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“How can we improve and speed up medical decisions?”

Digital progress is my motivation

Dialysis treatment in a pleasing environment

Terrassa, just outside Barcelona, is a major industrial city with a population of more than 200,000, making it one of the biggest cities in Catalonia, Spain. Since 2014, it has also been home to a modern Fresenius Medical Care dialysis clinic with a focus on sustainability.

The facility is partially solar-powered, and residual water is collected for watering the gardens. Bright rooms with names like “Sala Modernisme” play host to state-of-the-art dialysis technology and let patients enjoy a visually pleasing environment during their treatment. But probably the most interesting detail at the “Centro de Diálisis de Terrassa” right now is an object that Dr. Yamilet Ramos very often holds in her hand: a silver-coloured tablet computer.

The physician, who is originally from Cuba, is rarely seen without this particular accessory when she is out and about in the clinic. The tablet runs a piece of software that Ramos can no longer imagine being without: the “Doctor App”, developed by Fresenius Medical Care. The app can make it considerably easier for physicians to treat dialysis patients.

The app gives me more time for patients and is a great help in my work.

Dr. Yamilet Ramos
Medical Doctor Centro de Diálisis de Terrassa, Fresenius Medical Care

All information directly at the fingertips

Digital specialists from Fresenius Medical Care developed it and have put it to the test at 30 dialysis clinics in Spain. It allows physicians at the clinic to access the data and current values of each and every patient in real time. This alone is a great bonus for Ramos, as it allows her to give patients advice and information, and tailor their treatment individually from any location. “Otherwise I would have to go to my office or use the nursing staff’s computer to take a look at the current values.”

Now the physician, who has worked for Fresenius Medical Care since 2009, has all of the information at her fingertips. As well as saving time and effort, this can be vital when it comes to acute complications. “If I already have all of the latest data at my disposal when I am at a patient’s bedside, this means I can make quicker and better decisions to deal with acute problems or, in extreme circumstances, even save their life,” explains Ramos.

Dr. Ramos at a patient's bedside
The app allows Dr. Ramos to make adjustments to medication at her patient’s bedside.

Algorithms help physicians

The Doctor App also has a second, even more far-reaching purpose: It is equipped with artificial intelligence (AI) that assists physicians in making important decisions. For decades, AI was something that belonged more in the realm of science fiction. But there has been huge progress in this area in the past decade or so. Data specialists have succeeded in developing self-learning systems, i.e., systems that learn new skills autonomously – providing they are fed sufficient quantities of corresponding data.

Known as machine learning, this technology has triggered a revolution in research and has long become part of everyday life. One example of the possibilities offered by AI is the so-called anemia algorithm, which can be used to treat renal anemia during hemodialysis. It is not always easy for physicians to determine whether patients in this case should be given iron alone, or with erythropoietin – i.e., stimulating substances that boost the production of red blood cells – and what the exact dosage should be. The algorithm can support this decision. Niklas Best, Director Digital Ecosystem at Fresenius Medical Care, explains the importance of these digital decision aids: “We are talking about algorithms that can evaluate a number of parameters that a human would find almost impossible to juggle in their head.”

Physicians using the Doctor App
Getting information faster: Physicians can use the new Doctor App to view a patient’s current values wherever they are in the clinic.

A wealth of available data

Best was involved in the development of the Doctor App right from the start. “Our original aim was to make the anemia algorithm available to physicians in a usable form,” the digital expert says. But during the development process, his team realized there were many more things the app could offer in terms of making life easier for nephrologists. And so the Doctor App became a comprehensive application that uses all of the important parameters to help physicians make the right treatment decisions at the patient’s bedside.

The data for the Doctor App is supplied by the EuCliD system, a technical database used by Fresenius Medical Care to help nephrology institutions continuously ensure and improve the quality of their treatment. The system collects and evaluates defined indicators. “A long time ago, Fresenius Medical Care took the strategic decision to build this system within the Care Value e-services department. The result is an incredible wealth of data that we can use to our benefit,” Best explains. The Fresenius Medical Care AI Group in the EMEA region uses the EuCliD data to train algorithms. “You could even say that we are among the world leaders when it comes to the use of AI in dialysis. We can certainly compare with software groups in Silicon Valley,” Best adds.

The graphs displayed in the app also help to explain the complexities of treatment to patients.

Fresenius Medical Care’s digitization path

“The Doctor App is a core element of our digital strategy,” Best continues, “but many other kinds of other digital applications are conceivable or already available. For example, we are in the process of developing tools and services to support all patient groups with chronic kidney failure, whether they receive dialysis at home or in a clinic.”

The “My Companion” smartphone app allows dialysis patients at Fresenius Medical Care clinics to access their current treatment data, such as lab results or drug information. It also helps patients with their treatment and with adapting their lifestyle.

Another area for future developments is support for home dialysis patients. Telemonitoring is the keyword: The connected health platform “TheHub” by Fresenius Medical Care North America offers physicians real-time access to medical records from their device of choice and enables home therapy nurses to better care for their patients. Through daily monitoring and clinical decision support, the care team can catch potential issues earlier and intervene, giving home patients more confidence and personalized support.

Ramos claims that the new app has changed her daily routine in the dialysis clinic considerably.

“MY COMPANION” patient app

The app gives patients at Fresenius Medical Care clinics an overview of their treatment as well as the drugs prescribed to them and their lab results.

“THEHUB” connected health platform

The platform allows patients, care teams and physicians to better collaborate and monitor patient treatments. This supports our efforts to accelerate the introduction of home treatments while ensuring that our patients remain in close contact with their care teams.

“DOCTOR APP” for nephrologists

The app integrates all of the important parameters for dialysis treatment, allowing our physicians to adjust treatment individually and giving them more time for their patients.

Initial skepticism quickly dissipated

The use of digital technologies will alter the interactions between technology, physicians and patients in some areas. Physicians will have more time to spend on patient contact. And patients will be given more information and be more involved in their own treatment. Of course, new technologies are always eyed with suspicion at first. “But the initial skepticism toward the Doctor App quickly dissipated during the test phase. By the end, we were even getting exuberant responses when we turned up at the clinic,” Best reports.

Most physicians involved in the roll-out in Spain are now just as enthusiastic about the app as Ramos. Best has no doubt that the app has made work a lot easier for physicians: “Many have noticed that they can finally do what made them want to become a physician in the first place – namely treating patients.” He believes that digitization will continue to find its way into medical technology. “In the future, almost every medical decision will be taken with the aid of algorithms, simply because the risk is too great otherwise,” Best is convinced. “This is just the beginning,” he predicts.

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