Penn Medicine Researchers Develop Fast, Accurate, Inexpensive COVID-19 Diagnostic Test Based on Electrochemical Technology

The rapid diagnostic test costs less than $5 per unit and can be adapted for other diseases, the developers say, which opens a slew of possibilities for clinical laboratories

Just as the SARS-CoV-2 coronavirus spurred deployment of new vaccine technology based on messenger RNA (mRNA), the COVID-19 pandemic also could prove to be a watershed for in vitro diagnostics (IVD) innovation in ways that benefit clinical laboratories.

In one notable example, researchers at the Perelman School of Medicine University of Pennsylvania (Penn Medicine) in Philadelphia have developed a biosensor that uses electrochemical impedance spectroscopy (EIS) to detect the presence of the COVID-19 coronavirus in biological samples.

A Penn Medicine news release noted that “The RAPID technology … transforms the binding event between the SARS-CoV-2 viral spike protein and its receptor in the human body, the protein ACE2 (which provides the entry point for the coronavirus to hook into and infect human cells), into an electrical signal that clinicians and technicians can detect. That signal allows the test to discriminate between infected and healthy human samples. The signal can be read through a desktop instrument or a smartphone.”

Though still in its early stages, the technique potentially offers dramatically lower costs and faster results than traditional RT-PCR (reverse transcription polymerase chain reaction) molecular tests. Moreover, the RAPID technology might be useful for identifying other types of biomarkers and could be the basis for diagnostic tests that help reduce the cost-per-test in medical laboratory testing while providing comparable sensitivity and specificity to existing methodologies.

Clinical trials began on January 5, 2021, and the Penn Medicine researchers say the IVD test technology can be applied to other infectious diseases, which, if proven accurate, would be a boon to clinical laboratory testing.

The Penn Medicine researchers published their study on May 9 in the journal Matter, titled, “Low-Cost Biosensor for Rapid Detection of SARS-CoV-2 at the Point of Care.”

Diagnostic Test Results in Four Minutes for Less than $5/Test

According to the news release, the RAPID 1.0 (Real-time Accurate Portable Impedimetric Detection prototype 1.0) biosensor test costs less than $5 and can deliver results in four minutes. The researchers reported overall accuracy of 87.1% on (139) nasal swab samples and 90% on (50) saliva samples.

The technology uses electrodes that can be mass-produced at low cost on commercially-available screen printers, the researchers said. Results can be read on electronic devices connected to a PC or smartphone.

RAPID 1.0 COVID-19 diagnostic test

RAPID 1.0 (above) is a low-cost COVID-19 diagnostic test developed at the César de la Fuente clinical laboratory at the Perelman School of Medicine University of Pennsylvania in Philadelphia. At less than $5/test, plus the ability to be adapted to other diseases, clinical laboratories performing disease screenings in rural or remote locations may have a new tool in the fight against infections.  (Photo copyright: University of Pennsylvania.)

Does Penn Medicine’s RAPID 1.0 Test Replace Traditional RT-PCR Testing?

In their published study, the Penn Medicine researchers cited the need for “fast, reliable, inexpensive, and scalable point-of-care diagnostics.”

RT-PCR tests, they said, “are limited by their requirement of a large laboratory space, high reagent costs, multistep sample preparation, and the potential for cross-contamination. Moreover, results usually take hours to days to become available.”

Researchers who have studied the SARS-CoV-2 coronavirus know that it uses a spike-like protein to bind to angiotensin-converting enzyme 2 (ACE2) receptors on the surfaces of human cells.

As described in Penn Medicine’s published study, the biosensor contains ACE2 and other biochemical agents anchored to an electrode. When the SARS-CoV-2 coronavirus attaches to the ACE2, the biosensor transforms the chemical reaction into an electrical signal that can be measured on a device known as a potentiostat.

The researchers tested their RAPID 1.0 technology with two commercially available potentiostat models:

The researchers initially developed the electrode as a printed circuit board, which is relatively expensive. To reduce costs, they constructed a version that uses filter paper as the main component. The researchers noted that one screen printer in a lab can produce 35,000 electrodes per day, including time needed to incorporate the chemical elements. “However, it must be noted that these steps can be fully automated into a production line for industrial purposes, drastically reducing time requirements,” they wrote.

The test can be performed at room temperature, they added, and total cost per unit is $4.67. Much of that—$4.50—is for functionalizing the ACE2 recognition agent. The cost for the bare electrode is just seven cents.

