Introducing a web-app for remote guided self-management of renal patients
Dr Robert Lewis MD FRCP and Dr Nick Sangala MRC, Wessex Kidney Centre, Portsmouth
What we did
We have been using an internet-based “web-app” for remote guided self-management of renal patients since about 2018. It is called My Renal Care and was developed locally. We have about 100 patients with Chronic Kidney Disease (CKD) using it at the moment.
We have not seen anything similar elsewhere and we believe it has the potential to change the way long term kidney conditions (e.g. people with CKD or recipients of a kidney transplant) are managed. It is current practice in most renal units to schedule routine face-to-face review appointments at three to four month intervals. Using our system, we arrange short, focused reviews or “micro-consultations”, either routinely or initiated by patients themselves. This is more time-efficient for both patient and clinician and allows more frequent review of key variables such as blood pressure and kidney function.
How it works
Patients monitor their blood pressure at home and enter the readings into their health record which is held securely in the cloud and is accessible (from anywhere with internet access) via their smartphone or computer. Diary reminders entered by the clinician prompt patients to perform routine blood tests locally at a time which is convenient for them.
The Clinician receives notification via the web-app that the test has been done. He/she then remotely reviews the blood pressure entries and checks the blood results. An outcome is entered onto the clinical record and communicated to the patient. This may simply be “All well, no change” and includes a diary entry scheduling the next routine remote review. The web-app reminds the patient with an alert when the next review is required.
This system reduces the need for face to face clinics, but also empowers patients by involving them more closely in their own management. Patients can initiate a telephone consultation or a face-to-face review via the web-app when they require, thereby giving them a degree of control over their health.
We recently undertook a survey of users, and the responses from patients were very positive. It seems clear to us that people using MyRenalCare are enthusiastic about using it as a means of monitoring their health. Patients have told us that, when they feel well, what they need most is reassurance that their condition is stable. A remote review using the web-app can provide this without the need for a time-consuming trip to the hospital. This also releases clinic capacity allowing more time to be spent with patients whose problems need timely face-to-face attention.
It goes without saying that this system has been particularly valuable during COVID-19 – which hasn’t gone away….