Think of Tasso as the "Netflix of blood collection."

That was the vision of Ben Casavant and Erwin Berthier when they dreamed up the business in their University of Wisconsin lab. It was 2011, and the pair were conducting doctoral research: Casavant into cancer; Berthier into individuals' susceptibility to disease. The students used the most advanced technologies to produce diagnostics. But sometimes they had nothing to test.

Casavant and Berthier needed blood samples but couldn't get them until patients visited the hospital or phlebotomists had time to make house calls. Sometimes they waited for weeks. "There were only two ways to get a blood sample: through a finger stick or a venipuncture draw," says Casavant. "That means it is painful, and you have to take time out of your day to do it. Both ways are terrible."

Back then, Netflix was still shipping DVDs around the country, with customers shipping them back. Inspired, Casavant and Berthier imagined a simple device patients could use at home to do blood draws and a mechanism for returning those samples to the lab for analysis. At first, they saw the product--which they developed using 3-D printers--chiefly as a tool to monitor chronic diseases like heart disease or diabetes. "There are tens of billions of lab tests run per year. So it is a very big market," Casavant says.

The pandemic's acceleration of interest in telemedicine should significantly increase demand. The U.S. telemedicine market is expected to approach $10 billion this year, with 76 percent of hospitals providing some services remotely, according to the research firm Arizton.

The keystone of Tasso's system, called OnDemand, is a big red button, reminiscent of the one labeled "easy" that Staples made ubiquitous more than a decade ago. A patient places the button--made of injection molded plastic--on her upper arm, an area most people find less sensitive than others to pain. (Fingertips, by contrast, are very sensitive. Think paper cuts.) She clicks the button, releasing a tiny lancet, which needs only reach the capillary network right under the surface of the skin. "The needle doesn't go in very deep at all, so it doesn't even get to the nerves," Casavant says. "And because it all happens so fast you hardly feel anything."

The patient removes and caps the blood-collection tube and sends it to the lab in prepaid packaging provided by Tasso. The tubes are designed to fit directly into standard blood-analysis machines, so results are fast. Tasso also provides a logistics service, managing all the shipping for its lab and hospital clients.

Darpa, drugs, and distance medicine

Tasso officially launched in Madison in 2012. (The name derives from the Italian word for "badger," which is the University of Wisconsin's mascot.). Funding arrived a year later: a $150,000 grant from the Defense Advanced Research Projects Agency, which was interested in testing troops during deployment. Until then Darpa, like virtually everyone else working on diagnostics-on-demand, imagined creating smaller versions of laboratory machines to deploy wherever patients might be. "Darpa had asked for a technology called 'sample and send' that really matched our vision," says Casavant.

Government grants remained a critical resource for Tasso, which raised $13 million over eight years from agencies ranging from the National Institutes of Health to the Defense Threat Reduction Agency. The company had its first production-ready version in 2017 and began chasing venture capital the next year. To date, Tasso has raised $23 million from firms including Hambrecht Ducera Growth Ventures and Vertical Venture Partners.

Although chronic disease remains Tasso's chief focus, the founders soon spotted another application in clinical trials, which also require regular monitoring of subjects' blood. Patients often drop out of such trials because of inconvenience or squeamishness about needles, costing pharmaceutical companies a bundle. The drug giant Merck, which is among Tasso's investors through its Global Health Innovation Fund, has been piloting OnDemand to collect samples from enrollees in its drug trials. Merck is expanding the relationship to track patients taking its drugs that are already on the market.

Then came the pandemic. In March, Tasso, now based in Seattle, got a call from a physician at the University of Washington. "He said, 'I need to know my patients' levels for HIV, hepatitis C, and hepatitis B, but they are unable to get to the hospital,'" Casavant recalls. "'Can you guys help me?'" Since then Tasso has worked with hospitals around the country, including those of the University of Massachusetts and the University of North Carolina, and Cedars-Sinai. Under discussion is where Tasso might fit in a broader telemedicine platform--created in collaboration with other companies and organizations--that includes things like blood-pressure cuffs, heart-rate monitors, and mail-in urine samples. "An exciting thing in a tragic time is all this focus on remote care," says Casavant.

Jerry Radich, a professor in the clinical research division at Seattle's Fred Hutchinson Cancer Research Center, has been testing OnDemand with staff and will soon roll out the study to patients in his clinic, who suffer from chronic myeloid leukemia (CML). The goal, in a year or so, is to send the devices to people in developing countries, as part of a collaboration with the Max Foundation to globally expand CML treatment, which requires blood tests every three to six months. "In many places in the developing world, they can't get syringes," says Radich.

Radich says Covid has revealed other applications for use here, such as treating some patients remotely and--for those with more complex cases--making better use of clinic visits for talk rather than testing. "Originally, this was going to be for places of urgent need," says Radich. "But we could easily use it to monitor all sorts of things in the convenience of your own home."

Keeping athletes honest

Initially, the Tasso device collected only dried blood spots, which work well for some but not all tests. (The pharmaceutical companies, in particular, like it.) The version that collects liquid blood, expected to be in higher demand, is under review by the U.S. Food and Drug Administration.

The OnDemand buttons are single-use to remove the risk of contamination. Pricing is still under discussion. Traditional blood sampling costs around $25 to $50--more if the phlebotomist makes a house call. "We are trying to make this low cost and accessible, while also making sure our pricing reflects the value," Casavant says.

The company manufactures in its own Seattle facility, which it built out quickly when Covid spiked demand. Many of its 60 employees work in production. Tasso currently produces 50,000 devices per month and can scale to 150,000.

Tasso, which does not release sales figures, began generating revenue last year. Casavant says it has 25 to 30 paying customers, including pharmaceutical companies and hospitals. Tens of thousands of patients use the product. The Department of Defense progressed from funder to customer in April when it awarded Tasso a $7.5 million contract for several hundred thousand kits.

One organization piloting OnDemand is the U.S. Anti-Doping Agency, which manages drug testing for Olympic, Paralympic, and other athletes. Tasked with keeping sports clean in the midst of a pandemic, the USADA beginning in April tested Tasso for three months with 21 athletes, monitoring their blood draws over services like Zoom and FaceTime to enforce security.

Tasso is less expensive than the USADA's traditional approach of sending testers to athletes' homes, training locations, or competitions, says Matthew N. Fedoruk, the organization's chief science officer. And there's far less risk of compromising the athlete's performance, which a needle stick or even a finger-prick may do. "It went extremely well," says Fedoruk. "We did surveying after the fact and the athletes felt this could be something that we adopt as part of our routine testing."