“The overall cost of RAPID may be further reduced through recombinant production of ACE2 and ACE2 variants,” the researchers said, adding that the RAPID 1.0 test can detect the SARS-CoV-2 coronavirus at low concentrations correlating to the earliest stages of the COVID-19 disease.

Cesar de la Fuente, PhD

The Penn Medicine research team was led by César de la Fuente, PhD (above), an Assistant Professor in Psychiatry, Microbiology, Chemical and Biomolecular Engineering and Bioengineering at the Perelman School of Medicine. “Prior to the pandemic, our lab was working on diagnostics for bacterial infections,” he said in the Penn Medicine news release. “But then, COVID-19 hit. We felt a responsibility to use our expertise to help—and the diagnostic space was ripe for improvements.” (Photo copyright: University of Pennsylvania.)

Testing Penn Medicine’s RAPID 1.0 Test

The researchers evaluated the technology in blinded tests with clinical samples from the Hospital of the University of Pennsylvania. The evaluation included 139 nasal swab samples, of which 109 were determined to be COVID-19 positive by RT-PCR tests and clinical assessments. Among these, the RAPID test successfully detected the SARS-CoV-2 coronavirus in 91 samples, for a sensitivity rate of 83.5%. One sample was from a patient diagnosed with the highly contagious SARS-CoV-2 Alpha variant B.1.1.7, which the test correctly identified as positive.

Among the 30 samples determined to be COVID negative, the RAPID test scored a specificity rate of 100%, meaning no false positives. Overall accuracy, including sensitivity and specificity, was 87.1%.

The researchers also analyzed 50 saliva samples: 13 COVID-positive and 37 COVID-negative. The test correctly identified all 13 positive samples but produced five false-positives among the 37 negative samples, for a specificity rate of 86.5%. The researchers speculated that this could be due to interactions between ACE2 and other biomolecules in the saliva but suggested that performance “will improve when using fresh saliva samples at the point-of-care.”

Are There Other Applications for the RAPID Test?

The Penn Medicine news release said the RAPID technology can be adapted to detect other viruses, including those that cause Influenza and sexually-transmitted diseases.

Robert Michel, Editor-in-Chief of Dark Daily and its sister publication The Dark Report, said the test points to one silver lining in the COVID-19 pandemic. “Researchers around the world intensified their work to find ways to identify the SARS-CoV-2 virus that are faster, cheaper, and more accurate than the diagnostic technologies that existed at the time of the outbreak. In this regard, the COVID-19 pandemic may have accelerated the development and refinement of useful diagnostic technologies that will disrupt long-established methods of testing.”

Marcelo Der Torossian Torres, PhD, postdoctoral researcher at Penn Medicine and lead author of the study, said in the news release, “Quick and reliable tests like RAPID allow for high-frequency testing, which can help identify asymptomatic individuals who, once they learn they are infected, will stay home and decrease spread. 

“We envision this type of test being able to be used at high-populated locations such as schools, airports, stadiums, companies—or even in one’s own home,” he added.

Clinical laboratory managers may want to stay current on the development and possible commercialization of the RAPID 1.0 (Real-time Accurate Portable Impedimetric Detection prototype 1.0) biosensor test by the research team at Penn Medicine.

—Stephen Beale

Related Information

Low-Cost Biosensor for Rapid Detection of SARS-CoV-2 at the Point of Care

Rapid COVID-19 Diagnostic Test Delivers Results within Four Minutes with 90% Accuracy

UPenn Medical School Develops Low Cost COVID-19 Test Called RAPID

UPenn Working on Rapid COVID Test That Delivers Results Within Minutes

Rapid COVID-19 Test Developed at Penn Could Give On-the-Spot Results Quickly

One Step Closer to An At-Home, Rapid COVID-19 Test

Binary Fountain Survey Finds 70% of Millennials Share Their Healthcare Experiences Online and 70% of Americans Say Online Reviews Influence Their Healthcare Choices

Online reputation management is increasingly becoming a critical function that all providers, including clinical laboratories, must address or risk losing revenue

Recent surveys cite growing evidence that Facebook (NASDAQ:FB) and online review sites such as Yelp (NYSE:YELP) are swiftly becoming healthcare consumers’ preferred sources for researching doctors, hospitals, medical laboratories, and other medical service providers.

Healthcare consumers are using the Internet to review information on healthcare providers prior to visits. More important, data show a majority of Americans share their healthcare experiences publicly online following visits with providers.

