When Elizabeth Holmes started her company, Theranos, back in 2003, she had a revolutionary idea – make lab testing easily accessible to patients at a low cost using a minimal amount of blood and providing a secure portal for results to be viewed by both patients and their doctors.

At its height, the company was touted to be worth $4.5 billion dollars. Current valuation, close to nothing.

In addition, the Centers for Medicare and Medicaid Services, CMS, has proposed banning Holmes from any blood testing businesses for a minimum of two years, after thousands of samples were found to have inaccurate results and her lab in California didn’t pass inspection by regulators.

So, what did she do right?

Similar to other disruptive innovations like Uber and Airbnb, this approach to the traditional method of doing laboratory testing was a revolutionary new way to do business in the blood-testing industry.

The Theranos website listed what tests were available and their cost: Hepatitis C testing, less than $10; a full lipid panel, $9.11. This is not what most people or their insurance pay at a traditional lab. (Clinical Labs of Hawaii costs approximately $60 for Hepatitis C testing, $50 for a lipid panel, as quoted to me by their customer service representative, as of June 14.)

Full transparency was the goal, encouraging even those without insurance to consider the low cost of doing certain tests and hopefully opening up the playing field for everyone to monitor their health with specific lab tests. Even though the use of a Theranos Wellness Center lab would require the order of a doctor, results were fully accessible by patients and doctors alike for future care.

What if we took it a step further? What if patients could order their own labs, even without a doctor’s order? If someone is willing to pay for it, doesn’t it make sense that they could test what they wanted in their blood, when they wanted to, and not have to go through the traditional route of finding a doctor, scheduling an appointment, going in for an office visit and then doing tests?

Doctors may argue that this could lead to indiscriminate ordering of unnecessary lab tests, and sure, that’s true. Also, people might not understand what the results mean.

Certain tests are already commercially available, such as genetic testing through 23andMe. There are also ways to test for the breast cancer gene as well. But many of these tests still require a medical order from a doctor.

What if lab testing was easily accessible at any pharmacy without a doctor’s order? Would you do it? What would you test for?

I see patients in my office every day and often order lab testing for them. Honestly, I have no idea what the insurance pays for the tests or what the lab costs. But we pick and choose from some basic testing options that make the most sense for the patient, then often get together in person to review the results and determine if we need to check certain things periodically, like in six months or so.

One of the main reasons patients don’t comply with updating their lab tests is lack of convenience. Labs are open during business hours, sometimes at night, and maybe on Saturday. Fasting, which is required for some tests, would be very hard to do if someone waited all day, without eating, until after work.

If it was easier to do lab testing, patients might be able to responsibly monitor their values in between appointments, to see if they are on the right track. Blood sugar testing at home is offered to those with diabetes because it’s a helpful way to see if the amount of exercise or intake of food make a difference in the sugar values. Blood pressure machines are readily available to monitor for that as well.

Why not add cholesterol to the testing? This would help people to monitor their numbers and give them access to testing when they want it.

What about testing for sexually transmitted diseases? There would be a greater number of folks who would test for hepatitis, syphilis, HIV and more if there were easy ways to do so that didn’t require waiting to see a doctor every time.

It’s not that doctors aren’t willing to order the tests. It’s just that in order to get people to take charge of their health, maybe they need more tools to work with. Being able to self-order certain tests at a lab would be a good interim tool for those folks wanting to know if their extra efforts are worth it. Especially for those who might not have access to insurance but would have enough money to pay the lower cost of direct testing if it were as low as Theranos wanted to charge.

Patients could still see their doctor, even bring their test results, and we could review them together. It might lower the cost of their care if they are paying for their own tests and also provide enough competition for labs to lower the cost they are charging insurance companies to remain in business. 

That’s what Elizabeth Holmes got right. She wanted to bring the testing to convenient sites at a cheaper cost and make the whole process easier, using less blood, smaller needles and easy access to results. No, her company didn’t deliver on all of its promises, but maybe in the near future, another one will.