The season for respiratory illness is here. How is digital application ResAppDx saving healthcare resources by turning smartphones into tools for managing respiratory conditions?
We speak to ResApp Health’s VP of Commercial, Mike Connell, and Director of Sales and Marketing (Europe), Jamie Joint, for their take on this game-changing technology.
Summary
ResAppDx is a smartphone-based tool to instantly diagnose and manage respiratory disease, which uses the sound of a person’s cough to make a differential diagnosis.
It has been integrated into telehealth platforms to triage and diagnose respiratory diseases, hence escalating care only when needed and saving healthcare resources.
ResApp Health is undertaking research in COVID-19 and aims to use the technology in mass screening and COVID-19 patient management.
Our interviewees Director of Sales and Marketing (Europe) Jamie Joint (Left) and VP of Commercial Mike Connell.
Centivis: What is ResAppDx and what impact does it make on respiratory illness management?
Jamie: ResAppDx is a smartphone tool to instantly diagnose and manage respiratory disease. It uses the sound of a person’s cough to make a differential diagnosis. Using artificial intelligence and machine learning, ResAppDx picks up on the unique signatures of cough sounds with different disease profiles as a result of physiological changes in the lung.
We've now trained our algorithms on a data set of over 6,000 patient cough sounds and can match these signatures, using acoustic analysis, with known clinical diagnoses accurately and with instant results. Our clinical evidence demonstrates that our algorithms can identify a range of respiratory diseases for both adults and children with high sensitivity and specificity (see graphics below).
The beautiful thing is there's no requirement for any additional accessories or even Wi-Fi, just the smartphone everyone carries in their pockets.
How to use ResApp Dx: A user has to hold their smartphone in front of them at an angle, cough 5 times and ResApp Dx uses sound analysis to diagnose respiratory illness. The results are displayed instantly in an analysis report.
Mike: Respiratory disease is the single most common reason for a visit to a doctor and it is often complex to diagnose and manage in a timely fashion. Patients need to take time off to visit the doctor and, during the peak respiratory season, GPs can be overburdened.
However, by integrating ResApp into existing telehealth platforms such as Medgate or Alodoktor, we can support the effective remote diagnosis and management of respiratory patients. This reduces unnecessary referrals to F2F settings, thus creating cost savings for health care systems.
Jamie: We are not here to replace clinicians, as ResAppDx is an aid to respiratory disease diagnosis that improves the patient experience, reduces the time taken and the effort and resources required to get to that endpoint. We are seeking to give clinicians more time with their patients through efficiency gains.
Besides telehealth providers, we have also partnered with pharma companies to integrate ResApp into their clinical trials and asthma management platforms, and we’ll soon commence further health economic trials in Emergency Department settings in the UK.
The Breathe Easy Paediatric Clinical Study showed that ResApp was highly effective in diagnosing a range of respiratory illnesses amongst children (Reference 1).
The Breathe Easy Adult Clinical Study showed that ResApp was highly reliable in diagnosing a range of respiratory illnesses amongst adults (References 2,3,4,5).
Centivis: COVID-19 is the respiratory disease on everyone’s minds. Are you undertaking any initiatives around the Coronavirus?
Regarding COVID-19, we are researching 3 aspects:
1. Using ResApp as a mass screening tool
Mike: We are currently running research studies in the US and India, exploring how to use a sample of five coughs to identify COVID-19. We're certainly not trying to replace a gold standard PCR test. We would see the people that get a positive test in ResAppDx would go on to a PCR test, in the same way as you would with a rapid antigen test.
The breadth of our potential utilisation will clearly depend on the sensitivity and specificity results in the trial. Given we’re smartphone only, we’re nearly instantaneous and infinitely scalable. So, it’s natural to see opportunities for a ResApp COVID test where it's just not practical to roll out rapid antigen tests widely.
For example, going to a football game. If you're going to have a hundred thousand people in a stadium together, rapid antigen tests will be expensive and less practical. Could you use our smartphone-based screening test instead?
It might also be suitable for other low risk settings such as keeping COVID-19 out of schools and universities, workplaces and potentially a mass triage tool to prioritise testing in community outbreaks.
ResApp Dx can be integrated into telehealth platforms and benefits patients with a range of respiratory illnesses.
