Digital outpatient appointments for patients with chronic kidney disease (CKD)

The Wessex Kidney Centre is a renal and transplant centre with a catchment population of 2.2 million. It delivers outpatient care for more than 5,000 individuals with CKD.

Situation

In 2021, the Wessex Kidney Centre delivered more than 15,000 outpatient appointments to people with CKD. The team estimated that as many as 80% of these appointments were for individuals with stable kidney disease who were otherwise well and did not need face-to-face consultations.

Expected growth in CKD patients is straining the ability to deliver the same face-to-face appointments within budget.

Aspiration

Wessex Kidney Centre wanted to transform the way outpatient care is delivered to patients with CKD.

The centre wanted to replace unnecessary clinic-based management with digital alternatives.

Finally, the centre wanted to give patients the tools they need to take control of their CKD. This would help patients achieve their best possible health outcome with the remote help of their clinical team.

Solution and impact

MyRenalCare delivers remote monitoring and communication between specialists and patients with CKD.

It builds a health record which is stored in the cloud. The patient can access the record on any device connected to the internet. This engages them in their own care as patients monitor and report their own blood pressure, weight, symptoms and dialysis.

By using the app, the centre now runs 100% virtual consultations through a computer or smartphone.

Patients receive an email reminder when a review is due. This reminds them to arrange a blood test at a time and place convenient for them.

The patient notifies the clinician through the app when the blood test is done. The clinician reviews all the results, including the patient’s blood pressure, weight and symptom report. They then use these to make a clinical judgement remotely.

The clinician adds a note to the system which is fed back to the patient. If an issue is identified that needs face-to-face or telephone, the clinician can arrange this.

If all is well, the clinician enters a suggested date of the next routine review. Each routine virtual consultation can happen without the clinician or patient needing to be available to interact at a scheduled time or date.

If a patient needs direct interaction, they can request a face-to-face or phone consultation through MyRenalCare.

MyRenalCare also has short educational videos that inform patients about CKD, what to measure, and why. This delivers benefits for patients, clinicians and health providers.

Patients are empowered to achieve their best possible health outcomes as they have the tools they need to take control of their CKD. This avoids unnecessary hospital attendance which is inconvenient and time-consuming.

Clinicians make better use of their time by focusing only on relevant data in a digestible format. This helps to release clinic capacity.

MyRenalCare helps to reduce costs and increases capacity for healthcare providers by approximately 50%. This is within the NHS Long Term Plan to reduce face-to-face appointments by 30%. It achieves this because it:

• reduces the physical space needed to conduct appointments
• reduces clinic administration costs
• reduces clinician time per patient

Functionality

• MyRenalCare is a web app that can be used by any computer, mobile phone or tablet connected to the internet.
• All data is stored in the cloud.

Capabilities

MyRenalCare:

• engages patients to continuously self-monitor
• educates patients about how they can achieve their best possible health outcome in digestible animated videos
• empowers patients to determine when they need help and gives them direct access to their clinical team as part of the patient-initiated follow up (PIFU)
• helps clinical teams to remotely make informed decisions using patients’ continuous data, rather than infrequent data points
• reduces face-to-face outpatient appointments and improves efficiency across the system
• frees up clinic capacity

Scope

• Patients can monitor and manage their CKD at home or anywhere so long as they have access to the internet.
• Clinicians provide remote support from anywhere so long as they have access to the internet.

Key learning points

• Providers will benefit most from MyRenalCare by integrating it into their existing practice. This includes embedding it into care pathways and integrating it with IT systems so that data is easily available to audit.
• Digital healthcare needs to be viewed as 1 of a number of options available to deliver the best care. It should not replace face-to-face consultations as this could create a barrier to acceptance for clinicians.
• The team have found that patients are keen to use digital systems when they are offered to them.

Digital equalities

• MyRenalCare has reduced clinic utilisation from 93% to 71%, which creates capacity to deliver more responsive face-to-face care for those who can not use the system.

Key figures and quotes

• 98% of those using the digital system said they would recommend it to other patients.
• 60% of patients using MyRenalCare feel more engaged in managing their kidney conditions.

“The digital consultations are more efficient for me as I am not restricted to a scheduled interaction. In my experience they typically take no more than 5 minutes.”

Dr Robert Lewis, Consultant Nephrologist, Wessex Kidney Centre, Portsmouth Hospital University NHS Trust

“This is basically the future of long-term condition management and it’s a bit like looking into a crystal ball and seeing where we will be in 10 years time within healthcare but having it available now to PHU.”

Steve Dudfield, Care Group Manager Wessex Kidney Centre, Portsmouth Hospital University NHS Trust

Find out more

Case study on the Future NHS website (account required)

Remote monitoring in renal medicine: experience from a 6-month pilot during the COVID-19 pandemic

Introducing a web app for remote guided self-management of renal patients

Key contact

Dr Robert Lewis, Consultant Nephrologist, Wessex Kidney Centre, Portsmouth Hospital University NHS Trust

robert.lewis@porthosp.nhs.uk

Dr Nick Sangala, Co-Founder, MyRenalCare

nick.sangala@myrenalcare.com