Project in progress: A cost-effective and non-invasive hepatitis B test makes its way to China — thanks to Kiwi minds

An innovation project of the NZHIH could potentially have global impact thanks to one of the first ideas to be commercialised under the programme.

It started when Dr William Abbott from the Auckland District Health Board (Auckland DHB) made a serendipitous discovery: he found that active liver inflammation caused by the hepatitis B virus (HBV), specifically genotype C, could be detected one to eight years before serious complications occurred—using a cost-effective and non-invasive diagnostic test.

At the moment, a blood test will reveal if someone has HBV—in the majority of cases. The problem, though, is that for people who have genotype C, that same blood test may not show existing liver inflammation, meaning they miss the opportunity for treatment and may go on to develop cirrhosis and liver cancer.

Sunil Vather, Wellington UniVentures' commercialisation lead for NZHIH, says that Dr Abbott’s innovative diagnostic test could be a game-changer for the millions of genotype C patients in China—the country with the highest burden of HBV infection in the world.

“Liver biopsies carry risks and are not popular in China, so a non-invasive diagnostic alternative will be welcomed wholeheartedly.”

He says that Wellington UniVentures' established networks in China are proving invaluable to the commercialisation process: “We’re not only working closely with Professor Jin-Lin Hou—one of the world’s foremost hepatologists—from China’s Southern Medical University, but we have also secured a license from a Chinese company. Injections of funding will be used to validate the test in China and develop prototype diagnostic kits.”

The team has also secured a PreSeed Accelerator Fund (PSAF) contract from the Ministry of Business, Innovation and Employment—a fund that gives commercialisation projects a financial boost to get them to a point of investor-readiness. Once the development work in China is complete, the test will be made available in Australia and New Zealand.

“Being able to develop the diagnostic test using China’s economies of scale means we can ultimately offer the product to New Zealanders; if we’d had to develop it on a significantly smaller New Zealand scale, the expense would have prevented the project from ever getting off the ground,” Sunil explains.

He says that in addition to developing existing pipeline projects, next steps include creating a marketing and communications plan to ensure that staff from district health boards continue to feed the pipeline with their smart ideas.

“The HBV project is a great example of what can happen when we combine our research capability with commercialisation know-how. New Zealand healthcare has world-class researchers, and I expect this is just the first of many similar projects,” says Justin Kennedy-Good, Executive Leadership Committee member of NZHIH and the Programme Director of Performance Improvement, Auckland DHB.

Taking POPstix™ to the World

On sabbatical overseas in 2007, Dr Lyndsey Hayward noticed a common problem. As practising Urogynaecologist, she and her colleagues were in need of a tool to accurately measure POP-Q, the main clinical score to identify the severity of pelvic organ prolapse, and the anatomical success or failure of prolapse surgery.

The standard measure of the condition was introduced in 1996 by Bumpet al, without a tool to achieve the measure, clinicians had been improvising in the interim. 1 in 9 women have pelvic organ prolapse after childbirth.

Returning to New Zealand she researched the market further, designed a solution, and developed prototypes. Dr Hayward worked with AJ Park to register her trademark and found a New Zealand supplier. She used a medical illustrator in the US to produce a detailed instruction sheet for each pack. Finally in 2009, POPstix™ was released, as an accurate and disposable measuring tool.

POPstix™ is sold internationally through distributors in the US, the UK and Saudi Arabia. 95% of sales are export. She describes the assistance of her New Zealand distributors, Endoventure, as “priceless”.

However, it has not been all smooth sailing. A US colleague alerted her to a company infringing her product trade mark in the US. A cease and desist notice was swiftly issued and the offending company complied.

Lynsey describes the greatest challenge as scaling up manufacture to keep pace with demand. Planning for growth and managing the right level of stock are keys to successful business.

The New Zealand Health Innovation Hub congratulates Lynsey on her success so far. She is an inspiration to anyone with an idea that solves a real problem. Proving that with persistence, assistance and energy you too can bring a product to market and produce better health outcomes. Photo by Annaliesa Tran (AUT)

Design Led Thinking

Design led thinking led to the creation of the iAC console, the workstation he created after 20 years of clinical practice in Anaesthesia. The console solves real problems. It is space and time saving, reduces clutter and creates more time facing the patient, 88% of medical error in the operating theatre is estimated to be attributable to inadequate situational awareness.

A Freedom to Operate search by Everedge IP was completed as a first, preliminary step. It is fundamental to check your idea has not already been done before. Dr Foy had the wisdom to seek assistance. A favourable response led iAC IP Ltd to file patents to protect its intellectual property.

Dr Foy then approached a Research & Development Advisor at ATEED, and successfully applied for an MBIE (now Callaghan Innovation) R&D grant. The concept and prototype iteration was developed over two years with Engineer Kevin Butler. The U-shaped console was designed to be integrated with an anaesthesia machine module. As with the commercialisation of most medical technologies, they targeted key opinion leaders. The company has received positive responses from anaesthetists from around the world. Validation was based on ISO 62366 application of usability engineering to medical devices. Testing at University of Auckland Patient Safety Simulation Centre produced exciting results.

Dr Foy was introduced to Dr Robert Feldman, an independent consultant, through ATEED. They looked over the business proposition and refined strategy by considering the end at the beginning. They established a budget, and successfully raised funds from private investors.

