The COVID-19 pandemic presented new and further highlighted existing challenges in nephrology. One of the biggest challenges faced in effectively managing chronic kidney disease (CKD) and end-stage renal disease (ESRD) is access to renal care in a primary care setting. As of 2020, in the U.S., at least 20% of the population, and approximately 36% of registered veterans live in rural areas and have limited access to specialists.
The application of telehealth in nephrology to care for CKD and ESRD patients is referred to as Telenephrology. Telenephrology has been proposed as an approach to promote coordinated care between providers and payers and provide specialized care for rural CKD patients.
- Telehealth delivers primary and specialized healthcare services using electronic communication and information strategies.
- Telehealth can include everything from virtual consultations to remote monitoring and vital sign data transfer.
- Telenephrology can provide specialized renal care to geographically isolated CKD patients.
- Telehealth offers a single strategy for achieving improved patient outcomes, better care, and reduced costs.
Telehealth for Kidney Disease
Telehealth capabilities have been made achievable due to medical care and technology innovations for over a century. Telehealth can be defined as the delivery of healthcare services via the use of telecommunications and electronic communications technology to support long-distance healthcare, professional and patient education and health administration.
Telehealth aims to increase the delivery of quality healthcare in underserved areas (geographic, socioeconomic) while improving patient outcomes at population and individual levels and improving patient and provider care experience at a reduced cost. Telehealth applications include:
- Mobile applications
- Digital media
- Video conferencing
- Wireless communication (scales, glucometers, BP cuffs, etc.)
- Short messaging service
- Interactive voice response
CKD is associated with adverse clinical outcomes and increased financial burden and is a significant public health issue predicted to increase nationally and globally. Telenephrology can be leveraged to address the following:
- Reduced population screening for early detection of CKD
- Poor patient adherence
- Absence of appropriate CKD management strategies
Before 2020, telehealth for kidney disease was only available to Medicare beneficiaries if they lived outside of the metropolitan statistical area or if the area was rural. Due to the challenges presented by the pandemic, the Centers for Medicare and Medicaid Services expanded their services to include payment for telehealth services. Thus, the use of telehealth increased exponentially and has been adopted rapidly in nephrology.
Areas of current advancements in telehealth for kidney disease include increased at-home dialysis, improved patient education, remote patient management, and renal care coordination.
Remote Patient Monitoring
Telehealth can be used to monitor a kidney disease patient’s blood pressure, the blood flow rate for home dialysis, adherence to dialysis, weight, fluid removal, and inflow and outflow for peritoneal dialysis patients.
Remote patient monitoring (RPM) can be leveraged to address the following gaps in kidney care:
- Low patient satisfaction
- Poor transitions of care
- Poor management of patient comorbidities
- Inadequate patient education
A well-designed RPM program provides CKD patients access to comprehensive support services and educational content. RPM has the potential to enhance CKD patient follow-ups, to determine how effective treatment strategies are. Future advancements of RPM include patient engagement technology to be utilized in managing patients on dialysis and patients in pre-and post-transplant care.
Patients receiving at-home dialysis are not reliant on hospital hours and may experience more freedom than those receiving in-center dialysis. Research has shown that dialysis patients traveling for more than an hour presented with decreased quality of life, while at-home dialysis patients experienced increased quality of life.
In 2020, CMS issued a COVID-19 waiver for at-home dialysis patients, stipulating that they no longer need to be seen in person for three visits to establish care. The waiver also stated that all patient visits could be conducted via telehealth and that Medicare was allowed to pay for telehealth, office, and hospital visits.
For the first time in renal care, the in-center hemodialysis unit could now be an originating site, with the clinical presenter (a dialysis unit staff member) setting up a connection with the provider via a video platform. The electronic device would then allow the dialysis patient to be seen by their clinician.
Improved CKD patient outcomes are directly related to patient education. It is estimated that in the U.S., roughly 90% of adults own a mobile device, thus providing an incredible reach for patient education. Compared to historical forms of CKD education (paper or in-person), telehealth educational applications are more adaptable and flexible for the patient. These CKD educational applications can include both auditory and content delivery modalities, offering more opportunities for patient engagement.
These educational applications also allow healthcare professionals a platform to reinforce key ideas that they might not have time for during an in-person visit. Access to CKD educational platforms provides patient empowerment, which positively impacts patient engagement and outcomes.
The most significant benefit of telehealth for kidney disease patients is increased access to care. Faster and more accessible care may reduce hospitalizations, emergency visits, and mortality and morbidity, reducing healthcare costs.
Other benefits of telehealth in nephrology may include the following:
- Improved and increased access to specialized care for patients in remote or rural areas
- Reduction in patient no-shows
- Increased patient engagement and education via mobile applications
- Reduction in clinic wait times and clinic burden
- Increased access to renal care for patients with transportation and mobility barriers
The potential benefits of telenephrology for future patients include increased efficiency, quality, and access to quality care. Remote management of CKD is set to continue advancing across practice settings, with the ability to improve satisfaction, access, and outcomes for both providers and patients.
There is increasing patient demand for immediate, accessible, and efficient kidney care and a demand for healthcare systems to introduce better patient management and improved clinical outcomes. Telehealth has been identified as a critical element in coordinated kidney care.
Future trends will see increased and extensive utilization of telehealth. When used in nephrology, it will help healthcare professionals understand the social determinants of renal Health, patient outcomes, cost of kidney care, and the burden of disease CKD places on the healthcare system.
Our value-based kidney care platform provides physicians with integrative technology, workflow management, and analytics that enable them to increase patient engagement, improve planned and at-home dialysis starts, reduce patient hospital admissions, and improve overall patient outcomes and quality of life.