SystemOne: Next Gen Disease Surveillance

A major opportunity now exists to leverage SystemOne's existing connected networks of Cepheid’s GeneXperts and PCR devices in 30 LMICs to gain access to real-time outbreak data which can be utilized for country preparedness, real-time decision-making and response. SystemOne proposes to build a novel disease surveillance module within our current Aspect platform, supplemented by the Aspect Reporter mobile app, that will be fed automatically by live diagnostic data of positive cases. The data will be supplemented by environmental and geographic public data sets to enable AI and machine learning analysis. For initial development, COVID-19 data will be used as a base case, but the system will be translatable to other diseases of outbreak potential. Our solution will enable Ministries of Health to proactively identify infectious disease hotspots of COVID or MDR-TB outbreaks by geography for immediate action. 

Millions of people already affected by TB are at even greater risk with the spread of Coronavirus. The biggest bottleneck of the COVID-19 response has been the lack of timely testing data to inform contact tracing and isolation efforts. Expediting development of both the COVID and Surveillance modules will serve reactive and proactive needs to control the COVID pandemic and spread of infectious diseases into the future.

As was seen with the 2014-2016 Ebola outbreak, the current COVID-19 pandemic is highlighting one of the major failures of current disease surveillance systems. For countries that have surveillance systems in place, the severe lack of timely and accurate data reporting is making it impossible for health systems to mount a coordinated response and contain the pandemic in a timely and appropriate manner. This is often due to the need for manual data entry and passive reporting which can delay the reporting process by days to weeks. When a country is dealing with a highly transmissible infectious disease, time more than anything, determines the success of a response. Some low- and middle-income countries (LMIC) lack any type of surveillance system, thus making them ill-prepared to deal with an outbreak situation.

SystemOne’s platforms - GxAlert and Aspect - currently connect around 3,500 labs and diagnostic instruments in 40 countries. We enable test results to be received automatically and in real-time, reporting to health care workers via Android App or SMS. Aspect is compatible with multiple diagnostic instruments in central lab and point of care settings including the Roche Cobas, the Abbott M2000, the Alere Q, and more. Aspect’s machine-agnostic functionality enables all diagnostic devices to be immediately connected and integrated as COVID-19, HIV, and TB testing capacity is needed and brought online. 

Drawing from this core of data, the surveillance module will provide the following: 1) real-time, automated collection and aggregation of data directly from instruments; 2) real-time reporting of diagnostic data to the point of patient care including contact tracing teams; 3) automated alerts and triggers when positive cases exceed a predefined threshold; 4) dashboards showing geo-location of diagnostic results to monitor hotspots/outbreak areas ; 5) heat-maps to monitor disease progression over time; 6) geo-spatial and demographic trend analysis with the potential to overlay HIV and TB burden in areas to show existing burden of disease already present in communities and any potential information, or surrogate markers for strain diversity.

SystemOne works in with Ministries of Health in high TB burden countries around the world. We serve TB and HIV patients who rely on diagnostic testing to monitor VL levels and confirm TB diagnoses. Rapid return of test results enables patients to take action to protect their own health (seek TB or HIV treatment) and reduce transmission to their family and neighbors. Rapid diagnostics also serves the greater good with reliable population level data needed to control infectious diseases. Originally designed using Human Centered Design principles with MOH health officials, the software is constantly being refined and customized with user input and socialized to our entire user community. 

With the addition of surveillance capabilities, the MOH and their public, will proactively view disease patterns by geography and the strength of relationships to other variables. Such information is vital to Emergency Operating Centres (EOCs) in ensuring their contact tracing teams have up-to-date information for deployment. Similarly, this information can be provided to regional bodies (WHO, CDC, Africa CDC, African Union, for example) for monitoring of outbreaks and hot-spots within the various sub-regions.

We are partnering with an AI firm and the MOH of Pakistan to further refine ideas and approach.