This should serve as a wakeup call for clinical laboratories and anatomic pathology groups that have not developed effective social media strategies, as they are clearly among the health services being evaluated.

Significance of Online Reputation Management

Healthcare Dive reported research conducted by Binary Fountain indicated that:

  • More than half of Americans (51%) reported sharing their healthcare experiences online, an increase of 65% over just one year ago;
  • Among Millennials (people born between 1981 and 1996) that number jumps to 70%, a 94% increase over last year;
  • 70% of Americans overall say online ratings and reviews influenced their choices of physicians and facilities;
  • More than 40% of respondents admitted they researched doctors online even after being referred to them by another healthcare professional.
“The survey results underscore the significance of online ratings and reviews as online reputation management for physicians becomes ever-more important in today’s healthcare environment,” said Aaron Clifford, Senior Vice President of Marketing at Binary Fountain, in a statement. “As patients are becoming more vocal about their healthcare experiences, healthcare organizations need to play a more active role in compiling, reviewing, and responding to patient feedback if they want to compete in today’s marketplace.”

Healthcare Dive also noted that Millennials are likely to consider online reviews and ratings of healthcare professionals to be trustworthy.

  • 97% of 24- to 34-year-olds report believing online comments are reliable;
  • While 100% of the 18- to 24-year-olds surveyed felt similarly.

Pathologists and clinical laboratory administrators should consider the two findings above as evidence that a major change has already happened in how the younger generations look for—and select—their hospitals, their physicians, and their clinical laboratory providers. Thus, every pathology group and clinical laboratory should have a business strategy for managing the Internet presence of their labs. Failure to do so means that competing labs that do a good job of managing their Internet presence will be more successful at winning the lab testing business of Gen Xers (born 1965-1980), Millennials (Gen Y, born 1981-1996), and Gen Z (born 1997-2009).

In addition, the survey discovered that the most important qualities consumers look for in a doctor are:

  • Friendly and caring attitudes;
  • Physicians’ ability to answer questions; and
  • Thoroughness of examinations.

Those polled reported the most frustrating issues when dealing with healthcare professionals were:

  • Office wait times;
  • Cost and payment concerns;
  • Wait times for exam and medical laboratory results; and
  • Scheduling appointments.

It’s All in a Word

Earlier this year, Healthcare Dive also reported on research that examined online reviews and their content conducted by Penn Medicine. Researchers at the University of Pennsylvania used digital tools and data analytics to help healthcare providers better understand and improve the patient experience.

The researchers analyzed 51,376 online reviews about 1,566 hospitals posted on Yelp over a 12-year period. They published their findings in the Journal of General Internal Medicine (JGIM).

They concluded the word most often found in positive Yelp reviews was “friendly.” Their example of how positive review writers used this word: “The doctors, nurses, and X-ray technician who helped me out were all so cool and friendly. It really restored my faith in humanity after I got hit on my bike.”

Other words the researchers commonly found in good online reviews include “great, staff, and very.”

“Told” was the word most often found in negative reviews. The researchers’ example: “I constantly told them that none of that was true and the nurse there wouldn’t believe me.” It appears from the JGIM study that Millennials often felt healthcare professionals did not listen to them.

The researchers identified “worst, hours, rude, said, no and not” as other words often found in negative reviews.

“As providers, we need to take a moment to think about how we talk in hospitals, but also what patients are hearing,” said lead author of the Penn Medicine study Anish Agarwal, MD, Assistant Professor of Emergency Medicine at the University of Pennsylvania. “I may say something, but the way it’s heard and interpreted and then processed within patients when they’re going through a vulnerable time can be different.” (Photo copyright: University of Pennsylvania.)

Half of Millennials Prefer Internet Research and Online Virtual Healthcare

Another survey conducted by Harmony Healthcare IT, a health data management firm based in South Bend, Ind., found that more millennials are researching the Internet for medical advice in lieu of actual doctor visits.

PC Magazine reported Harmony Healthcare IT’s survey found:

  • 73% of Millennials reported following medical advice found online instead of going to a doctor; and
  • 93% reported researching medical conditions online in addition to a doctor visit. 

The survey also found that 48% of millennials trust online resources for medical information and that 48% prefer virtual doctor office visits over in-person visits.

In addition, 24% of this age group have gone five or more years without a physical and 57% prefer high-deductible health plans (HDHPs).