2. Patient management for COVID-19
Mike: The second thing we're doing is around patient management. Can we help to manage COVID-19 patients remotely? To answer this question, we are collecting longitudinal data (data over time) so we can spot early warning signs indicating potential deterioration in patients. We hope to identify these patients early, so doctors can intervene and focus their medical attention there. Given we have an existing algorithm to detect pneumonia in ResAppDx, we’re confident of our potential here.
Jamie: The key to reducing the burden on healthcare facilities is managing cases with only mild symptoms in isolation at home and identifying the 20% of cases with more severe symptoms that require further treatment and possibly hospitalisation, for example where it is progressing towards pneumonia.
2. Long COVID
Mike: Anywhere between 5% and 30% of patients have long COVID symptoms that last for 3 months to 12 months. There is not a lot known about it, but a subgroup of patients seems to be developing fibrosis in the lungs, which is a very serious disease. Once the fibrosis really takes hold, it's very difficult to treat. We may be able to use our algorithms to identify these patients earlier and also help track how a patient's recovery is progressing.
By using ResApp, patients get a diagnosis on their smartphones, advising them to travel to the doctor’s office only when necessary.
Centivis: The COVID initiatives are still being studied. But who pays for the current ResApp Dx solution?
Mike: Europe and Western markets are typically reimbursement markets, so we are working on how to gain reimbursement in those settings. The DiGA in Germany, for example, presents an interesting and innovative opportunity. However, many Asian or African countries are private Payer markets where individuals pay for themselves.
With telehealth companies, we have licensing deals based on either a per-test rate or a subscription model based on forecasted usage. One of our focuses right now is to drive usage and experience, and through that, be able to gain a foothold in different markets and build a variety of use cases.
For example, a recent Swiss pilot with telehealth platform Medgate has been informative for us as it has allowed us to collect real-world data and refine how we onboard new clients and clinicians etc. Most importantly, Medgate elected to proceed to commercial use after successful completion of the pilot project.
Centivis: What is next for ResApp?
1. Reimbursement
We have conducted some pilots with telehealth providers that will provide us with essential data for reimbursement purposes. Germany’s DiGA is an interesting opportunity, but reimbursement is just the tip of the iceberg. The next step is to promote it to say it's available to get doctors and patients using it.
2. Adding more indications
COVID-19 diagnosis and patient management are an obvious one here. Further, the differential diagnosis of pneumonia and TB in the developing world is a challenging problem and there is massive unmet need. Smartphone usage is increasing. It would be great if ResApp could contribute to solving this piece in the puzzle. Meanwhile, we are also looking into capturing more longitudinal data to understand the progression of respiratory illnesses and identify deterioration in patients e.g. COPD where frequent exacerbations result in poor clinical outcomes for the patient and enormous costs for payers.
3. Using ResApp in passive listening
We have recently concluded a deal in Germany with CarePath where ResApp will be added to their NELA platform, which works akin to a Google Home or Amazon Alexa device passively listening in the background. We’re aiming to stretch our technology and add more use cases and value with connectivity to devices other than the smartphone. This combined with the additional indications above could significantly extend our business models and value propositions in the future.
Want to know more about ResApp? Listen to this podcast on Talking Healthtech
References:
1. Porter, P et al., A prospective multicentre study testing the diagnostic accuracy of an automated cough sound centred analytic system for the identification of common respiratory disorders in children, Respiratory Research 20(18), 2019.
2. Claxton, S et al., Identifying acute exacerbations of chronic obstructive pulmonary disease using patient-reported symptoms and cough feature analysis, npj Digital Medicine 4(107), 2021.
3. Porter, P et al., Diagnosing community-acquired pneumonia: diagnostic accuracy study of a cough-centred algorithm for use in primary and acute-care consultations, British Journal of General Practice 71(705), 2021.
4. Porter, P et al., Diagnosing chronic obstructive pulmonary disease on a smartphone using patient reported symptoms and cough analysis: diagnostic accuracy study, JMIR Formative Research 4(11), 2020.
5. Claxton, S et al., Detection of Asthma Exacerbation in Adolescent and Adult Subjects with Chronic Asthma Using a Cough-Centred, Smartphone-Based Algorithm, ANZSRS/TSANZ Annual Scientific Meeting 2020.
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