The essence of the Challenge is to create and deploy innovative tools to deliver data to decision makers and control disease outbreaks faster. In the time of COVID, an opportunity exists to disrupt the status quo, to integrate systems and leverage wider sets of data across the health system. SystemOne can leverage its multi-disease platform that is integrated across disease streams to feed real-time data to a AI-driven analytics platform to create a next generation surveillance system for MOH infectious disease response teams.

Diagnostic devices being utilized in central or regional labs are not networked to provide real time delivery of diagnostic results and support trend analysis and planning.  The overwhelming majority of data collection in LMICs is paper-based which is error-prone and slow to be digitized into more usable forms and doesn’t allow rapid response to outbreaks.

SystemOne developed GxAlert, an innovative software platform, that is designed to support GeneXpert TB and HIV programs by providing real time delivery of digital TB results via SMS, email, and data dashboard. GxAlert has been implemented in 43 countries and over 750 laboratories and continues to provide value to TB programs.  AspectTM is a new and improved version of GxAlert, designed as a multi-disease, multi-instrument, disease intelligence software platform. Like GxAlert, Aspect connects directly to diagnostic instruments, laboratory and health information systems (LIS, HIS), and case management systems to support health programs. 

Even with proven results, we compete with a lower-end offering names Savics who also connect GeneXperts. As we move beyond connectivity to AI driven surveillance we will compete with Zenysis, a Silicon Valley funded start-up and Premise, also a data company. We can differentiate ourselves with 1- existing footprint in 43 countries; 2 - existing source of high quality data sets; 3 - broad set of relationships with many MOH and international donors. Our ability to trace genomic results from the GeneXpert machines and apply intelligence to surveillance of highly infectious MDR-TB, co-infections of HIV/TB and potentially COVID gives us a unique offering. 

The technology stack is

Database: MySQL

API: NodeJS/Hapi

Front-End: React/Redux/Material UI

Message Queue: RabbitMQ

External Services:

SMS: Twilio

Email: Sendgrid

Push Notifications: Firebase

Aspect Reporter is built in React Native

AI platform overlay

Aspect and GxAlert have already collected 10.7 million diagnostic results globally, each with different custom data fields and associated information. Over 75,000 real-time, customized case notifications are sent via SMS and email every month, with over 2.4m notifications sent globally to date. Some countries use Aspect as the national operational management of their diagnostic instruments for TB.  Other use cases have seen the Aspect system being used in the context of (near) real-time initiation of patients in care in maternity wards leveraging near-patient testing and result delivery via SMS to the health care workers in the maternity ward. The AI platform is being used in Pakistan and South Afric

Outputs

• Connect Aspect to deliver real-time COVID-19 diagnostic test results to clinicians, via SMS, email and mobile application

• Digitizing diagnostic results and clinical management of diagnostic outcome allows all levels of health system, including point of care, to inform faster diagnosis and improved patient management

• Operational data can be used to reliably predict the need/supply for drugs when they become available and where additional cartridges are required. 

Outcomes

Map and monitor disease burden and trends temporally and geospatially

Improve more timely clinical decision making and patient management

Provide more timely and accurate COVID-19 and infectious disease information to inform suveillance activities. 

Goal

Reliable and complete data on COVID-19 and infectious disease status within the country and where resources need to be deployed to control outbreaks.

We measure our impact in test results and are proud to have crossed the 10 million result mark in March of 2020. This loosely represent people, though people can be tested more than once. 

SystemOne hopes to broaden its customer base to provide an elegant connected diagnostic solution to more countries, both in the public and private sector. We believe automated delivery of near-time test results for multiple disease streams will populate the health system information system with quality, timely data that health officials can rely on for program decision making. 

In the next five years, we intend to leverage connectivity and diagnostic accountability technologies to cultivate a well-maintained network and the flow of test results. This means that within the next 5 years, and the next 10 million tests, we will ensure that each patient is linked to TB, HIV VL treatment or the appropriate COVID response to close the loop of continuum of care for each disease, through the use of Aspect and Aspect Reporter and a trained workforce. Beyond the simple distribution of results, notifications and link to treatment is the potential of implementing precision public health principles, to use predictive analytics with our data, satellite imagery, publics data sets, etc to proactively control disease. SystemOne is actively seeking partners and funding to move in this direction.

