Remote monitoring of renal replacement treatments · delivered by telemedicine, and telenephrology...
37
Remote monitoring of renal replacement treatments Pierre Simon Société Française de Télémédecine (French Society of Telemedicine) ANJH Paris 20 mai 2019 1
Transcript of Remote monitoring of renal replacement treatments · delivered by telemedicine, and telenephrology...
Remote monitoring of renal
replacement treatmentsPierre Simon
Socieacuteteacute Franccedilaise de Teacuteleacutemeacutedecine (French Society of Telemedicine)
ANJH Paris 20 mai 2019
1
The transformation of the health system in the 21st century2
ANJH Paris 20 mai 2019
Life expectancy
at birth in the
world during the
20th century
ANJH Paris 20 mai 2019
3
3
The number of persons aged over 65 years in 2050
the global burden of ageingSource US Bureau of the Census (2000)
ANJH Paris 20 mai 2019
4
ANJH Paris 20 mai 2019
5
Kalid N Zaidan AA Zaidan BB Salman OH Hashim M Muzammil HBased Real Time Remote Health Monitoring Systems A Review on Patients Prioritization and
Related Big Data Using Body Sensors information and Communication Technology
J Med Syst 2017 Dec 2942(2)30 doi 101007s10916-017-0883-4 Review
5
Health Expenditures
Growth
due to chronic diseases
in the USA
Health expenditures growth per capita
in Western Europe
Finland
France
Germany
Italy
Netherlands
Sweden
United Kingdom
EU members
before May 2004
Denmark
OMS 2011
6
ANJH Paris 20 mai 2019
6
The tools of e-Health to the 21st century
Telemedicine
Mobile Health IoT
Medical Artificial Intelligence
Internet 2000
Smartphone 2007
IBM Watson 2014
GAFAM BATX
ANJH Paris 20 mai 2019
7
Big Data
New medical organizations DocHome
ANJH Paris 20 mai 2019
8
The Health-HUB system before 2007
ANJH Paris 20 mai 2019
9
Today smartphone for Quantified self
ANJH Paris 20 mai 2019
10
Data transmission
Data access
General
Practitioner
Hospital amp EPR
Hospital (Hospital Cliacutenic amp Hospital Mataroacute)Patientrsquos situation (at home)
Patient
Videoconference System amp
Patient Portal
Telemonitorin
g devices
Clinical Patient
Management
System
NurseHospital
video
interface
Interface amp
Gateway
Case Manager
Nurse
Hospital
Specialist
Call Centre amp Health coach
New medical organization cooperation
City-Hospital in Catalonia10
ANJH Paris 20 mai 2019
11
HomeCare in patients with chronic
diseases Overall Scheme
Sensors for multi-parametric monitoring
Hospital
Health call
Centre
Data communication and feedback
Data processing amp analysisData acquisition
200 400 600 800 1000 1200 1400 1600 1800 2000 2200
500
1000
1500
t [sec]
RR
[mse
c]
TiltSympthoms
200 400 600 800 1000 1200 1400 1600 1800 2000 220050
100
150
t [sec]
SBP
[mm
Hg]
200 400 600 800 1000 1200 1400 1600 1800 2000 22000
50
100
SCM
I [
]
t [sec]
200 400 600 800 1000 1200 1400 1600 1800 2000 2200
-05
0
05
Ris
k [-
-]
t [sec]
Positive VVS Risk
Medical
expertise
Intelligent
analysis
Support to diagnosis
decision amp treatment
11
ANJH Paris 20 mai 2019
12
ANJH Paris 20 mai 2019
13
J Med Syst 2017 Dec 2942(2)30 doi 101007s10916-017-0883-4 Review
14
Clinical data collection for an algorithmic medicine
Remote monitoring (RM) of renal replacement treatments14
ANJH Paris 20 mai 2019
ldquo
rdquo
Despite growing evidence for the use of RM in
the management of patients with ESRD
(including peritoneal dialysis and home
haemodialysis) this disease had the lowest
recognition of RM value in this current research
Katherine Rojahn1 Suzanne Laplante1 James Sloand1 Claire Main2 AftabIbrahim2 Janet Wild2 Nicky Sturt2 Thelga Areteou3 and K Ian Johnson3
Remote Monitoring of Chronic Diseases A Landscape Assessment of Policies in Four European Countries (United Kingdom Geremany Italy Spain)
PLoS One 2016 May 1911(5)e0155738 doi 101371journalpone0155738 eCollection 2016
