COVID-19 the acme of ‘there’s an app for that’

This week started off with the interesting news that private health insurer Medibank had invested $10 million in telehealth start-up Medinet. Telehealth start-ups are of course a dime a dozen, promising to revolutionise this and disrupt that, but that’s been the case for the last 10 years or so for those in the business.

We’ve been reporting on telehealth for 15 years and remember the big uptake beginning in 2010-2012, along with health insurer interest in telehealth platforms. For instance, HCF took an early stake in long-standing platform GP2U, which recently sold to UK-based telehealth provider Doctor Care Anywhere for $11m.

Several private telehealth providers have come and gone, most notably Telstra Health’s efforts and Medibank’s own Medibank Health Solutions, and fierce resistance from GP groups has historically seen off some of Healthdirect’s publicly funded efforts. The only benefit we can see in Medibank’s investment in Medinet is its ability to generate digital referrals to specialists, pathology and imaging, and its low initial cost for GP consults and prescriptions. That might be the key.

Medinet is charging $38 for a consult, which is pretty much on par with face-to-face GPs before they tack on their fee. Even with a Medicare rebate, you’d come out close to evens using this telehealth service, particularly as GPs are increasingly being encouraged to go down the mixed billing route. Perhaps Medibank is onto a winner after all in capturing a growing cohort of patients who want convenience at the same price as old-fashioned face to face consultations. The RACGP might have missed a boat here, or Medibank has chosen the right time to invest.

Another big story this week was the announcement by ASX-listed ResApp that it had adapted its existing technology for investigating lung conditions through cough sounds to take in COVID-19 screening. ResApp has a few runs on the board in terms of a diagnostic test for pneumonia, which is CE Marked and TGA approved, and is also used for COPD and asthma.

It has quite a bit of science behind it from UQ associate professor of biomedical engineering Udantha Abeyratne and a number of studies over the last decade, but it still seems a bit out there that cough sounds can distinguish diseases and conditions. Every doctor we have spoken to this week has voiced scepticism, to put it mildly, but ResApp insists its algorithms work, and it is now looking to head into clinical trials.

COVID-19 is obviously topical, but ResApp is also looking at seasonal respiratory illnesses such as flu and RSV. A cheap, easily distributed app that rules out infection but may have a high false positive rate, which can then go on to further testing like RAT or PCR, would prove very attractive in mass screening initiatives, particularly those in low income nations.

The other big news this week was some very minor movement in the excruciatingly slow roll-out of eReferrals to public hospitals in NSW – eHealth NSW appears to be the big bureaucratic nightmare in all of this – and the alleged “blindsiding” of the private hospital sector in the development of new cybersecurity rules for Australia’s critical infrastructure, such as tertiary hospitals with ICUs. It appears that the Parliamentary Joint Committee on Intelligence and Security (PJCIS) only included Private Healthcare Australia (PHA) – the private health insurance body – rather than the Australian Private Hospitals Association (APHA) – in its consultations.

It’s common as muck for the private healthcare sector to go cap in hand to regulators claiming they simply can’t afford new regulations, but it is something else that they claim they never heard of those new regulations in the first place. Something has gone seriously amiss here.

That brings us to our poll question for this week: while private hospital whinging over paying for cyber security is interesting enough, we were far more taken by the ResApp story. Taking into account that ResApp has TGA-approved diagnostics and is active in pneumonia, COPD and asthma:

Do you think ResApp’s technology for diagnosing COVID-19 has potential?

We urge you to look at the science before voting here and leaving your comments below.

Last week we asked: Will Hills succeed with its new healthcare-focused corporate strategy? It was a close-run thing: 44 per cent said no, 56 per cent said yes. But we also asked what you thought of its chances for success and why: here’s what you said.

Comments  

+1 # Kate McDonald 2022-04-01 16:06
Last week, we asked: do you think ResApp’s technology for diagnosing COVID-19 has potential? The vast majority agreed: 83 per cent to 17 per cent. We also asked what evidence you used for your conclusion. Here’s what you said:

- Udantha abeyratne has been studying coughs sounds for a very long time and has the data to back it up

- Company has an algorithm that has been tested against clinical trials, peer reviewed and years of experience in many situations

- Incredible results

- The app seems trialed and tested with more accuracy than a RAT . The convenience is amazing. Look forward to see the future

- New technology will win

- Scientific research by world leading universities have identified unique Covid cough signatures. ResApp leveraged off their existing regulatory approved respiratory framework and capabilities to conduct this new Covid ML study.