“With an emphasis on convenience, low cost, and technology, it will be interesting to see how this generation helps shape the future of health and how both patients and providers will adapt to those changes along the way,” Harmony Healthcare IT wrote in a blog post.

The results of these surveys illustrate why clinical laboratories and anatomic pathology groups must have a social media strategy for managing their reputations and presence on the Internet, especially where Millennials are concerned.

That strategy should include easy and informative ways for patients to learn about medical laboratory services, pricing of lab tests, quality of work, and methods consumers can use to leave online feedback and receive responses to their comments. 

—JP Schlingman

Related Information:

More than Half of Americans Share Doctor Experiences Online, Survey Shows

“Told”: The Word Most Correlated to Negative Online Hospital Reviews

No. 1 Word in Online Negative Hospital Reviews is ‘Told’

Doctors? Nah; Most Millennials Get Medical Advice Online

Millennials Forge New Paths to Healthcare, Providing Opportunities for Clinical Laboratories

JAMA Study Shows American’s with Primary Care Physicians Receive More High-Value Care, Even as Millennials Reject Traditional Healthcare Settings

Apple’s Update of Its Mobile Health App Consolidates Data from Multiple EHRs and Makes It Easier to Push Clinical Laboratory Data to Patients

January’s press release confirmed the tech company is working to integrate critical medical data into its mobile devices, while further promoting interoperability and patient access

While interoperability has improved since the earliest electronic health record (EHR) systems, today’s active patients often need to sort through multiple healthcare portals—including those of clinical laboratories and anatomic pathology groups—to get a comprehensive view of their medical history. Not only can this be time consuming, but also inconvenient if the patient lacks access to a computer.

Thus, it’s no surprise that in a January 24 press release, mobile technology giant Apple announced plans to enter the development ring and create an improved EHR for its mobile device users by updating its existing “Health” mobile application (app). The iOS 11.3 update, among other things, is designed to enable Apple iPhone owners to receive critical medical data, such as medical laboratory test results, directly on their devices.

“Our goal is to help consumers live a better day. We’ve worked closely with the health community to create an experience everyone has wanted for years—to view medical records easily and securely right on your iPhone,” said Apple COO Jeff Williams in the press release.

Jeff-Williams-COO-Apple

Jeff Williams (above), COO at Apple, notes that, “By empowering customers to see their overall health, we hope to help consumers better understand their health and help them lead healthier lives.” (Photo copyright: Apple.)

The new features are already available to developers in the latest iOS 11.3 beta 3 release. However, release to the public is expected soon with the issuance of the iOS 11.3 final release. This means that patients will not need to download extra apps—or remember to use them—to take advantage of the feature.

New Way to Improve Patients’ Access to Health Data or Just Another Data Silo?

The Apple Health Records platform adheres to Fast Healthcare Interoperability Resources (FHIR) protocols for transmission of data. Providers send information to Apple which then aggregates the information, transmits it to patients’ iPhones and notifies them of the updates.

All information stored on the device is encrypted in storage and protected from unauthorized access by the user’s password.

Through the new Health Records interface, users view this aggregated data as a timeline, conduct searches, and share information with other parties as they deem appropriate.

Current medical information listed in the press release includes:

  • Allergies;
  • Conditions;
  • Immunizations;
  • Clinical laboratory results;
  • Medications;
  • Procedures; and,
  • Vitals.

Currently, the platform integrates data from three major EHR developers:

  • Epic;
  • Cerner; and,
  • AthenaHealth

Apple-health-records-ios-11.3-Update

Apple’s update to the Health app makes it easier for people to access and control of all of their health records and data. This included medical laboratory tests. (Image and caption copyright: Apple.)

Apple is also working with 12 health institutions across the US in the first phase of the project, including:

In the Apple press release, Stephanie Reel, CIO at John Hopkins Medicine in Baltimore, stated, “Streamlining information sharing between patients and their caregivers can go a long way towards making the patient experience a positive one. This is why we are excited about working with Apple to make accessing secure medical records from an iPhone as simple for a patient as checking email.”

Previous Attempts at Mobile Health Record Devices Got Mixed Results

This isn’t the first time a major technology company has attempted to enter the mobile health market. Google Health was shuttered in 2011 citing low adoption. Wearable fitness trackers, such as Fitbit (NYSE:FIT) enjoyed a bubble, but are now seeing mixed success in terms of long-term adoption and use, according to The Motley Fool. More to the point, they’ve never quite become the holy grail of monitoring and data collection that some experts predicted, Huffington Post reported.