ANJH Paris 20 mai 2019
15
ldquo
rdquo
The evidence regarding the quality of care
delivered by telemedicine and telenephrology
in particular compared with in-person care is
limited in USAhellip
Videoconferencing is widely used in Australia to manage kidney disease including chronic
kidney disease dialysis pediatric nephrology
and post-kidney transplantation carehellip
Rohatgi R Ross MJ Majoni SW Telenephrology current perspectives and
future directions Kidney Int 2017 Dec92(6)1328-1333 doi
101016jkint201706032 Epub 2017 Oct 12 Review
ANJH Paris 20 mai 2019
16
Remote monitoring of renal
replacement treatments in France and
in EuropePatients treated by Dialysis
ANJH Paris 20 mai 2019
17
Teledialysis in Tromsouml since 2001
TMS
Tromsoslash
Vefsn
Sandnessjoslashen
Rana
Harstad
Hammerfest
Narvik
Lofoten
Bodoslash
Kirkenes
Alta
bull Control
bull Remote visit guidance and teachingANJH Paris 20 mai 2019
18
Mapes DL Lopes AA
Satayathum S McCullough
KP Goodkin DA Locatelli F
Fukuhara S Young EW
Kurokawa K Saito A Bommer
J Wolfe RA Held PJ Port FK
Health-related quality of life
as a predictor of mortality and
hospitalization the Dialysis
Outcomes and Practice
Patterns Study (DOPPS)
Kidney Int 2003 Jul64(1)339-
49
ANJH Paris 20 mai 2019
19
Teledialysis in BrittanySt Brieuc-Lannion (since June of 2001)
ANJH Paris 20 mai 2019
20
Remote monitoring in teledialysis
Software that processes the parameters
of the session in real time
ANJH Paris 20 mai 2019
21
Software that processes the settings
for each session for a period of 6 mois
Predictive diagnosis of vascular access stenosis
ANJH Paris 20 mai 2019
22
Teleconsultation at the end of hemodialysis session
ANJH Paris 20 mai 2019
23
Validation of teledialysis process by
French Health Authority in january 2010
Janvier 2010
ANJH Paris 20 mai 2019
24
Introduction of teledialysis in a new decree
in February 2012
Home
dialysis
Satellite
dialysis
Satellite dialysis
with nurse
Heavy dialysis
center
Doctor time given by the end of session teleconsult
On-site nephrology
team
Cs month Cs et visitmonth Visitweek
Consent of the patient
Patient stabilized in dialysis treatment
Decree of
september 2002Telemedicine decreeof february 2012
ANJH Paris 20 mai 2019
25
Lighted dialysis
center (UDM)
Compliance of the dialysis population to quality indicators
Pre dialytic phosphate (mmoll)
Summary graph of the dialysis population
Patients below the normal range
Patients over the
normal range
ANJH Paris 20 mai 2019
26
Diatelic system in Peritoneal Dialysis
since 2001(1)
ANJH Paris 20 mai 2019
27
Diatelic system in Peritoneal Dialysis
since 2001(2)
Patient nurse family physician give dialysis data from home over
the internet
By secure messaging the patient expresses his ou her remarks with
the healthcare team by continuous exchange
=gt
ANJH Paris 20 mai 2019
28
ldquo
rdquo
In the nephrology setting home telemonitoring has
been evaluated in home dialysis patients but data
are scarce concerning chronic kidney disease (CKD)
patients before and after renal replacement
therapy The eNephro study is designed to assess thecost effectiveness clinicalbiological impact and
patient perception of a home telemonitoring for
CKD patients
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R
Laplaud D Noeumll C Kessler M Cost-effectiveness of home telemonitoring in chronic
kidney disease patients at different stages by a pragmatic randomized controlled
trial (eNephro) rationale and study design BMC Nephrol 2017 Apr 518(1)126
doi 101186s12882-017-0529-2
ANJH Paris 20 mai 2019
29
The future in remote monitoring of patients treated by
hemodialysis ETAPE Program led by French Ministry
of Health and Health Insurance (2018-21)
Experimentation of telemonitoring funding in hemodialysis patients outside the heavy dialysis center