- Results of there testing over the years

- Science

- Scientific results

- Invested in RAP and I the science says it works

- it works

- Preliminary trials have been successfully carried out. Excellent results.

- I’ve been following the company and trials. They have publicly shared evidence screening works. Diagnosis yes, but will the public embrace that

- Clinical specificity so low (80%) entirely useless.

- Followed The Company for 7 years, Trials, peer reviews Medgate signon,plus others

- Their previous record in diagnosing respiratory disease

- Science

- You just need to read the results.

- The research of others more knowing than me.

- Recent trial results from RAP and MIT uni study

- Confirmation from Doctors that are using it and reporting it's success.

- Machine learning algorithms

- 92% accuracy

- Their past experience in diagnosing respiratory diseases

- Excellent results and proven product

- Already approved europe and tga for other lung related diseases

- The world is changing fast, I'm in health and see it all the time.

- The history of their achievements, regulatory approvals of their other products and increasing acceptance and use of their approved products is the Telehealth platforms.

- Read all data during testing and listen to many different arguments from both sides. Why do doctors not believe it. The evidence is compelling. This is far superior to doctors stethoscope When does patient health come first. If doctors won,t use it give it straight to patient. This can save lives and what a great management tool for Covid.

- ResApp's previous successful double blind clinical trials as well as them testing along side the gold standard PCR. Unique real world data set of respiratory sound signatures. Strong likelihood of success.

- 6 years of research

- If you take a pair of drums and strike them, even if they have different notes, the sounds they make are still recognisable as that of a drum. If you were to syringe some water into the drums the notes would become distorted and would probably sound different to human ears however the pattern of distortion would be similar between the two drums (i.e, a pattern that looks like water being stuck in there), this would be true were you place some pebbles in the drums, or sludge etc.
The human lungs are essentially one big set of drums so when you cough you are in essence beating your lungs to create a sound (this is why cough doesn't need to be a symptom for the ResApp algorithms to work). In Asthma you have constricting of the lung walls, this will have a specific pattern of distortion, in COPD you have lung wall rigidity in particular, in pneumonia you have inflammatory processes including fluid build up that will cause specific patterns of distortion.
The algorithms are looking for these specific patterns of distortion that indicate the presence of a particular disease. As many studies have already shown, the lung pathology of COVD-19 is pretty unique to the disease (https://pubs.rsna.org/doi/full/10.1148/rg.2020200159) and so my expectation is that the ResApp algorithms are picking up this pattern of change caused by COVID-19.

- ResApp has already published peer-reviewed data on the real-world application of the algorithms and though the n in this particular study was small it did meet the values submitted to regulators on sensitivity, specificity, and accuracy: https://innovations.bmj.com/content/8/1/55
As a screening tool for people to use within daily life to hugely reduce the risk of transmitting SARS-CoV-2 to others I think the ResApp tool has a lot of potential. It won't be a diagnostic tool, however, a screening tool to triage those who need to undergo diagnostic testing could be invaluable. If I could take a quick screening test before leaving the house and going to a big dinner and know that everyone at the dinner has done the same would definitely put my mind at ease.

- From ResApp’s initial reporting of pilot clinical trial of 741 patients

- I've been a shareholder for 8 years and have followed the technology very closely

- Clinical trials

- FDA News

- Clinical experience

- The results of the studies over the last 5 or so years, even the studies used for FDA approval showed it was more accurate than 3 doctors. I think it would be unlikely that the early covid results couldn't be used at least for a screening tool.

- AI may have a way to go. It has to start somewhere; so "potential"?
- Certainly

- Cough is nowhere near specific enough to be useful, and currently the pre-test probability of a patient having COVID vs many other viral coughs is so high, a specificity of 80% is meaningless and indicates performance no better than an educated guess.

- Interview between ceo and investsmart

- COVID is not just a respiratory disease with many positive and symptomatic patients having no cough symptoms

- Diagnosis is an exaggeration. It might become a test that provides an indication that further investigation is necessary. It's typical tech over-selling.

- They achieved CE TGA mark

- COVID 19 will continually have a variant like the flu it is a virus. We need to concentrate on the co-morbidities rather than this. Millions have been spent yet the at-risk groups ie people with obesity, asthma (which has been exacerbated due to masks)mental health issues have skyrocketed.

- Just another over priced app

- The high sensitivity and specificity rates

- Plenty of other options already available, just another app thats not needed.

- Quick review of published papers ; anecdotal evidence from listening to coughs & auscultation as a physiotherapist

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