Leveraging a Digital Health App to Address Anemia, Maternal Health

April 04, 2023 - About eight years ago, Huiri Kim was told that she might be anemic. She then did what many people with anemia symptoms tend to do — ignore them and hope they go away.

"About 3 million people in the US have anemia, but I think a lot of them aren't aware. Or even if they are, they don't care," Huiri Kim said in a phone interview. "I was the same way."

Because she did not take any steps to get tested for anemia and address the condition — wherein your blood is not producing a normal amount of healthy red blood cells resulting in a lack of oxygen-rich blood — Huiri Kim ended up needing a blood transfusion. As a result, she had to take six months off work.

Had she been tested earlier, she could have "just taken a supplement or eaten more steak or spinach, and it would've solved the problem," she added.

Today, Huiri Kim is the CEO of a digital health startup that aims to ease the diagnosis process for anemia and a host of other conditions resulting from low blood hemoglobin levels by bringing the testing into patient homes on their smartphones, enabling earlier detection.

Called HemaChrome, the company is developing a smartphone application that enables clinicians to measure blood hemoglobin levels noninvasively. Typically, blood hemoglobin measurement requires invasive venous draws, but the app only requires a picture of the lower inner eyelid of a patient.

Photos contain spectral or detailed color information, which the app analyzes using a proprietary algorithm to calculate the blood hemoglobin level.

While a spectrometer is usually required to assess spectral information, the algorithm is able to do the same numerically, according to Young Kim, PhD, developer of the algorithm and HemaChrome's founder and chief science officer.

"We use the concept called hyperspectral learning," said Dr. Young Kim, who is also a professor and associate head for research at Purdue University's Weldon School of Biomedical Engineering, in a phone interview.

A biomedical engineer with a research interest in biophotonics and spectroscopic imaging systems, Dr. Young Kim has been developing and testing the technology for years, eventually creating HemaChrome in 2019. CEO Huiri Kim came on board a few years later.

"[In] about 2021, early 2022, when I was out and about, and I just happened to meet a friend of a friend, and she told me about what Young was doing," Huiri Kim said. "Right away, I realized how this could really benefit people like me and people in parts of the world that don't have access to care, don't have the money. So, I said, 'I need to meet him; I want to talk to him. I want to be a part of this.'"

As the app is being developed, the HemaChrome team has to consider the external factors that could impact the accuracy of the technology. A major factor is lighting.

"During our trials, we found that because of lighting conditions, those photographs can appear yellow or bluer or what have you. And that was affecting our accuracy, and we obviously want the blood hemoglobin reading to be quite accurate," Huiri Kim said.

To combat this issue, the team is working on a method to calibrate the photo for different lighting conditions to ensure accurate color information, and by extension, accurate hemoglobin measurement.

The app has the potential for widespread application — from helping tackle anemia in low-resource countries to mitigating maternal mortality risk — as it can help make blood hemoglobin testing easier to obtain.

"Our technology is, No. 1, very, very cheap because it's software-based, and it uses what most people already have, right? A mobile phone," Huiri Kim said. "Whereas with other technologies, you need expensive equipment, expensive consumables, technicians, whatnot. So we are going to make blood hemoglobin testing much, much cheaper. On top of that, because you can test remotely over a video call, we're going to be able to [provide] access [to] people that currently are in remote locations."

The app's possibly significant impact on maternal care outcomes caught the eye of the National Institutes of Health. HemaChrome won phase 1 of the National Institutes of Health's (NIH) RADx Tech for Maternal Health Challenge.

The challenge aims to support the development of devices, wearables, and other remote-sensing technologies that can help improve care for birthing people in the postpartum period, which extends for the first year after giving birth or the end of a pregnancy.

"That's one of the reasons that the NIH was interested in us for the Maternal Health Challenge because there are a lot of women that give birth at home or recover at home, and they don't have a way to measure blood hemoglobin, which is essential during birth because hemorrhage is one of the leading causes of death during childbirth," Huiri Kim said.

Anemia is also a common problem post-childbirth. According to the National Institutes of Health, research among women in high-income countries shows that 10 to 30 percent of postpartum women were anemic. This prevalence may be higher among postpartum women in low-and middle-income countries.

"And a lot of these women, especially after having a baby, they don't get checked because they're tired, they don't have the resources, and they think, 'Well, [if] I'm tired, it's because I have a baby. It's not because something's wrong with me,'" Huiri Kim added.

The NIH will provide up to $8 million in cash prizes to winners in total. For winning the first phase, or the initial Viability Assessment Phase, HemaChrome received $20,000. A panel of experts in various areas, including science and business, reviewed the app to assess the technology's potential, Huiri Kim said.

And the challenge offers more than just financial support.

"There is a nice mix of everything," Dr. Young Kim said. "Definitely financial support, and also we receive in-house support from NIH to learn about the FDA [approval] process and digital health and regulatory issues."

But, before focusing on FDA approval, the company plans to continue solidifying the app's reliability through clinical trials.

HemaChrome recently started a large clinical trial in Rwanda, Africa. A hospital in Rwanda contacted the company, wanting to use the technology to screen for malaria among its population., Huiri Kim said. Malaria causes anemia and, thus, low blood hemoglobin levels.

"So [using the app] is a very cheap way for them to screen for [malaria], which, right now, they don't have the resources to screen everybody who they suspect has malaria, especially school children who often get ignored and our study is focused on school children," she said.

The company is also exploring other use cases for the technology in clinical settings as well as at-home versions for consumer self-monitoring.

As healthcare-focused apps become increasingly popular among patients and providers alike, HemaChrome aims to add to the growing trove of digital health resources that can support the early detection of medical conditions and close care gaps.

"One-quarter of the entire population worldwide is anemic," said Dr. Young Kim. "I'm so grateful actually that our technology has the potential to help many people."