A precise perimeter (autodialysis UDM homehemodialysis ()) strict eligibilityconditions Patients should be extracted from heavy dialysis center
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient Study followed by HealthInsurance information system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the healthprofessional responsible for the therapeutic accompaniment the provider of theremote monitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
30
31 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Remote monitoring of renal
replacement treatmentsPatients treated by kidney graft
ANJH Paris 20 mai 2019
32
The future in remote monitoring of patients treated by
kidney graft ETAPE Program led by French Ministry of
Health and Health Insurance (2018-21)
Experimentation remote monitoring funding of patients grafted for more than 6months
A precise perimeter strict eligibility conditions
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient followed by Health Insuranceinformation system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the health professionalresponsible for the therapeutic accompaniment the provider of the remotemonitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
33
34 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Three prospectives studies controlled and
randomized (results end 2019-2020)
Foucher Y Meurette A Daguin P Bonnaud-Antignac A Hardouin JB Chailan S Neau K Papuchon E Gaboriau S Legendre C Moreacutelon E Tessier P Giral M
A personalized follow-up of kidney transplant recipients using video conferencing basedon a 1-year scoring system predictive of long term graft failure (TELEGRAFT study) protocolfor a randomized controlled trial
BMC Nephrol 2015 Jan 28 16 6 doi 1011861471-2369-16-6
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R Laplaud D Noeumll C Kessler M
Cost-effectiveness of home telemonitoring in chronic kidney disease patients at differentstages by a pragmatic randomized controlled trial (eNephro) rationale and study design
BMC Nephrol 2017 Apr 518(1)126 doi 101186s12882-017-0529-2
Pape L de Zwaan M Tegtbur U Feldhaus F Wolff JK Schiffer L Lerch C Hellrung N KliemV Lonnemann G Nolting HD Schiffer M
The KTx360deg-study a multicenter multisectoral multimodal telemedicine-based follow-upcare model to improve care and reduce health-care costs after kidney transplantation inchildren and adults
BMC Health Serv Res 2017 Aug 23 17(1)587 doi 101186s12913-017-2545-0
ANJH Paris 20 mai 2019
35
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
The transformation of the health system in the 21st century2
ANJH Paris 20 mai 2019
Life expectancy
at birth in the
world during the
20th century
ANJH Paris 20 mai 2019
3
3
The number of persons aged over 65 years in 2050
the global burden of ageingSource US Bureau of the Census (2000)
ANJH Paris 20 mai 2019
4
ANJH Paris 20 mai 2019
5
Kalid N Zaidan AA Zaidan BB Salman OH Hashim M Muzammil HBased Real Time Remote Health Monitoring Systems A Review on Patients Prioritization and
Related Big Data Using Body Sensors information and Communication Technology
J Med Syst 2017 Dec 2942(2)30 doi 101007s10916-017-0883-4 Review
5
Health Expenditures
Growth
due to chronic diseases
in the USA
Health expenditures growth per capita
in Western Europe
Finland
France
Germany
Italy
Netherlands
Sweden
United Kingdom
EU members
before May 2004
Denmark
OMS 2011
6
ANJH Paris 20 mai 2019
6
The tools of e-Health to the 21st century
Telemedicine
Mobile Health IoT
Medical Artificial Intelligence
Internet 2000
Smartphone 2007
IBM Watson 2014
GAFAM BATX
ANJH Paris 20 mai 2019
7
Big Data
New medical organizations DocHome
ANJH Paris 20 mai 2019
8
The Health-HUB system before 2007
ANJH Paris 20 mai 2019
9
Today smartphone for Quantified self
