The Future of Blood Collection: Is it in our Homes?
Healthcare is changing. Staff shortages, increasing pressure to reduce the carbon footprint, rapid development of digitalization and artificial intelligence as well as the simple human desire to be responsible for one’s own health, are all factors driving change forwards.
Blood samples collected by venepuncture in a professional setting by trained healthcare specialists have been the gold standard for decades. But what if there were a viable alternative? What if blood sampling were possible from the comfort of one’s own home, enabled by our mobile phones or tablets? What if healthcare workers, already stretched to the limit, could free up resources for other critical care activities? On the other hand, can we rely on diagnoses based on self-collected samples?
We discussed these questions with Neil Spooner, chair of PCSIG (Patient Centric Sampling Interest Group) and Vincent Molenaar, global market manager at Greiner Bio-One for alternative sampling systems.
Currently, UK and the Netherlands are leading the way when it comes to decentralization of blood collection procedures.
Amongst others, there are online providers in the UK working together with the NHS to provide self-test screening services for sexual health, for example, ensuring professional care with fullest discretion.
In the Netherlands, there are some services already working in collaboration with healthcare professionals, which gives people the convenience of organizing tests to use at home when it is convenient for them with the advantage of digital access to reliable results, preventing the need to take time off work or obstruct, for example, busy family life.
We asked Neil first about how crucial it is, to shift the focus of blood sampling away from venepuncture and towards alternative sampling methods. He tells us, “Traditionally, the collection of blood samples has put the needs of the laboratory, meaning sample volume and format, to the fore, along with those of healthcare providers – the old adage, it’s how we have always done it - and those involved in budgets, who assume that the alternative is too expensive”. If blood sampling were to focus more on the patient, this means addressing their needs, making a blood collection possible in locations and under conditions and at times that increase convenience to the patient and ideally reducing the volume of the blood samples we are taking, for example self-sampling at home. Neil emphasizes though, that this does not mean ignoring the needs of others in the workflow. Rather, there should simply be a balance, and that the patient’s preference also be taken into consideration. This means in particular vulnerable patients who find it difficult to get to a clinic or laboratory or may want to self-sample at home if they are likely more to be prone to infection and thus at increased risk in a clinic or hospital setting.
With self-sampling in a home setting, Vincent highlights the importance of analyte stability. “Some analytes are simply more stable than others”. He thinks therefore, that there are already areas of testing that can be shifted to a home setting without the need for a phlebotomist, for example chronically ill patients with diabetes mellites and he firmly believes that “we should focus on the patients that will benefit from this the most”. To achieve this, there is still a journey to ensure the development of intuitively functioning tools such as the appropriate digital solutions to ease not just the application at home but also the further processing of samples.
Thinking from the perspective of a laboratory, it could well be, that currently fully automated workflows need to be adapted, should self-sampling involving a range of sampling methods become more widespread. As Neil says, “a number of the patient centric sampling approaches deliver samples in a different format to how laboratories are set up for with their high throughput sample analysis, i.e. dried samples, whole blood”. To become routine, and be sure of rapid and affordable analysis, changes in the lab processing will be necessary, as the sample provided could require additional manual steps.
The future societal impact though, may well be a driver for this change. The obvious reduction in travel needed for centralized blood collection would be beneficial in reducing the healthcare carbon footprint. Hospitals are well known as one of the biggest contributors to the carbon footprint, responsible for 5% of global greenhouse gas emissions1. Furthermore, to promote diversity and equal treatment of the whole population means that all people have a right to the best available healthcare, and home-sampling offers immense benefits to under-served groups, such as those with disabilities, chronically ill people, those living in remote areas or areas with poor infrastructures. As Vincent points out, “nowadays, one can organize of lot of things from your phone” and he believes that healthcare is going to catch up in the coming years with digital solutions, empowering the patient to control their own health. There is already an increasing understanding of the potential for home sampling and the benefits to society, thinks Neil and the next few years could be a tipping point for healthcare decision makers and laboratories to make the availability of home sample collection, where a phlebotomist is not required, and the appropriate analysis technologies an inevitability.
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