Hacker News Reader

Baby girls are especially prone to urinary tract infections while they are in diaper. Moreover it is really very difficult to take urinary samples before they are toilet trained. If you keep in mind that they can't express their symptoms, I'm sure I'd like to keep a couple of tests ready at home when my daughter was young (now 7). Good luck!

Thank you for sharing––we've gotten a handful of inquiries from parents asking if they can use the UTI test kit to identify UTI in babies/children. Anyone is able to test with Scanwell, but we can only direct those over 18 to treatment via telehealth. Nonetheless, we see Scanwell being a useful tool for parents in similar situations to yours––simply knowing, before heading to the emergency room, can bring peace of mind to new parents and parents of younger children.

This is super cool! UTI's are a major problem in the eldery community as well. While I don't have vetted data, I do have my day-to-day experience working in the Fire/EMS industry as a first responder.

I had a patient yesterday, 77 y/o female that was initially called in for erratic behavior. Right when I got in the truck I had a suspicion this was a UTI based on the address, care home, and the comments on the MDT. While UTI's don't always present with a fever, this one did and the care taker knew enough to not flush the toilet... Yes sir, I was 99.999% sure it was a UTI. However....

I had to call a BLS ambulance to take her to the ER because we don't transport to urgent care. The costs associated with this UTI will be in the thousands. I hope we could carry your kit on our fire engines and ambulances as it would reduce unnecessary visits to the ER and the burden on our EMS system.

Wow! The kit being used on fire engines/ambulances isn't a use case we often think about, but your story certainly makes a great argument!

Also though, I'm surprised to learn that the care home didn't have access to/use a dipstick...

Why do a urinalysis at all when most treatment for acute uncomplicated UTI in females, complaining of cystitis and/or urethritis, is empiric as long as there are no signs of pyelonephritis? Urinalysis in the treatment of urinary tract infections is probably one of the most useless tests done in an urgent setting. Urine culture remains the gold standard particularly in areas of high anti microbial resistance.

Great question! While empiric treatment for most patients presenting with acute uncomplicated UTIs is appropriate, recent studies (happy to share these) have shown that 30-50% of the time these patients are being overtreated. Our test result + patient’s symptoms increases the diagnostic accuracy significantly and can help reduce the misuse of antibiotics. With the growing threat of antibiotic resistance, we believe having a cheap and accessible screening test like ours can make a big difference in the care of this common problem.

Over treatment with antibiotics is rampant not only with genitourinary syndromes but even more with respiratory diseases. I am not sure how a female patient, afebrile, without any other morbidity, presenting with classic symptoms of dysuria, urgency, frequency, and hematuria, but having a normal urinalysis, would dissuade me from prescribing antibiotics empirically. As much as most physicians would do a urinalysis routinely, just because it’s done like many other unnecessary tests, it adds little to the management. And let’s not even go into the challenges of obtaining a clean catch. What I would do if not sure of the organism or the patient had been previously treated, is to order a urinalysis with a reflex urine culture.

Nonetheless, after my argument against the use of urinalysis in managing an uncomplicated UTI, I still think you may have a winner given that testing is still widely done. If you have robust medical provider support who understands the limitations, then a significant number of patients would benefit without incurring the large cost or time spent seeking help.

Thank you for your comments. We agree that in the situation you described it is likely that woman would get treated with empiric antibiotics regardless of what her test results show since false negatives are still possible. This is why the telehealth visit always combines test results with additional information from the patient. From our experience, not every person presents with all of the classic UTI symptoms. Having the positive leukocyte/nitrite results provide the telehealth clinicians the confidence they need to treat these patients. For patients with negative results, it provides another data point to recommend in-person evaluation. We also recognize the challenge of obtaining a midstream sample, which is why we have spent a lot of time and effort (including user interviews and focus groups) to create simple to follow instructions in our app.

We would love to chat further about any additional concerns you may have. Feel free to contact us at clinical@scanwellhealth.com. Thanks for taking the time to review our product and leaving your comments!

Congratulations on the launch. This is a rare instance where the combination of cost, technology, and ease of use makes this solution 10x better than the status quo and a no-brainer.

How extensible is this to other tests? Is it just a matter of pilots and trials or are there certain tests that are too sensitive for computer vision to reliably assess?

What % of the diagnostics market is urine-based versus blood-based?

Thank you, for your kind words and encouragement!

We feel this technology can be extended to many other tests––another test we are currently working on addresses/monitors CKD (chronic kidney disease).

Currently, the CKD test is being used in a clinical trial in partnership with Kaiser Permanente (more on that here: https://www.scanwellhealth.com/chronic-kidney-disease-study.

So, I might be missing something, but that's in essence a ~$1 test strip plus some color matching, plus "find a provider".