ANJH Paris 20 mai 2019
10
Data transmission
Data access
General
Practitioner
Hospital amp EPR
Hospital (Hospital Cliacutenic amp Hospital Mataroacute)Patientrsquos situation (at home)
Patient
Videoconference System amp
Patient Portal
Telemonitorin
g devices
Clinical Patient
Management
System
NurseHospital
video
interface
Interface amp
Gateway
Case Manager
Nurse
Hospital
Specialist
Call Centre amp Health coach
New medical organization cooperation
City-Hospital in Catalonia10
ANJH Paris 20 mai 2019
11
HomeCare in patients with chronic
diseases Overall Scheme
Sensors for multi-parametric monitoring
Hospital
Health call
Centre
Data communication and feedback
Data processing amp analysisData acquisition
200 400 600 800 1000 1200 1400 1600 1800 2000 2200
500
1000
1500
t [sec]
RR
[mse
c]
TiltSympthoms
200 400 600 800 1000 1200 1400 1600 1800 2000 220050
100
150
t [sec]
SBP
[mm
Hg]
200 400 600 800 1000 1200 1400 1600 1800 2000 22000
50
100
SCM
I [
]
t [sec]
200 400 600 800 1000 1200 1400 1600 1800 2000 2200
-05
0
05
Ris
k [-
-]
t [sec]
Positive VVS Risk
Medical
expertise
Intelligent
analysis
Support to diagnosis
decision amp treatment
11
ANJH Paris 20 mai 2019
12
ANJH Paris 20 mai 2019
13
J Med Syst 2017 Dec 2942(2)30 doi 101007s10916-017-0883-4 Review
14
Clinical data collection for an algorithmic medicine
Remote monitoring (RM) of renal replacement treatments14
ANJH Paris 20 mai 2019
ldquo
rdquo
Despite growing evidence for the use of RM in
the management of patients with ESRD
(including peritoneal dialysis and home
haemodialysis) this disease had the lowest
recognition of RM value in this current research
Katherine Rojahn1 Suzanne Laplante1 James Sloand1 Claire Main2 AftabIbrahim2 Janet Wild2 Nicky Sturt2 Thelga Areteou3 and K Ian Johnson3
Remote Monitoring of Chronic Diseases A Landscape Assessment of Policies in Four European Countries (United Kingdom Geremany Italy Spain)
PLoS One 2016 May 1911(5)e0155738 doi 101371journalpone0155738 eCollection 2016
ANJH Paris 20 mai 2019
15
ldquo
rdquo
The evidence regarding the quality of care
delivered by telemedicine and telenephrology
in particular compared with in-person care is
limited in USAhellip
Videoconferencing is widely used in Australia to manage kidney disease including chronic
kidney disease dialysis pediatric nephrology
and post-kidney transplantation carehellip
Rohatgi R Ross MJ Majoni SW Telenephrology current perspectives and
future directions Kidney Int 2017 Dec92(6)1328-1333 doi
101016jkint201706032 Epub 2017 Oct 12 Review
ANJH Paris 20 mai 2019
16
Remote monitoring of renal
replacement treatments in France and
in EuropePatients treated by Dialysis
ANJH Paris 20 mai 2019
17
Teledialysis in Tromsouml since 2001
TMS
Tromsoslash
Vefsn
Sandnessjoslashen
Rana
Harstad
Hammerfest
Narvik
Lofoten
Bodoslash
Kirkenes
Alta
bull Control
bull Remote visit guidance and teachingANJH Paris 20 mai 2019
18
Mapes DL Lopes AA
Satayathum S McCullough
KP Goodkin DA Locatelli F
Fukuhara S Young EW
Kurokawa K Saito A Bommer
J Wolfe RA Held PJ Port FK
Health-related quality of life
as a predictor of mortality and
hospitalization the Dialysis
Outcomes and Practice
Patterns Study (DOPPS)
Kidney Int 2003 Jul64(1)339-
49
ANJH Paris 20 mai 2019
19
Teledialysis in BrittanySt Brieuc-Lannion (since June of 2001)
ANJH Paris 20 mai 2019
20
Remote monitoring in teledialysis
Software that processes the parameters
of the session in real time
ANJH Paris 20 mai 2019
21
Software that processes the settings
for each session for a period of 6 mois
Predictive diagnosis of vascular access stenosis
ANJH Paris 20 mai 2019
22
Teleconsultation at the end of hemodialysis session
ANJH Paris 20 mai 2019
23
Validation of teledialysis process by
French Health Authority in january 2010
Janvier 2010
