Fresenius introduced its new dialysis machine, the 2008T, late last year at the American Society of Nephrology meeting in Denver. Among its features is its ability to enter information at the chairside, which could have a positive impact on dialysis clinic workflow. To get a better understanding of what the new dialysis machine offers, RBT spoke with Christian Schlaeper, Vice President of Marketing at Fresenius Medical Care.
What was your general role in developing the machine?
My role was to guide the whole process from a customer needs side all the way to a product, which we launched to the market. That includes integrating all the disciplines throughout the development process.
What were the major goals the development team set to meet?
When we looked into the dialysis platforms we currently have in the market, we identified that there was a true need in the integration of dialysis delivery systems with medical information systems. Documentation as well as accessibility to patient data is getting more important, especially in a bundled environment.
How can the integrated MIS system help streamline a dialysis clinic’s workflow?
By 2014, we expect will all be connected to a medical information system, so they have to get into this. What we see currently is that clinics have a stand-alone computer either on a countertop or somewhere in the proximity in between a couple of machines. A few clinics have a computer on wheels in between the machines. All of this is related to hardware expenses, and we integrated this hardware and this access point to the medical information system right into the dialysis machine. Now, there is an opportunity for a true paperless environment. This means that at each patient’s chairside you have an access point to retrieve information but also to document and enter treatment progress notes.
How are the dialysis and MIS systems set up within in the machine? Are they separate?
This was an important criterion for us that the access to the medical information system is clearly separated from the functionality of the dialysis machine. Both use the same screen to display data and use the keyboard as a data entry point, but between the access to the medical information system, which we call our CDX (Clinical Data Exchange) System, and the dialysis machine, there is no point of interference. This is in case of any malfunction on the medical system side. It would never impact the operation of the dialysis machine. The user uses a blue toggle key on the keyboard to toggle at any time back-and-forth between the medical information system and dialysis screens. If you are in the medical information system screen and the machine has an alarm, it automatically turns the attention back to the alarms and the dialysis screens.
How does the machine deal with HIPAA and protecting patient privacy?
HIPAA requirement are always important, especially when a machine is sitting in an environment with multiple features. The machine has a number of interesting features. There is an automatic timeout, so if a clinician is accessing the medical information system through our CDX system and has data screen on for a period of time, the machine automatically turns it back to the dialysis screen after a maximum of two minutes of non-interaction with the machine. Therefore, no confidential data are sitting out in public in case a nurse has to walk away.
What software can be used with the machine?
We recognized early on that in the IT landscape in the dialysis industry, small clinics as well as the large organizations may have already vested into a medical information system of their choice. For us, it was important early on that all major renal medical information systems are running on the 2008T machine. So if a clinic already invested in a specific medical information system, this is then accessible from the machine. We worked with the major vendors in this industry.
Any structure of the medical information systems is handled by the software vendors. We offer our own software. We provide the platform, which allows them to display the medical information system on our machine.
What are the advantages of a chairside environment?
By having a true chairside paperless environment there is a higher chance that you track any activity with the patient for billing purposes and a documentation and form a clinical point. If you make paper notes or keep something in your mind you have to walk over to a central point to enter this data; this information may be forgotten or it may not be tracked correctly. The chance to keep this information is much higher if you can enter it chairside.
How is the keyboard protected against infection?
We are in an environment where we have blood contamination and other contamination points. The keyboard is specifically designed for a dialysis environment. It’s all encapsulated and can be disinfected with the outside of the machine with the standard procedure bleach solution. Not only can you clean you clean it after treatment and have a truly protected keyboard environment, but it also keeps the environment closed for one patient. Any interaction with one patient environment, you can wear the same pair of gloves with the patient and the machine. If you have any computer on wheels in between the machines, or if you have central computer, each time you walk over to that computer you have to take off your gloves to make sure you don’t increase the risk of cross-contamination. We think we really have made a step forward here with the 2008T machine.
In addition to the MIS integration, what improvements were made to the dialysis end of the machine?
First, the CDX system itself focused on the data exchange and documentation side. Just by providing data chairside and having access to medical information, you’ll see that you’ll have a good chance to improve how to deliver care to the patient as you have more important data to inform the decision. In addition to this, the 2009T machine was built on the same reliable technology as our 2008K platform which comes with key features such as online clearance, access flow, and so on.
Is the machine expandable after it is purchased?
The 2008T is our new platform, and what we usually see is that over the next few years you can expect us to launch new features for this machine. We have several new features in the pipeline. It’s too early to discuss these, but the machine has been designed as a platform allowing for those upgrades to happen easily. As we get to the market and get those features cleared by the FDA, we will roll them out to be implemented into the 2008T platform. The whole design of the machine is to understand that a machine is used for eight or more years, and we want to make sure that our customers have access to the latest technology and to be able to upgrade to the newest features in the coming years.
Do you see any ability for cost savings in the clinic?
Yes, we foresee cost savings for clinics. At this time, we believe the best way to measure the value of the 2008T is through maximized efficiencies. For example, the integrated design of the 2008T frees floor space in the clinic that provides the potential for additional treatment chairs, as well as maximizes documentation efficiencies at the chairside. Also, we see significant reduction in several cross-contamination risks with this new technology.
Is there an increased sense of safety?
We think there is a reduced OSHA risk without all of the components in the way as well as the cables from computers on wheels that can get in the way. It definitely reduces the clutter in the dialysis clinic.
What will be the overall impact for the clinic operation?
We foresee that flow of the clinic operation will change. It’s not only that we addressed some of the infection issues, it will open up space in the clinic, and it optimizes the workstream by having all of the data available. We see that this will bring significant efficiencies to the clinic. RBT