What's the reason people would choose this over e.g. Azo test strips? (I'd assume the main value here would be in fast-tracking the access & response from the provider, but "connect them to a provider" is doing a lot of work here :)

I think the main reason someone would use Scanwell over an AZO test strip would be two-fold:

1. No guessing when reading the strip. Knowing the technology is FDA-cleared, and considering that the phone relays the result, lends more confidence to the end result.

2. Connecting to a provider/treatment––and here's why: in 2013, less than half of US adults reported being able to get a same or next-day appointment with their PCP, and over 60% said their only option was going to the emergency room.

Even with an AZO result in hand, the patient will still need to coordinate getting treatment. Scanwell gives them the option of getting treatment for a consultation fee of $25, and a guaranteed wait time of 2hr during business hours (which includes weekends).

Ah, the 2h guaranteed maximum wait time is indeed a killer feature. Might be worth calling out :) (I dug around the web site, I didn't see it - that's why I asked)

I guess I should clarify, the 2hr wait time is guaranteed by our telehealth partner Lemonaid (aka the provider we connect them to for treatment). Because it's a Lemonaid policy and not our own, we don't call it out on our site. But, we probably should find a way to communicate it!

I'm a woman who gets semi-frequent UTIs. I know 100% of the time when I have them, but unfortunately a lot of doctors won't prescribe me medication unless I get a full centrifugal test done, and even then the centrifugal test might come back negative (the centrifugal test detects blood, of which there might not be any if I've caught on early enough to my UTI).

I'm totally excited for this product to be totally honest!

Great idea. I've read about Scanwell before. Does the accuracy of the results vary at all with the quality of the camera (newer vs older iPhones)? Also, if a patient is someone who is colonized with bacteria, and doesn't necessarily have an acute infection, would the app be able to inform them as such?

Thanks for your question! Each test kit includes a color card which calibrates the camera for different lighting environments, phone models, etc. Currently, our test supports devices running iOS 9 or Android 9 and newer.

In regards to detecting chronic issues; our test currently detects leukocytes and nitrites. In addition to these two indicators, the treating telehealth provider will collect typical patient info (symptoms, medical history, allergies, etc.), and then determine appropriate treatment. For patients with asymptomatic bacteriuria, treatment with antibiotics isn't recommended per clinical guidelines.

Super interesting company!

You've gotta figure out how to get these into retail. If I had a UTI right now, I'd want to go straight to Walgreens and get a strip in right now! And I might run a few stops signs on the way.

Working on it! The test kits will be available in a major nationwide retailer come Q2 2020, so stay tuned!

Some questions here:

Is quantitative testing possible especially if you use a colour reference chart to compensate for lighting conditions?

Do you have any measures to prevent the patient from scanning the dip stick too soon?

What processes do you have in place to pick up red flags eg recurrent UTIs, pyelonephritis, urosepsis etc?

What measures do you have in place to ensure appropriate antimicrobial prescribing? This includes managing patient expectations in the event of a positive test result.

Thanks for your questions!

We feel strongly that quantitative testing is possible, and is something we're currently exploring.

As far as measures to prevent the patient from scanning too soon––the testing flow within the app includes a timer, during which the test would be processing. Only after the timer is finished does the camera open, enabling the user to scan.

In terms of addressing/identifying red flags like recurrent UTIs, advanced infections, etc.: after the user receives their test result from Scanwell, they have the option to receive treatment via telehealth from our partner (Lemonaid Health). Lemonaid collects additional patient info including symptoms, past infections, etc. In some cases (i.e. pregnancy, postmenopause, signs of an advanced infection) treatment via telehealth won't be possible, and the patient will be recommended to seek in-person treatment.

Is there a possibility that using this method might actually cause people to delay treatment? (i.e. ordering this kit instead of immediately going to their doctor)

I like the idea though, especially once you expand the number of tests available. Would be nice to be able to take a test when I get a cold/flu to confirm that it's actually cold/flu instead of something else that warrants a doctor's visit.

There have been a few times when we've had customers reach out, and say that they're experiencing symptoms and that they want to order the test. Currently we sell the strips direct-to-consumer on our site, and our fastest shipping option is next business day. So in the event that the customer is experiencing symptoms, and doesn't have a test on-hand, we'll recommend they get in-person treatment.

However, we've just partnered with a major nationwide retailer to to make getting the test easier/faster, and are looking into same-day delivery options for e-commerce.

Additionally, we've seen a good number of customers buying the test preemptively.

I think the problem is not really in the diagnostic (when you have your first one, you'll know when you get another) but rather the antibiotic management: resistance testing and rotation if UTIs are recurrent. That's where the value of a visit to the hospital or lab comes from in my opinion.

Does this solution address that part?

Does this product work for males as well?

This is a question we get a lot! The short answer is yes; men can use Scanwell as a screening tool, to identify a UTI.