ANJH Paris 20 mai 2019
24
Introduction of teledialysis in a new decree
in February 2012
Home
dialysis
Satellite
dialysis
Satellite dialysis
with nurse
Heavy dialysis
center
Doctor time given by the end of session teleconsult
On-site nephrology
team
Cs month Cs et visitmonth Visitweek
Consent of the patient
Patient stabilized in dialysis treatment
Decree of
september 2002Telemedicine decreeof february 2012
ANJH Paris 20 mai 2019
25
Lighted dialysis
center (UDM)
Compliance of the dialysis population to quality indicators
Pre dialytic phosphate (mmoll)
Summary graph of the dialysis population
Patients below the normal range
Patients over the
normal range
ANJH Paris 20 mai 2019
26
Diatelic system in Peritoneal Dialysis
since 2001(1)
ANJH Paris 20 mai 2019
27
Diatelic system in Peritoneal Dialysis
since 2001(2)
Patient nurse family physician give dialysis data from home over
the internet
By secure messaging the patient expresses his ou her remarks with
the healthcare team by continuous exchange
=gt
ANJH Paris 20 mai 2019
28
ldquo
rdquo
In the nephrology setting home telemonitoring has
been evaluated in home dialysis patients but data
are scarce concerning chronic kidney disease (CKD)
patients before and after renal replacement
therapy The eNephro study is designed to assess thecost effectiveness clinicalbiological impact and
patient perception of a home telemonitoring for
CKD patients
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R
Laplaud D Noeumll C Kessler M Cost-effectiveness of home telemonitoring in chronic
kidney disease patients at different stages by a pragmatic randomized controlled
trial (eNephro) rationale and study design BMC Nephrol 2017 Apr 518(1)126
doi 101186s12882-017-0529-2
ANJH Paris 20 mai 2019
29
The future in remote monitoring of patients treated by
hemodialysis ETAPE Program led by French Ministry
of Health and Health Insurance (2018-21)
Experimentation of telemonitoring funding in hemodialysis patients outside the heavy dialysis center
A precise perimeter (autodialysis UDM homehemodialysis ()) strict eligibilityconditions Patients should be extracted from heavy dialysis center
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient Study followed by HealthInsurance information system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the healthprofessional responsible for the therapeutic accompaniment the provider of theremote monitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
30
31 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Remote monitoring of renal
replacement treatmentsPatients treated by kidney graft
ANJH Paris 20 mai 2019
32
The future in remote monitoring of patients treated by
kidney graft ETAPE Program led by French Ministry of
Health and Health Insurance (2018-21)
Experimentation remote monitoring funding of patients grafted for more than 6months
A precise perimeter strict eligibility conditions
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient followed by Health Insuranceinformation system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the health professionalresponsible for the therapeutic accompaniment the provider of the remotemonitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
33
34 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Three prospectives studies controlled and
randomized (results end 2019-2020)
Foucher Y Meurette A Daguin P Bonnaud-Antignac A Hardouin JB Chailan S Neau K Papuchon E Gaboriau S Legendre C Moreacutelon E Tessier P Giral M
A personalized follow-up of kidney transplant recipients using video conferencing basedon a 1-year scoring system predictive of long term graft failure (TELEGRAFT study) protocolfor a randomized controlled trial
BMC Nephrol 2015 Jan 28 16 6 doi 1011861471-2369-16-6
