Anneke Muller Kobold and Patrick van Rheenen won the 2018 UMCG Innovation Prize for their application of home-testing for patients with inflammatory bowel disease. Anneke explains: “We have received the prize for setting up a system for accurately measuring disease activity at home in an easy way.” Patrick: “Within two hours you will have the results. If you’ll have your stool tested in the hospital, results can take as long as two weeks. Plus, the sample could take a long time to arrive at the lab, by which time the sample may have reduced in quality. By having the patients test their stool sample themselves at home we can advise whether they should be seen at the Inflammatory Bowel Disease (IBD) clinic or not.”
Why the project focuses on children
The project of Anneke and Patrick focusses on children, because this promises the biggest added value. Anneke: “Patrick is a paediatric gastroenterologist, I am a clinical chemist. It was Patrick’s idea to implement self-testing for kids with inflammatory bowel disease.” Patrick explains why: “Teenagers don’t easily tell their parents or doctor that they don’t feel well, because that could mean they will have to go to the hospital, or take nasty medication. So they have a motive to keep quiet. Therefore, you cannot rely solely on an interview with a teenager. Detecting an increased level of the protein calprotectin in the stool indicates that the disease is active.” Anneke adds: “By using the self-test, the patient could stay at home, or not miss school, and the parent does not have to take a day off.” For many (parents of) patients, this idea of self-testing is enticing. Patrick: “A month ago we published a press-release about the self-test. This led to hospitals throughout the Netherlands being called by patients who wanted to use this method.”
In order to guarantee the success of this project, Anneke and Patrick have involved the patients early on. Anneke: “The test itself has only recently become available. We are currently training patients to use it. But we have asked patients for input in a very early stage.” Patrick: “Most patients are comfortable working with the self-tests, but of course some don’t like working with samples of their own stool.” The development of the test together with the patients is very much in line with the UMCG philosophy of having the patient clearly in focus for everything that is done.
Development of patient training and IT infrastructure
The UMCG Innovation Prize comes with a fund of 50.000 euro to further the innovation project, much welcomed by Anneke and Patrick. Anneke: “Developing the patient training is part of the project, and so is the development of the IT infrastructure. The training was developed together with the department of clinical chemistry, and takes place face to face between patients and nurse consultants. During this training, patients learn to perform the self-test by using their smartphone to take measurements. The procedure is performed at home. In this time of corona pandemic, people have familiarized themselves with self-tests.” Patrick: “The test is very similar to a corona test, but for this specific test the smartphone is used not only to determine the presence of the calprotectin protein, but also to measure the concentration of this protein as well.”
The procedure and the performance of this self-test by the patient was investigated in previously published studies from the two researchers, in which home-testing was benchmarked against tests performed in the laboratory. To enable its use in routine patient care, the self-test-results had to be reported to the UMCG health care professionals. To increase safety and reliability, Anneke and Patrick had a closed system in mind, in which test results are entered into the digital patient record without interference by intermediaries. According to Patrick, this was the hardest part of the project: “The innovative part of the project is the link with Epic, the software for keeping and sharing medical records of patients, and GLIMS, the laboratory information and management system. This link is unique, and we are really happy that we found Bert Nijholt to make it a reality.”
The added value of the UMCG innovation prize
The UMCG Innovation Prize not only puts a spotlight on innovative projects, it also fills a gap in the research funding landscape. Implementing new medical methods is an academic activity that is much underfunded. Patrick: “Funding for implementation needs to come from the funding for your initial project. Our project started in 2012, and when it was done, there simply was no money left for implementation. Sometimes, implementation could be funded by health care insurers. But our research was not generic enough for this.
The project is currently being rolled-out. A future expansion of the self-test towards adult IBD patients is in the pipeline.