However, men aren't able to get treatment through our telehealth partner. This is due to clinical guidelines––when a man presents with a UTI, additional testing is typically required, so in those cases we'd recommend in-person treatment.

How do you make sure other apps can't access images of the test strip?

Can you elaborate on what you mean? We don't store images on the phone, so it wouldn't be possible for other apps to access images of the strip.

That answers it. I'm not a mobile developer and didn't know the camera worked in a way such that images didn't have to be stored.

“To commercialise a dipstick method to exclude UTI is a blunder attributable to the base rate fallacy: Making a judgment without considering the prior probabilities. To do so, despite world literature on dipstick artifice, is to bungle badly.”

(https://mobile.twitter.com/JamesMaloneLee3/status/1154694034...)

This is dangerous. Dipstick testing CANNOT exclude UTI. This service relies on an outdated testing protocol and reliance on this test risks harming significant numbers of patients. (start here: http://www.cutic.co.uk/patients/gp-information-sheet/). Up to 50% of dipstick tests, and 50% of urine cultures, miss the infection, and with this service a negative test would be assumed to indicate no infection. Professor James Malone-Lee of University College London has published extensively about the failings of current urine testing and how this can lead to chronic debilitating bladder disease being missed. For example, from a presentation he made to the UK Parliament:

“The betrayal of the cystitis sufferer”

Urinary tract infection (cystitis / UTI) affects 150 million people worldwide each year: 33% of women are expected to suffer before they are 24.

Women presenting with symptoms of UTI in primary care will be managed according to a guideline, there are several of these; they are contradictory and most ignore the published science. ... Many practices will test the urine with dipsticks and, if these prove negative, the patient is informed that there be no infection. This is incorrect advice and confuses no evidence of disease with evidence of no disease. The dipstick test will miss well over 50% of all infections.

If a urine sample is sent to the laboratory for culture, and this is reported as negative, it is probable that this will be assumed to refute the diagnosis of UTI. This is also wrong; the standard MSU culture will also miss well over 50% of all infections, so that a negative test is not evidence of no disease.

If the patient is fortunate enough to be diagnosed with a UTI it is possible that she may be prescribed antibiotics, typically for three days. This may not work: 20% to 30% of patients will fail recommended treatment whether prescribed for three days or 14 days. If she complains that she has not recovered is likely to be dismissed: She will have been advised to drink plenty, her urine, suitably diluted, will be devoid of pathological signals. Thus it is assumed that she must be better – The test says so.

These facts have been available in the scientific literature for a large number of years. The standard guidelines seem to ignore this evidence placing people at risk of being denied appropriate treatment. We do not know the consequences of untreated UTI persisting over months or years, but it may reap harm. The current anxieties about antibiotic resistance make it harder to bring sober reflection to this problem.

This may be an orphan subject but a cause of immense suffering for many people

James Malone-Lee MD FRCP Professor of Medicine, Whittington Campus, UCL Medical School 6th July 2016”

Various interesting papers on the subject:

https://www.ncbi.nlm.nih.gov/pubmed/25949979?dopt=Abstract Reliability of dipstick assay in predicting urinary tract infection. “Nitrite test and leukocyte esterase test when used individually is not reliable to rule out UTI.”

A blinded observational cohort study of the microbiological ecology associated with pyuria and overactive bladder symptoms https://link.springer.com/article/10.1007%2Fs00192-018-3558-... “In this study, routine laboratory culture did not differ between patients and controls at any stage. It is worrying that the gold standard diagnostic test cannot discriminate patients from controls, despite other measures showing clear, consistent, inflammatory and microbiological differences.”

https://link.springer.com/article/10.1007/s00192-018-3569-7 Recalcitrant chronic bladder pain and recurrent cystitis but negative urinalysis: What should we do?

Thank you for your comment. You bring up a good point and we would like to clarify that we do not rely solely on the test results when determining the best course of action. We combine the results of our urine test with the patient’s symptoms and other pertinent information (past medical history, medications, allergies, etc) for the virtual clinician. If there are any concerns about treating the patient using telehealth, the patient will be referred to see someone in person for further evaluation. We will need time to review the different articles you provided, but based on your reading is there a better recommended approach to diagnosing and treating UTIs?

"It is now widely accepted that pyuria (≥1 WBC μl−1) detected by microscopy of a fresh unspun, unstained specimen of urine is the best biological indicator of UTI available." - see Khasriya, R., Barcella, W., De Iorio, M. et al. Int Urogynecol J (2018) 29: 1019. https://doi.org/10.1007/s00192-017-3472-7

And BTW, if you could develop an at home microscopy based test, that could TRULY revolutionise UTI testing. Inspired? ;-)

Launch HN: Scanwell (YC S18) – At-home UTI test with same-day treatment options