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R Laplaud D Noeumll C Kessler M
Cost-effectiveness of home telemonitoring in chronic kidney disease patients at differentstages by a pragmatic randomized controlled trial (eNephro) rationale and study design
BMC Nephrol 2017 Apr 518(1)126 doi 101186s12882-017-0529-2
Pape L de Zwaan M Tegtbur U Feldhaus F Wolff JK Schiffer L Lerch C Hellrung N KliemV Lonnemann G Nolting HD Schiffer M
The KTx360deg-study a multicenter multisectoral multimodal telemedicine-based follow-upcare model to improve care and reduce health-care costs after kidney transplantation inchildren and adults
BMC Health Serv Res 2017 Aug 23 17(1)587 doi 101186s12913-017-2545-0
ANJH Paris 20 mai 2019
35
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
Life expectancy
at birth in the
world during the
20th century
ANJH Paris 20 mai 2019
3
3
The number of persons aged over 65 years in 2050
the global burden of ageingSource US Bureau of the Census (2000)
ANJH Paris 20 mai 2019
4
ANJH Paris 20 mai 2019
5
Kalid N Zaidan AA Zaidan BB Salman OH Hashim M Muzammil HBased Real Time Remote Health Monitoring Systems A Review on Patients Prioritization and
Related Big Data Using Body Sensors information and Communication Technology
J Med Syst 2017 Dec 2942(2)30 doi 101007s10916-017-0883-4 Review
5
Health Expenditures
Growth
due to chronic diseases
in the USA
Health expenditures growth per capita
in Western Europe
Finland
France
Germany
Italy
Netherlands
Sweden
United Kingdom
EU members
before May 2004
Denmark
OMS 2011
6
ANJH Paris 20 mai 2019
6
The tools of e-Health to the 21st century
Telemedicine
Mobile Health IoT
Medical Artificial Intelligence
Internet 2000
Smartphone 2007
IBM Watson 2014
GAFAM BATX
ANJH Paris 20 mai 2019
7
Big Data
New medical organizations DocHome
ANJH Paris 20 mai 2019
8
The Health-HUB system before 2007
ANJH Paris 20 mai 2019
9
Today smartphone for Quantified self
ANJH Paris 20 mai 2019
10
Data transmission
Data access
General
Practitioner
Hospital amp EPR
Hospital (Hospital Cliacutenic amp Hospital Mataroacute)Patientrsquos situation (at home)
Patient
Videoconference System amp
Patient Portal
Telemonitorin
g devices
Clinical Patient
Management
System
NurseHospital
video
interface
Interface amp
Gateway
Case Manager
Nurse
Hospital
Specialist
Call Centre amp Health coach
New medical organization cooperation
City-Hospital in Catalonia10
ANJH Paris 20 mai 2019
11
HomeCare in patients with chronic
diseases Overall Scheme
Sensors for multi-parametric monitoring
Hospital
Health call
Centre
Data communication and feedback
Data processing amp analysisData acquisition
200 400 600 800 1000 1200 1400 1600 1800 2000 2200
500
1000
1500
t [sec]
RR
[mse
c]
TiltSympthoms
200 400 600 800 1000 1200 1400 1600 1800 2000 220050
100
150
t [sec]
SBP
[mm
Hg]
200 400 600 800 1000 1200 1400 1600 1800 2000 22000
50
100
SCM
I [
]
t [sec]
200 400 600 800 1000 1200 1400 1600 1800 2000 2200
-05
0
05
Ris
k [-
-]
t [sec]
Positive VVS Risk
Medical
expertise
Intelligent
analysis
Support to diagnosis
decision amp treatment
11
ANJH Paris 20 mai 2019
12
ANJH Paris 20 mai 2019
13
J Med Syst 2017 Dec 2942(2)30 doi 101007s10916-017-0883-4 Review
14
Clinical data collection for an algorithmic medicine
Remote monitoring (RM) of renal replacement treatments14
ANJH Paris 20 mai 2019
ldquo
rdquo
Despite growing evidence for the use of RM in
the management of patients with ESRD
(including peritoneal dialysis and home
haemodialysis) this disease had the lowest
recognition of RM value in this current research
Katherine Rojahn1 Suzanne Laplante1 James Sloand1 Claire Main2 AftabIbrahim2 Janet Wild2 Nicky Sturt2 Thelga Areteou3 and K Ian Johnson3
Remote Monitoring of Chronic Diseases A Landscape Assessment of Policies in Four European Countries (United Kingdom Geremany Italy Spain)
