Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform

Summary

The MACCS platform is a comprehensive telemedicine concept aiming at better outcomes after kidney transplantation by sharing key medical information between patients and physicians. A telemedicine team reviews incoming data to detect potential complications and to improve adherence in kidney transplant recipients to achieve better long-term outcomes.

Abstract

The MACCS (Medical Assistant for Chronic Care Service) platform enables secure sharing of key medical information between patients after kidney transplantation and physicians. Patients provide information such as vital signs, well-being, and medication intake via smartphone apps. The information is transferred directly into a database and electronic health record at the kidney transplant center, which is used for routine patient care and research. Physicians can send an updated medication plan and laboratory data directly to the patient app via this secure platform. Other features of the app are medical messages and video consultations. Consequently, the patient is better-informed, and self-management is facilitated. In addition, the transplant center and the patient's local nephrologist automatically exchange notes, medical reports, laboratory values, and medication data via the platform. A telemedicine team reviews all incoming data on a dashboard and takes action, if necessary. Tools to identify patients at risk for complications are under development. The platform exchanges data via a standardized secure interface (Health Level 7 (HL7), Fast Healthcare Interoperability Resources (FHIR)). The standardized data exchange based on HL7 FHIR guarantees interoperability with other eHealth solutions and allows rapid scalability to other chronic diseases. The underlying data protection concept is in concordance with the latest European General Data Protection Regulation. Enrollment started in February 2020, and 131 kidney transplant recipients are actively participating as of July 2020. Two large German health insurance companies are currently funding the telemedicine services of the project. The deployment for other chronic kidney diseases and solid organ transplant recipients is planned. In conclusion, the platform is designed to enable home monitoring and automatic data exchange, empower patients, reduce hospitalizations, and improve adherence, and outcomes after kidney transplantation.

Introduction

Kidney transplantation is the treatment of choice for patients with end-stage renal disease (ESRD) as it prolongs life, improves quality of life (QoL), and saves money and resources compared to maintenance dialysis^1,2. QoL is defined as the general well-being of individuals, and health-related QoL (HRQoL) is an assessment of how the individual's well-being may be affected over time by a disease, disability, or disorder³. Recently, QoL, HRQoL, and specific patient-reported outcomes were considered core outcome domains for kidney transplantation, which have become critically important....

Protocol

The protocol follows the current guidelines of the ethics and data protection committees at Charité - Universitätsmedizin Berlin and is in compliance with current EU GDPR.

1. Perspective of the telemedicine team

1. Screening for patients
   NOTE: Key data of the project are provided in Table 1.
   1. Ask the nurse to screen incoming outpatients or patients on the ward for eligibility. Ask the telemedicine team (nurse and physician) to talk to patients in the outpatient clinic or on the ward about the content, data protection, and aim of the project.
   2. After agreeing, ensure that the pat....

Results

In the first 5 months between February and July 2020, 172 KTR matched the inclusion criteria and were asked to participate (Table 1). Out of 172 participants, seven needed to borrow a smartphone (four did not own one, three needed a new one); all other patients owned a smartphone. The app does not need wireless access (Wi-Fi) as data can be transferred by mobile phone via regular telecommunication services, and 2/172 patients were equipped with a subscriber identity module (SIM) card for mobile data tran.......

Discussion

A comprehensive telemedicine platform was created to improve the care of KTR. The platform was readily accepted by patients with excellent participation in sending vital signs from home. To develop the platform and to provide these services to patients, extensive software engineering was necessary. Critical steps included (a) constant software development with the involvement of all stakeholders from the beginning, and (b) a comprehensive data protection concept, which was achieved with the help of a specialized law firm.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
comjoodoc EASY app	comjoo business solutions GmbH		Patient app for patients to share information with the transplant center
HL7 FHIR standard	Medworxs.io		Provider of MACCS API
FHIR server	Medworxs.io		Host of MACCS patform
NEPHRO7	MedVision AG		Electronic health record of home nephrologists
myTherapy	smartpatient GmbH		Patient app for medication intake and alternative transmission of vital signs and well being
TBase	Charité - Universitätsmedizin Berlin		Electronic health record of outpatient care center at Charité