Late last year I thought I'd try the Theranos lab test at a local Walgreens, but I was a little too early for their direct-to-consumer (DTC) process. Theranos could have taken my order for a select number of tests (under Arizona law at that time), but they elected to wait for two major milestones.
The first was state legislation allowing for any lab test to be ordered by a consumer without a doctor's request. Arizona Governor Doug Ducey signed House Bill 2645 in April that allows Arizona consumer's to "obtain any laboratory test from a licensed clinical laboratory on a direct access basis without a health care provider's request or written authorization."
The second milestone ‒ FDA approval of the Theranos hardware, software, and testing platform ‒ occurred earlier this month, so I decided to try again.
A key element of the Theranos model revolves around retail convenience and for those of us in the Phoenix metro that's fairly easy to see with the Walgreens partnership.
The Theranos Wellness Center inside the Walgreens I visited was small but very modern and comfortable. The retail convenience also meant being open during regular pharmacy hours (which is often less than stores hours but open on weekends).
The order form itself is well designed but doesn't list all the available tests. At some point this could be an online ordering process (which could also help with scheduling), but the day I went (a Sunday morning) there was no line at either the pharmacy counter or the Theranos facility. The Walgreens Health Clinic had a few anxious mothers with infants, but the Pharmacy/Theranos side was wait-free.
There was a standing rack of order forms and I filled one out and gave it to the pharmacist.
This is, of course, healthcare so there's no getting around HIPAA. I was given the Theranos 4-page Privacy Notice to keep (also available online here) and then asked to sign an Acknowledgment of Receipt. My information was entered by the Pharmacist and then came billing. The cost for the test I ordered was low enough that it didn't trigger my thinking to use an HSA card ‒ but I easily could have. The order was completed in the same way that any retail pharmacy transaction is completed.
At this point, the order is then transferred electronically to Theranos and I was greeted by the one phlebotomist on duty. There was a sliding door for privacy and then a brief overview of the process. The one surprise here was an insistence to take my picture ‒ presumably as yet another way to authenticate my identity to the test. The photo process appears to be baked into the software application itself and it simply used a camera attached to the top of the desktop monitor. This was really the only surprise in the sense that I wasn't expecting this, but it's also fair to consider this a safeguard relative to authentication, time-stamp, and chain-of-custody logic.
The other surprise was that the phlebotomist said she was unaware of the test ordered ‒ and that's by design (for additional privacy). Both Walgreens and Theranos know, of course, but not the phlebotomist taking the sample. The order as entered by the pharmacist indicates how many vials of blood are needed for a given test and the phlebotomist is simply tasked with filling the right number of vials for the test ordered.
The test itself was fairly rapid. My finger was wrapped in a small, chemically induced warming wrapper for a minute or two and then wiped with alcohol. A small, disposable lancet was then used to prick my finger and collect the small blood sample.
I snapped a picture of the vials (while the phlebotomist was entering data on her computer with her back toward me), but the shutter sound was on and I was immediately told "no pictures are allowed." Oops.
My finger was then wrapped with a small band-aid and the test was done. Total elapsed time for the Theranos test was 19 minutes, but I can easily see where the whole process could be less than 10 minutes (I kept interrupting with questions). At the end of the test I was told the results would be available within 24-48 hours and I was sent an email notification with a "visit code."
Exactly 27.5 hours later I received an email notification that my results were ready. Using the "visit code" I was sent at the end of the test, I logged into my Theranos account and was prompted to enter a new password in order to download the encrypted PDF file. Once downloaded, the Acrobat Reader software then prompted me for that password in order to open the encrypted file. At that point, I could see (and manage) the PDF directly ‒ including saving it to my hard drive, printing etc... The convenient mobile app also has my results but requires an additional PIN to access.
The application logic is clearly around legal chain-of-custody and protection for sensitive health data delivered online.
The Theranos process really has removed much of the friction I associate with blood tests I have taken in the past. Access is through a familiar retail facility with pharmacy hours. Billing is a typical retail transaction with credit, debit and HSA cards (or cash/check). The lowest price blood test is $2.70 (Glucose) and Theranos advertises that their pricing is at least 50% below Medicare reimbursement rates for all tests.
The highest price test on the Theranos order form was $59.95 ‒ a comprehensive test for Sexual Health. For comparison purposes, RequestATest (which appears to be an online, front-end for using LabCorp locations around the country), charges $199 for a comprehensive STD test and AnyLabTest Now (with 3 locations in the Phoenix metro) charges $229 for a comprehensive STD test.
I did prefer the finger-stick over watching vials of blood being siphoned out of my arm.
All in all ‒ the Theranos experience is well thought out as a retail experience and about as frictionless as possible. Some may have trouble understanding the PDF encryption process, but everything else online (account setup, email notifications, login etc...) mirrored other retail accounts with an online (and mobile) experience.
Arizona has taken an important step in building a new model for preventive healthcare in our country. With the new direct access law, patients are empowered to get the information they need to make important and preventive health decisions with their physicians. Our Theranos Wellness Centers give individuals access to affordable and convenient lab testing services so that they can engage with their own health and work with their doctors to get the care they need before it is too late. Elizabeth Holmes ‒ Chairman, CEO and Founder of Theranos
A great consumer experience doesn't resolve the clinical controversy surrounding the company, of course, but it absolutely does have to behave like a retail, consumer experience. The one test I took certainly lived up to any retail expectation I had and was frictionless, pain-free and low-cost. It also includes a new consumer experience that's been a long time coming ‒ and in some health circles ‒ equally controversial. Direct access to my own clinical data.
