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Bringing the laboratory into the home: Innovations in at-home testing

With the shift from volume to value and emerging technologies that enable remote monitoring, getting care and health care services at home rather than in a medical facility is becoming increasingly common. As the obesity epidemic has risen, tests for sleep apnea are in higher demand, with thousands of sleep clinics around the country poised to help diagnose and treat the condition. A recent study published in the Annals of Internal Medicine shows that at-home testing may be as effective in diagnosis as laboratory testing and may help cut costs.

Obstructive sleep apnea causes the muscles in the throat to relax too much, momentarily cutting off airflow during sleep and leading to disruptive, restless sleep patterns. The study in Annals included nearly 400 patients with suspected sleep apnea. Researchers randomized the patients into two groups – one group received full laboratory sleep testing, and the other received home testing (simulated in a lab). The study showed that the proportion of patients diagnosed with sleep apnea was roughly the same across groups. This study adds to the research literature and growing evidence that in-home sleep tests and monitoring are effective.

The number of private accredited sleep clinics peaked in 2014 but have slightly declined since then, possibly in part due to increased acceptance of at-home testing. At-home tests appeal to many consumers, who may prefer the comfort of their home. And, since they are significantly less expensive, many health plans are interested as well.

EverlyWell, a startup out of Texas, is aiming to meet the health care system’s demand for more convenient, accessible in-home testing. It provides a platform for consumers to order lab tests online, provide samples (either blood, urine, or saliva), and receive results in an easily readable format. The company works with four certified lab partners to provide home testing in areas including food sensitivity, thyroid, metabolism, female fertility, cholesterol and lipids, heavy metals, sleep, and stress. Rather than diagnosing anyone, the company provides evaluation information for consumers to take to their physician. Company founders point to the popularity of the at-home pregnancy test, as well as the rise in at home genetic tests, and activity, fitness, and sleep trackers as to how they identified the opening in the market.

Analysis: Health care professionals continue to debate the future of consumer-ordered lab tests. Some argue that patients may be confused by test results they have to interpret at home and may receive false positives or negatives that they cannot interpret. Others argue that the testing is not replacing the physician’s role, but supplementing the role of the physician in a way that helps to inform the patient and makes health care more accessible.

Deloitte’s 2016 report “Technology-enabled home health: Are consumers ready?” presented findings from focus groups that aimed to better understand consumer expectations and preferences for receiving health care services in the home. The focus groups showed that younger consumers are more open than older consumers to certain self-service options, such as using lab kits to perform lab tests, while older consumers showed a preference for house calls from a nurse or lab technician. Many consumers also like the idea of having access to a mobile clinic, where clinicians could perform basic lab and diagnostic services at or near their home.

(Source: Ching Li Chai-Coetzer, et al, “Physician decision making and clinical outcomes with laboratory polysomnography or limited-channel sleep studies for obstructive sleep apnea: A randomized trial, Annals of Internal Medicine, January 24, 2017)

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Author bio

Doug leads Deloitte Consulting LLP’s Life Sciences and Health Care practice. With 24 years of experience, he works closely with multiple top health care organizations on major clinical and enterprise transformation efforts and on large-scale technology implementation projects. Doug has extensive experience in comprehensive quality and patient safety transformations, turnaround and performance improvement in academic medical centers as well as organization/workflow redesign and technology enablement. He has served as the lead on a number of enterprise transformation initiatives with some of Deloitte’s most largest and most complex clients.