The app “works like a secure digital ‘boarding pass’ that can be scanned to enter organizations and other places where people gather.”

Armed with a digital boarding pass, will people be lured into a false sense of security and relax other health and safety protocols?

Diagnostic laboratories continue to provide the gold standard in COVID testing, known as PCR testing (which stands for polymerase chain reaction). While these tests can take longer to process, they are far more accurate. Moreover, people tend to take more precautions while awaiting the results.  One example of a testing success story is Cornell University.  Martha Pollack and Michael Kotlikoff co-authored an Op-ed piece for the Washington Post, where they share their COVID-19 testing and contact tracing protocol.  The university is currently testing more than 30,000 individuals per week using its own testing lab and a partnership with Cayuga Health.

Dr. Charles Mikel, Founder and Principal Scientist at Nightmaker Science, had this advice to offer regarding key testing requirements for large groups of asymptomatic students, “It is important to have very high negative predictive value, but also high sensitivity.  If a student tests negative, the university must be confident in the accuracy of that negative result.  If a student is positive, they are quickly identified, and can be quarantined before they spread the disease.”

With hindsight 20/20, we now know that rapid COVID tests alone are not sufficient to protect groups from spreading COVID. Put simply, rapid tests should not be considered a replacement for tried-and-true diagnostic lab testing. More importantly, a negative result should not be considered permission to waive the need for social distancing and wearing masks. While rapid tests can be a powerful tool in the arsenal to fight the pandemic, the public should be educated to their short-comings and continue to rely on lab testing, along with the safety practices that have become commonplace during the pandemic – social distancing, contact tracing and wearing a mask.


Why Crowdsourcing Can Unlock the COVID-19 Test Bottleneck

 

October 5th, 2020

By Greg Stein

 

You are running a 103 temperature and struggling to breathe.  Despite your delirium, you drive to a COVID testing site where the line is so long that it stretches several city blocks.

And then you wait.

And wait.

And wait.

But the wait for the test is nothing compared to the lag to get test results. According to the San Francisco Chronicle, delays in test results were as bad as 19 days. By then, you have either checked into a hospital, recovered, or quarantined for absolutely no reason. Or worse, you gave up mid-quarantine, and infected your elderly neighbor.

There is a better way.

The solution is to distribute testing through the existing healthcare infrastructure – the primary care clinician.  Back in early 2020, when we knew far less about COVID-19, it was not appropriate for everyday clinics to handle a potentially deadly and extremely contagious disease.  But now it is time to shift the paradigm back to the way healthcare operates most efficiently – away from the emergency room and into the primary care setting.

How will the individual primary care Doc get test kits and receive test results when giant institutions such as hospital labs, public agencies, and major labs are doing everything they can just to keep up with demand?

The answer is crowdsourcing.

(Photo by Kevin Winter/Getty Images)

 

There are more than a thousand labs around the country – many of whom have already stood up COVID-19 test capability.  From a couple hundred to a couple thousand daily test capacity, these labs collectively represent hundreds of thousands of daily test capacity able to be rapidly shifted to hot spots around the country. Labs can accelerate and automate the results process using innovative technologies such as the Shadowbox created “COVID-19 DX HUB”.

Now imagine you have that fever, but in a crowdsourced distributed site world.  You visit your doctor and she assesses your symptoms.  If a test appears appropriate, the sample is professionally collected in a controlled environment to reduce spoilage, and the order is made electronically while collecting all the federally mandated patient information.  The sample is then shipped overnight to one of the crowdsourced labs with results provided electronically within 48 hours – enough time to provide clear clinical direction relative to the outcome of the test. Simple, safe, and accurate with no more crowds, long lines, or false results.

Much better.

 

 


In the Fight Against Coronavirus, the Feds May Have Done Something Right

 

August 29th, 2020

By Gregory A. Stein and James Dieter

 

Everything from op-eds to angry tweets are being written about the US Government’s apparent missteps in addressing the Coronavirus (COVID-19) pandemic.  Buried in the back pages, however, are new regulations implementing the 21st Century CURES Act (Cures Act) that may have a powerful impact on combating the disease).

The Cures Act was enacted to accelerate medical product development and deliver innovative healthcare advances to patients who need them faster and more efficiently. Signed into law in December 2016, these regulations provide protections for technology companies enabling them to improve patient care through innovation, integration, and information transparency.

The new regulations encourage technologies designed to help patient data flow more efficiently across the healthcare ecosystem, while still maintaining patient privacy and security. It also prevents technology incumbents from blocking a clinician or patient’s access to the electronic health information stored on their systems.

So how does this enhance the fight against Coronavirus? Part and parcel to ubiquitous access to Coronavirus testing, is ensuring that information flows quickly and efficiently to the right place. To stem the tide of the virus, we need to know who has been exposed, how they are reacting, and whether to quarantine in place or hospitalize.  All these data points can be answered by diagnostic laboratory testing – and laboratories are responding.

Diagnostic laboratory companies like Principal Health Systems (PHS) have developed tests to address these concerns. PHS is specifically focused on nursing home care, where the risk of dying from COVID-19 can be as high as 15%. Early testing can clearly save lives, especially for those who are at high risk.  However, the availability of testing is merely half the battle, the other half is getting those tests into the hands of doctors as quickly as possible.

Today, if a clinician wants to order one of these lab tests, that lab must be “integrated” into that clinician’s electronic health record (EHR) software.  But what if they aren’t?  In that case, the clinician must write an order on a piece of paper and – we aren’t kidding here – FAX it to the lab.  In some cases, the lab may have an online ordering portal, but even then, the clinician must now perform data entry which is both time consuming and a high potential for error.

If the lab wants to integrate with that clinician’s EHR, they must be willing to invest thousands of dollars per location, commit internal IT staff, and if everything goes smoothly, get the integration up and running in a few months.  In the crisis environment in which we are operating today, this is simply unacceptable.  We don’t have a few months to make tests available everywhere.  Even a single days’ delay can result in exponential expansion of infections.

The CURES Act now allows labs and doctors toinstantly integrate.” This means the innovative lab paired with the innovative software technology can offer tests to clinicians within minutes of a request.  Technology companies such as Shadowbox are specialized in the lab and healthcare integration space to accelerate the integration of systems to allow doctors to electronically order a test from an otherwise non-integrated lab that day.  These orders and their results are securely, compliantly, and securely exchanged between systems in seconds.

We believe that every person desiring to be tested for COVID-19 should have access to, and payer support for, immediate and periodic testing; for peace of mind, for informed behavior changes, and for the sake of protecting our loved ones and community. While there is still much to do to ensure the widespread availability of diagnostic tests, The CURES Act rules now make it easier and far faster to access those tests and receive results.

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Gregory A. Stein is the Co-Founder and CEO of Shadowbox, Inc. – a technology start-up bringing disruptive innovation to healthcare.

James Dieter is the Founder and CEO of Principle Health Systems – a multi-faceted healthcare ancillary services provider focused on services and support for skilled nursing facilities, hospice, and at-home healthcare organizations.