Next was the appointment of an experienced board chair. The company is still in the early stages, but considerable time has been spent on business fundamentals; budgets, IP ownership, good governance and strong strategy.

NZHIH has not been involved with Dr Foy or iAC IP Ltd but congratulates them on a fine example of partnering to enable clinician led design to be commercialised. More details of the company can be found on their web site at IA Console.

IV Sprout Pole

As a third year undergraduate student, Neerali Parbu designed the IV Sprout pole in response to her brief to improve the paediatric experience for children in oncology. Her own experience in hospital as a toddler shaped her thinking and design of the replacement to the standard unstable IV pole.

“I talked to nurses up at the hospital and they also had a lot of issues with the standard IV pole and I began to understand that kids weren’t emotionally attached to it, even though they were physically attached to it.”

She continued refining her design after completing her degree and approached Starship Children’s hospital with a prototype. Successfully securing initial funding, but without a champion assigned, her supervisor introduced her to the NZHIH.

With NZHIH facilitation assistance, Neerali presented her ideas to the Charge nurses at Starship and received useful feedback. The first prototype had a circular platform, which Neerali saw as a space for children to put their toys on. But Nurses worried children would use it like a skateboard, making it a significant safety hazard. She went back to the drawing board and instead designed five curved legs.

Continuing with her studies, Neerali gained Honours and Masters Degrees. At the end of her Honours year, a simulation trial with the IV pole was conducted with 13 healthy children evaluating two versions of sprout pole in a simulated hospital.

NZHIH reviewed the protocol for a further validation trial to ensure it would be appropriate and accepted by the DHB Research office, invaluable assistance according to Neerali. Children overwhelmingly preferred her pole to the standard version.

Mercury Energy have commissioned the production of twenty IV poles. Starship have agreed to use the IV pole in their day stay units. A great outcome of the tenacity and persistence she has displayed over the years to bring her innovative idea to reality.

Dr Richard Aickin, director of child health at Starship, says well designed equipment like the Sprout pole delivers a better experience for children while still meeting the hospital’s clinical needs.

“We know that the hospital environment plays a big part in the experience of children who need to come here. We expect that the Sprout IV Pole will reduce stress and add a more playful feel to children’s immediate surroundings in hospital.”

Photo by Annaliesa Tran (AUT)

Smartpage from On Call

Dr Aidan Gill, now in his late 20’s, started medical school when he was 16.

Whilst working on the wards, he noticed a problem and created Smartpage as the solution.He briefly studied software engineering before deciding to go to medical school, he is taking a break from practising as a doctor and spent 2 years developing Smartpage fulltime.

The smartphone application has replaced old pagers on Waitakere Hospital's wards from 4pm till 8am weekdays and on the weekend while doctors are on-call. It allows more reliable and direct communication between nurses and doctors, resulting in better patient care.

Dr Gill began Oncall Health to improve hospitals and health-care delivery, providing patients with faster, better and safer care. Smartpage changes the way staff communicate, improving their standard of care and makes them more efficient.

Smartpage provides analytical data that could allow hospitals to track doctors' workloads. Electrocardiogram, and photographs can also be sent through the system and nurses are immediately notified whether the message has been read or not.

Smartpage was trialled at WDHB for a month and the technology had been well received by medical staff. Problems with hospital pagers have prompted a trial of smartphone technology by the Waitemata District Health Board.

The trial covered five after-hours wards in January 2013. 170 nurses and 22 doctors used the system, covering all afternoons, nights, weekends and public holidays, with a total of 670 hours in use and 1,316 tasks sent. All tasks were acknowledged and completed.

Feedback from doctors and nurses was overwhelmingly positive. 100% of doctors surveyed ranked speed and workflow with Smartpage to be good or very good, with self-reported time savings to be as much as 10-15 minutes per hour on average.

Waitakere Hospital nurse Aparna Soman says she can now categorise cases depending on urgency so doctors can identify the patient's condition and act accordingly.

Smartpage is being used in the medicine, surgery and obstetrics and gynaecology departments at both Waitakere and North Shore hospitals.

It works on 3G or wi-fi networks and enables nurses to send instant messages from their desktop computer to the on-call doctor's hospital-allocated smartphone.

Waitemata District Health Board head of division for medicine Jonathan Christiansen says Smartpage has transformed the interactions between nursing staff and junior doctors after hours and will enhance patient care and safety.

"On call doctors can now offer clinical advice, prioritise tasks and review the progress of patients over multiple wards with greater efficiency and accuracy.

"The two-way communication is a great advantage for nursing staff, relieving the frustration and uncertainty that are the norm with standard paging systems," he says.

Oncall Health won the ‘Excellence in Research and Technology’ award in the 2013 Waitemata DHB Health Excellence Awards.

Oncall Health was one of the top three New Zealand businesses in the 2013 ANZ Flying Start Business Plan competition.

"On call doctors can now offer clinical advice, prioritise tasks and review the progress of patients over multiple wards with greater efficiency and accuracy.

"The two-way communication is a great advantage for nursing staff, relieving the frustration and uncertainty that are the norm with standard paging systems," Jonathan Cristiansen says.

Photo by Dean Purcell