Existing digital health solutions have contributed to improvements in diagnosing and treating infectious diseases in low-resource settings. However, both disease programs and solutions are often siloed, preventing their ability to achieve their highest potential at clinical, operational and financial levels. Moving towards integration is slow and wrought with bureaucracy. Most critically, the sales cycle in public health is often 18 months from expression of interest to contract signing.

SystemOne will explore the private sector and higher end data partners to realize these goals, including contracts with device manufacturers and Pharma companies. 

Siloed disease funding: Pitch proposals to reflect WHO guidance on multiplex testing, and use concepts and themes to attract traditional funders.

Sales Cycles lag time: Explore new funding sources outside of global health including partnerships with device manufacturers (Cepheid) and companies interested in outbreak analysis, such as Pharma companies.

Funding opportunities: The economic impact of COVID may decrease international donor and national government health contributions in the future. SystemOne will look to create an offering for domestic use to improve sales cycles and create a portfolio to distribute sales risk beyond the international sector.

Bureaucracies: We intend to approach trans-national bodies with our solutions, such as ALSM or Africa CDC to have broader impact.

N/A

Full time: 11

Part-time: 0

Contractors: 13

Our staff includes public health specialists, data scientists, laboratory experts, software developers, IT specialists and product engineers. We have partnered extensively with Global Fund, CDC, UNITAID, and USAID-funded projects and also provide support with funds from the Bill and Melinda Gates Foundation. To these ends, we effectively manage millions of US Dollars in grants, contracts, and subcontracts. We have established the necessary administrative, financial and management systems to effectively execute these grants on time and on budget with project staff, sub-awardees, and short-term contractors.

SystemOne has partnered extensively with implementing partners such as Abt Associates, PATH, Jhpiego, CHAI, URC, etc. We work directly with Ministries of Health, and their National Tuberculosis Programme’ in all countries. We have relationships with funders such as Global Fund, CDC, UNITAID, USAID and the Bill and Melinda Gates Foundation. We are currently exploring private-sector partnerships with Cepheid, Everwell, Delft and and Dimagi. 

SystemOne Four Year plan: Our market map (see figure below) shows the continuum of our sales strategy and how we could potentially move from $2-3million, to $5-6milion, to a $10 million company. Each set of circles represents critical stakeholders/purchasers. The business model we are hoping to test lies in our 2020 goals represented by the green circle. It also lies within the blue circle in so much as we can find more rapid and streamlined ways to be procured in the global health donor community.

Currently, SystemOne is supported by a Series A investment from the TPG / Rise Fund as an Impact Investment. We’re also paid via various donor organizations including USAID, CDC, ASLM, Global Fund on a per project, per country basis. We also continue to work with the above organizations to move towards a per-test pricing model for countries to be able to procure our services via both WAMBO and the GDF. We are also working with various diagnostic instrument manufacturers for potential service bundling to include result reporting to clinicians as part of the diagnostic service offering.

SystemOne has been in business for 7 years and operated successfully on some levels, including reach and creating an impressive reputation in the global TB community. But we are not profitable and seek new relationships and markets for a surveillance product. 

We are looking for business partners with similar interests to help us weather the sales cycle delays and to expand markets, especially in the private sector.

One solution would be to find an overseas distributor for our product with a target for private sales. We welcome Solver partners with similar goals.

Our technology capes are strong but additional corroboration would be helpful.

SystemOne will leverage its existing technologies, including Aspect and Aspect Reporter, to create an AI-powered disease surveillance system. Immediate impact can be offered to national TB programs in the proactive control of drug resistant TB (MDR-TB) which is the most lethal of TB types, and expensive to cure. As HIV and COVID data becomes available from connected PCR devices, co-infection hotspots can also be identified and targeted with predictive analytic techniques. Given existing relationships with MOH in high TB burden countries, we feel the impact can be unique.