PLoS One 2016 May 1911(5)e0155738 doi 101371journalpone0155738 eCollection 2016
ANJH Paris 20 mai 2019
15
ldquo
rdquo
The evidence regarding the quality of care
delivered by telemedicine and telenephrology
in particular compared with in-person care is
limited in USAhellip
Videoconferencing is widely used in Australia to manage kidney disease including chronic
kidney disease dialysis pediatric nephrology
and post-kidney transplantation carehellip
Rohatgi R Ross MJ Majoni SW Telenephrology current perspectives and
future directions Kidney Int 2017 Dec92(6)1328-1333 doi
101016jkint201706032 Epub 2017 Oct 12 Review
ANJH Paris 20 mai 2019
16
Remote monitoring of renal
replacement treatments in France and
in EuropePatients treated by Dialysis
ANJH Paris 20 mai 2019
17
Teledialysis in Tromsouml since 2001
TMS
Tromsoslash
Vefsn
Sandnessjoslashen
Rana
Harstad
Hammerfest
Narvik
Lofoten
Bodoslash
Kirkenes
Alta
bull Control
bull Remote visit guidance and teachingANJH Paris 20 mai 2019
18
Mapes DL Lopes AA
Satayathum S McCullough
KP Goodkin DA Locatelli F
Fukuhara S Young EW
Kurokawa K Saito A Bommer
J Wolfe RA Held PJ Port FK
Health-related quality of life
as a predictor of mortality and
hospitalization the Dialysis
Outcomes and Practice
Patterns Study (DOPPS)
Kidney Int 2003 Jul64(1)339-
49
ANJH Paris 20 mai 2019
19
Teledialysis in BrittanySt Brieuc-Lannion (since June of 2001)
ANJH Paris 20 mai 2019
20
Remote monitoring in teledialysis
Software that processes the parameters
of the session in real time
ANJH Paris 20 mai 2019
21
Software that processes the settings
for each session for a period of 6 mois
Predictive diagnosis of vascular access stenosis
ANJH Paris 20 mai 2019
22
Teleconsultation at the end of hemodialysis session
ANJH Paris 20 mai 2019
23
Validation of teledialysis process by
French Health Authority in january 2010
Janvier 2010
ANJH Paris 20 mai 2019
24
Introduction of teledialysis in a new decree
in February 2012
Home
dialysis
Satellite
dialysis
Satellite dialysis
with nurse
Heavy dialysis
center
Doctor time given by the end of session teleconsult
On-site nephrology
team
Cs month Cs et visitmonth Visitweek
Consent of the patient
Patient stabilized in dialysis treatment
Decree of
september 2002Telemedicine decreeof february 2012
ANJH Paris 20 mai 2019
25
Lighted dialysis
center (UDM)
Compliance of the dialysis population to quality indicators
Pre dialytic phosphate (mmoll)
Summary graph of the dialysis population
Patients below the normal range
Patients over the
normal range
ANJH Paris 20 mai 2019
26
Diatelic system in Peritoneal Dialysis
since 2001(1)
ANJH Paris 20 mai 2019
27
Diatelic system in Peritoneal Dialysis
since 2001(2)
Patient nurse family physician give dialysis data from home over
the internet
By secure messaging the patient expresses his ou her remarks with
the healthcare team by continuous exchange
=gt
ANJH Paris 20 mai 2019
28
ldquo
rdquo
In the nephrology setting home telemonitoring has
been evaluated in home dialysis patients but data
are scarce concerning chronic kidney disease (CKD)
patients before and after renal replacement
therapy The eNephro study is designed to assess thecost effectiveness clinicalbiological impact and
patient perception of a home telemonitoring for
CKD patients
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R
Laplaud D Noeumll C Kessler M Cost-effectiveness of home telemonitoring in chronic
kidney disease patients at different stages by a pragmatic randomized controlled
trial (eNephro) rationale and study design BMC Nephrol 2017 Apr 518(1)126
doi 101186s12882-017-0529-2
ANJH Paris 20 mai 2019
29
The future in remote monitoring of patients treated by
hemodialysis ETAPE Program led by French Ministry
