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In vitro diagnostics

Digitalised and personalised in vitro diagnostics for an ageing population.

Strategic Initiatives of the FHNW: In vitro diagnostics

Patient-centred point-of-care diagnostics in the digitised society

People with limited mobility and those in sparsely populated regions of Switzerland often find it difficult to get medical help and medication quickly. The project focused on patient-centred and timely medical care for older people being cared for in their home by a Spitex organisation.

The following questions were addressed

  • How is it possible to offer Spitex clients all-inclusive medical care, which includes everything from a visit by the nurse and online contact with the doctor to on-the-spot laboratory tests, the ordering and delivery of medication, and therapy?
  • Can such all-inclusive care be designed as a new service in a complex system like the healthcare system?
  • Can access to medical care – complete with backpack laboratories in combination with telemedical consultations involving doctors – be provided decentrally at home?
  • Can point-of-care diagnostic devices be used accurately and precisely to determine meaningful parameters for the doctor, and how is data exchanged between the players?
  • Can the biochemical and physical diagnostic equipment in backpack laboratories be linked to software for transferring diagnostic results to the doctor?
  • Is the concept of digitised all-inclusive medical care transferable?
  • Is this socio-politically relevant project of interest to investors?
  • How is it possible to offer Spitex clients all-inclusive medical care, which includes everything from a visit by the nurse and online contact with the doctor to on-the-spot laboratory tests, the ordering and delivery of medication, and therapy? What would be relevant use cases for this: what is the specific need for remote in vitro diagnostics in this situation? And what requirements and conditions in terms of use have to be met to realise this process (alternatively: cycle)?
  • What would a service model (or concept) for remote in vitro diagnostics for this target group look like? And what do usage scenarios and the user journey look like specifically?
  • How can access to medical care – complete with backpack laboratories in combination with telemedical consultations involving doctors – be provided decentrally at home?
  • Can the biochemical and physical diagnostic equipment in the backpack transmit diagnostic results to the attending doctor without communication problems?
  • Can the attending doctor have the relevant parameters determined precisely and reliably even if he/she is not operating the diagnostic equipment him/herself?
  • Is the concept of digitised all-inclusive medical care transferable to other target groups?
  • Is this socio-politically relevant project of interest to investors?

The following impacts were achieved

  • It was possible to design an all-inclusive medical care system (fig. 1). This was based on a detailed analysis of the context of use involving all players and from the perspective of the disciplines involved. The processes of all-inclusive care were defined and visualised in the form of a user journey map (fig. 2).

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Figure 1: Medical all-inclusive care.

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Figure 2: Part of a user journey map.

  • The design of the all-inclusive care concept was evaluated in a final process simulation that included a number of industry partnerships. This saw the entire process – from the onset of medical symptoms to the telemedical consultation with the backpack laboratory and the referral to a specialist – rehearsed. It was possible to identify specific requirements and needs from the activities of those involved, their statements and their interactions with each other.
  • The backpack laboratory (fig. 3) contains key items of equipment needed for the Spitex organisation’s all-inclusive on-the-spot medical care. The onset of the corona pandemic meant that a field test under real conditions could not be conducted. The experiences gained from the process simulations suggest that it should be possible to successfully transfer the process to the real world. It is not clear what costs can be charged to the various players.

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Figure 3: The backpack laboratory.

  • Qualified nursing staff determine the relevant parameters at the client’s home. The requisite diagnostic equipment is commercially available and certified. The biochemical and physical diagnostic equipment intended for the backpack laboratory has not yet been finalised. A key component of our supply concept is the newly developed SeHDL software library. It standardises the exchange of data and the measurement processes of different diagnostic devices (fig. 4). This offers developers of telemedical apps (Android and iOS) a straightforward way of addressing large numbers of such smart devices, and thus represents a step change in quality for telemedicine.

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Figure 4: The software library facilitates the standardisation of data exchange and measurement procedures.

  • The concept of all-inclusive medical care can be transferred in a modified form to other patient groups. In collaboration with external partners (University Hospital Basel, Momm Diagnostics, the research and technology organisation CSEM in Muttenz, and the Federal Institute of Technology in Basel), we have begun developing test systems for patients in the areas of organ transplantation, pre-eclampsia and Covid-19.
  • The Covid-19 pandemic has clearly demonstrated the socio-political relevance of patient-centred point-of-care diagnostics. Doctors and consumers have come to realise that much of what they do can also be done virtually. Health insurers are key players: they have it in their hands to approve cost-effective digitised treatment procedures. This allows the service cycle to be extended to other target groups. The composition of players operating the coronavirus mobile response service is complemented by cantonal authorities and national organisations such as the Swiss Red Cross. Going forward, the backpack laboratory can make an important contribution to containing the spread of the coronavirus.

Interdisciplinary collaboration

Three of the FHNW’s schools – representing the disciplines of applied psychology, engineering and life sciences – are playing a significant role in the project and have, in the course of the project, worked alongside external partners to design the process of digitised all-inclusive medical care.

  • A range of qualitative methods was used, including field observations, interviews and focus groups. These surveys were conducted with the relevant players in the future service cycle. These included Spitex, the medical staff of telemedicine provider eedoctors, general practice surgeries, nursing homes, mini clinics and potential patients.
  • A joint learning process facilitated the development of requirements for use scenarios surrounding iron deficiency, urinary tract infection and the control of long-term blood sugar levels in diabetics. Key stakeholder focus groups including eedoctors and Spitex analysed the three scenarios in detail and assessed them for desirability, feasibility and economic viability. One finding that emerged is that ferritin deficiency represents a particularly important potential for all players.
  • The use case for ferritin was evaluated in a final process simulation involving a walkthrough with relevant parties, namely medical professionals from telemedicine provider eedoctors and nursing staff from Spitex. This saw the entire process rehearsed – from the onset of problems to the telemedical consultation with the backpack laboratory and the referral to a specialist. It was possible to identify specific requirements for a successful implementation of the future service process from the activities of those involved, their statements and their interactions with each other.
  • A simulation of the client’s interaction with the Spitex nurse and doctor was conducted and filmed by project team members (Ferritin Simulation 1.0 - YouTube). The tools (backpack laboratory, in vitro tests and equipment) were also put together by project team members and made available for the simulation.
  • The players were involved in a timely manner to ensure the smooth running of the service cycle. This ensured that the requisite diagnostic devices and rapid tests were available and that the diagnostic data measured could be exchanged between the various mobile applications via the electronic device library.

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Figure 5: Carrying out a rapid test

Contact

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Prof. Dr. Daniel Gygax
Research Bioanalytics & in-vitro Diagnostics

T +41 61 228 55 79 (direct)          ZGFuaWVsLmd5Z2F4QGZobncuY2g=

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