However, Apple’s investments and interest in healthcare-related technologies has led to wide speculation that they would enter the health market this year. (See Dark DailyApple May Be Developing Mobile Device Technology to Monitor User’s Health and Transmit Data in Real Time.”)

Larry Dignan, Editor-in-Chief at ZDNet, builds a compelling case for why this could be the attempt that succeeds in providing a consolidated platform for clinical laboratories, physicians, and other care providers to push data directly to patients and—with the patient’s permission—to each other, regardless of the platforms healthcare facilities use to store and transmit data.

He notes that much of Apple’s newest features build on foundations laid by the healthcare industry to create scalable, functional EHR systems. By working with existing protocols, Apple’s Health Records platform is already positioned for compatibility with many healthcare providers.

Furthermore, Apple is already known for partnering at the enterprise level with major businesses and industries, while also holding the trust of millions of Americans who store their personal information on Apple devices.

Is Apple the Future of EHRs?

Despite this, until the platform—and adoption by the public—is proven a success, it will be yet another walled garden of medical information. Even then, Apple is only one segment of the global mobile market.

Unless Apple provides access to other platforms (such as Android), those patients—and the medical communities serving them—are left consolidating information on their own through a sprawl of various portals. This also means that medical laboratories, pathology groups, and other service providers must continue to invest time and funding into communicating data in ways compatible with a plethora of internal and external systems and software.

Still, the platform offers an intriguing glimpse at the future of medical records and heralds a shift toward empowering patients with easy, comprehensive access to their own data, which would be a boon to the medical laboratory industry.

—Jon Stone

Related Information:

Apple Previews iOS 11.3

Apple Announces Effortless Solution Bringing Health Records to iPhone

With Medical Records Tools, Apple Wades Deeper into Digital Health

Apple Confirms “Health Records” Solution with Aim to Bring Medical Records to iPhone

Apple Will Let You Keep Your Medical Records on Your iPhone

Apple Unveils mHealth Integration with EMR Data through Health App

Apple, Inc. Wants to Solve the Problem of Electronic Health Records

Viewpoint: How Realistic Is Apple’s Attempt at the EHR Industry? Very—6 Reasons Why

Apple Can Win Electronic Medical Record Game with Health Records in iOS 11.3: Here’s 7 Reasons Why

Apple Is Officially in the EHR Business. Now What?

Apple to Launch Health Records App with HL7’s FHIR Specifications at 12 Hospitals

Could Amazon or Apple Actually Make a Dent in the EHR Market?

Apple May Be Developing Mobile Device Technology to Monitor User’s Health and Transmit Data in Real Time

Diagnostics Marketing Association’s (DxMA’s) Global Marketing Summit Will Convene in New Orleans Just Prior to the Executive War College (EWC) to Discuss Primary Trends Facing IVD Manufacturers, Clinical Laboratories

The DxMA Summit’s agenda will complement EWC’s and will explore disruptive technologies likely to be of great interest to medical laboratory leaders and pathology groups

Cybersecurity, wearable technology, and social media are the primary trends facing in vitro diagnostics (IVD) manufacturers and clinical laboratories.

That’s according to Debra Harrsch, President-elect of the Diagnostics Marketing Association (DxMA), a self-funded organization devoted to helping diagnostic marketing professionals stay abreast of industry trends and effectively navigate the changing legal, regulatory, and technology landscape.

DxMA will be holding its annual Global Marketing Summit April 30-May 1 at the Sheraton New Orleans Hotel on Canal Street. Coincidentally, the 2017 Executive War College (EWC) will takes place in the same venue, May 2-3, directly following the DxMA summit. (more…)

Study Reveals Surprises in How Healthcare Consumers Respond to Wellness Programs and Incentives, Some of Which Utilize Clinical Laboratory Tests as Benchmarks

80% of US employers are using financial incentives in wellness programs, and Penn Medicine research suggests better incentive design is needed to get people to exercise

In recent years, there’s been plenty of headlines about wellness programs offered by employers and health insurers. Data show that such programs are cost-effective. But, until now, there were few studies about employees’ attitudes toward wellness programs. Because some of these wellness programs incorporate clinical laboratory testing, medical labs have a stake in their future.

The fact is that companies want healthier employees and they’re willing to pay for it. Experts say about 80% of US employers use financial incentives in worker wellness programs. And for each dollar a company spends on a wellness program, it saves about $3 in medical costs, according to an article the journal Health Affairs. (more…)

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