WinnerRemote Treatment Monitoring with the Tablo Hemodialysis System

Winning Submission

The Tablo Hemodialysis System is an all-in-one, easy-to-learn, rapidly deployable device that provides chronic and acute renal replacement therapy. In response to COVID-19, we designed and deployed a cloud-based remote-monitoring service enabling clinicians to track critical treatment parameters on Tablo remotely and in real time without having to go bedside.

Description

Amidst the COVID-19 pandemic, a critical need emerged to reduce patient proximity during care. Remotely viewing dialysis treatment data in real time could help maintain staff safety while ensuring effective care.

The Tablo Hemodialysis System (Tablo) is an all-in-one, easy-to-learn, easy-to-use, and connected solution that fulfills the increased demand for hemodialysis during this pandemic. Tablo incorporates sensors to track treatment and machine data, which are securely and wirelessly transmitted in real-time to the cloud. TabloHub is the web interface allowing clinicians to access this data. TabloHub provides an ideal platform to remotely view treatment data in near real time.

Transforming TabloHub into a user-friendly, real-time display required minimizing data latency, leading to novel methods of transmitting, displaying, and interacting with data. This resulted in not only visualizing individual treatments from a safe distance, but also displaying the status of all Tablo systems — thereby optimizing use of scarce resources.

Clinician interviews helped us prioritize which data was most important for them to access in real time. They were primarily interested in five critical areas of treatment data: alarms, pressures, ultrafiltration (UF), blood flow rate, and remaining treatment time. Not only did we provide clinicians with the ability to view nearly real-time critical treatment data, but also to view the historical data recorded earlier in the treatment.

Implementation and adaptability

All that is required to implement this solution is the FDA-cleared Tablo Hemodialysis System, along with a wireless or wired internet connection. All of the data transactions are securely handled by Outset's encrypted TabloCloud services and may be viewed by authorized users when logging into the TabloHub web portal.

From a staffing point of view, the new remote monitoring capability continues to build on the savings and efficiencies enabled by the Tablo Hemodialysis System. These savings include reduced staff training and setup time compared with traditional dialysis equipment. Increased efficiencies include not needing to transport additional water purification equipment to a patient's room or not needing to transport a patient to a dialysis unit. In addition, given that staff can be trained on Tablo within hours (not days), hospitals have been able to expand the types of staff who can treat patients on Tablo. This option allows for flexible resource management during the staffing crises that have come with COVID-19.

From a broader standpoint, the vast majority of chronic dialysis patients are treated in crowded clinics full of patients with comorbidities. Despite the best infection control measures that can be taken, this model presents a high transmission risk for this vulnerable population. Increased adoption of therapy in the home setting, such as home hemodialysis on the Tablo System, eliminates this risk. The Tablo System, cleared for home use in early 2020, is uniquely suited for use in the patient's home due to its small footprint, onboard water purification, and simplicity.

The remote-monitoring capabilities further enhance this value proposition, as it arms clinicians and care partners with the real-time treatment data needed to produce confidence and peace of mind, even when they cannot be physically present at a treatment. Despite this, many patients may not be eligible for treatment at home for various reasons. In this regard, it may be helpful to break the current dichotomy of clinic and home into more of a spectrum.

Current clinics are highly centralized, built around a large water purification room that requires a certain number of chairs to make financial sense. Decoupled from water infrastructure and designed for ease-of-use, devices such as Tablo enable new ways of thinking about care settings for chronic dialysis. Settings such as skilled nursing facilities (no need to transport patients to outpatient dialysis clinics) and smaller clinics without water rooms (easier to enforce infection control, less travel for patients) would not only help prevent transmission of infectious diseases but also improve patient quality of life.

Regardless of the care setting, the existing data infrastructure will enable remote-monitoring capabilities on any Tablo System that is connected to the internet. In the future, the same infrastructure can be expanded to include other data sources — such as onboard physiological sensors — to enable further treatment personalization and remote treatment adjustments based on feedback to improve outcomes. In addition, a future implementation could allow clinicians to remotely address alarms and adjust treatment parameters with Tablo, enabling true telehealth care.

Contact info

Aaron Carrano - acarrano@outsetmedical.com

Outset Medical