
Launch HN: Scanwell (YC S18) – At-home UTI test with same-day treatment options - stephenlchen
Hi HN,<p>I’m Stephen, the founder of Scanwell Health  (<a href="https:&#x2F;&#x2F;shop.scanwellhealth.com" rel="nofollow">https:&#x2F;&#x2F;shop.scanwellhealth.com</a>). We’re a modern diagnostics company, and we’ve created the first at-home UTI (urinary tract infection) test with same-day treatment options.<p>With a lifetime of experience in the diagnostics industry (literally––my family’s business is in manufacturing in-vitro diagnostics, and my first summer job was assembling pregnancy tests), I’ve always been interested in making these tests more convenient and cost-effective.<p>Why start with UTIs? Some studies estimate that up to 60% of women experience UTIs, prompting 10 million doctor visits in the US each year. Getting treatment for a UTI at urgent care costs around $150, while visits to the emergency room can cost over $2000––and one study found that ER visits for UTIs adds $4B a year in unnecessary healthcare costs. By taking the same urine test performed in doctor’s offices, hospitals, emergency rooms, etc. and making it accessible to anyone who has a Scanwell UTI test kit and a smartphone, we’re drastically reducing the time and cost it takes to treat UTIs.<p>Just like a traditional test, ours uses a chemically treated test strip that reacts with the patient’s urine sample. But instead of being read by a urine analyzer in a lab, the Scanwell app uses computer vision to assess the results. Results are provided to the patient in 2 minutes, with the same diagnostic accuracy as a urinalysis performed in a clinic. If the user has signs of a UTI, we’ll directly connect them to a healthcare provider who can prescribe treatment.<p>Our UTI product is FDA-cleared, and we are working to obtain clearances for other tests. One such test is our chronic kidney disease (CKD) test, which is currently being piloted with Kaiser Permanente to improve screening for and monitoring of chronic kidney disease at home.<p>Telehealth continues to grow but the piece that is missing is diagnostics, and that’s what we hope to provide. Whether it’s for detecting acute conditions like UTIs or managing longer term conditions like chronic kidney disease, we believe that the more we can enable at-home testing the more accessible healthcare will be for everyone.<p>We’re excited to hear your feedback and answer any questions you might have about Scanwell. Thanks everyone!
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damla
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!

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stephenlchen
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.

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monkmartinez
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.

~~~
stephenlchen
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...

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vo2maxer
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.

~~~
stephenlchen
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.

~~~
vo2maxer
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.

~~~
stephenlchen
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!

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anaskar
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?

~~~
stephenlchen
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](https://www.scanwellhealth.com/chronic-kidney-disease-
study).

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groby_b
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 :)

~~~
stephenlchen
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).

~~~
groby_b
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)

~~~
stephenlchen
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!

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dr_
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?

~~~
stephenlchen
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.

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futhey
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.

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

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uj8efdkjfdshf
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.

~~~
stephenlchen
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.

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newman8r
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.

~~~
stephenlchen
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.

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benfradet
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?

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spazx
Does this product work for males as well?

~~~
stephenlchen
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.

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

~~~
stephenlchen
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.

~~~
brlewis
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.

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behucrolig
“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...](https://mobile.twitter.com/JamesMaloneLee3/status/1154694034360872960))

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/](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](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-...](https://link.springer.com/article/10.1007%2Fs00192-018-3558-x)
“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](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?

~~~
stephenlchen
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?

~~~
behucrolig
"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](https://doi.org/10.1007/s00192-017-3472-7)

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