of Health and Health Insurance (2018-21)
Experimentation of telemonitoring funding in hemodialysis patients outside the heavy dialysis center
A precise perimeter (autodialysis UDM homehemodialysis ()) strict eligibilityconditions Patients should be extracted from heavy dialysis center
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient Study followed by HealthInsurance information system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the healthprofessional responsible for the therapeutic accompaniment the provider of theremote monitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
30
31 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Remote monitoring of renal
replacement treatmentsPatients treated by kidney graft
ANJH Paris 20 mai 2019
32
The future in remote monitoring of patients treated by
kidney graft ETAPE Program led by French Ministry of
Health and Health Insurance (2018-21)
Experimentation remote monitoring funding of patients grafted for more than 6months
A precise perimeter strict eligibility conditions
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient followed by Health Insuranceinformation system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the health professionalresponsible for the therapeutic accompaniment the provider of the remotemonitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
33
34 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Three prospectives studies controlled and
randomized (results end 2019-2020)
Foucher Y Meurette A Daguin P Bonnaud-Antignac A Hardouin JB Chailan S Neau K Papuchon E Gaboriau S Legendre C Moreacutelon E Tessier P Giral M
A personalized follow-up of kidney transplant recipients using video conferencing basedon a 1-year scoring system predictive of long term graft failure (TELEGRAFT study) protocolfor a randomized controlled trial
BMC Nephrol 2015 Jan 28 16 6 doi 1011861471-2369-16-6
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R Laplaud D Noeumll C Kessler M
Cost-effectiveness of home telemonitoring in chronic kidney disease patients at differentstages by a pragmatic randomized controlled trial (eNephro) rationale and study design
BMC Nephrol 2017 Apr 518(1)126 doi 101186s12882-017-0529-2
Pape L de Zwaan M Tegtbur U Feldhaus F Wolff JK Schiffer L Lerch C Hellrung N KliemV Lonnemann G Nolting HD Schiffer M
The KTx360deg-study a multicenter multisectoral multimodal telemedicine-based follow-upcare model to improve care and reduce health-care costs after kidney transplantation inchildren and adults
BMC Health Serv Res 2017 Aug 23 17(1)587 doi 101186s12913-017-2545-0
ANJH Paris 20 mai 2019
35
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
The number of persons aged over 65 years in 2050
the global burden of ageingSource US Bureau of the Census (2000)
ANJH Paris 20 mai 2019
4
ANJH Paris 20 mai 2019
5
Kalid N Zaidan AA Zaidan BB Salman OH Hashim M Muzammil HBased Real Time Remote Health Monitoring Systems A Review on Patients Prioritization and
Related Big Data Using Body Sensors information and Communication Technology
J Med Syst 2017 Dec 2942(2)30 doi 101007s10916-017-0883-4 Review
5
Health Expenditures
Growth
due to chronic diseases
in the USA
Health expenditures growth per capita
in Western Europe
Finland
France
Germany
Italy
Netherlands
Sweden
United Kingdom
EU members
before May 2004
Denmark
OMS 2011
6
ANJH Paris 20 mai 2019
6
The tools of e-Health to the 21st century
Telemedicine
Mobile Health IoT
Medical Artificial Intelligence
Internet 2000
Smartphone 2007
IBM Watson 2014
GAFAM BATX
ANJH Paris 20 mai 2019
7
Big Data
New medical organizations DocHome
ANJH Paris 20 mai 2019
8
The Health-HUB system before 2007
ANJH Paris 20 mai 2019
9
Today smartphone for Quantified self
ANJH Paris 20 mai 2019
10
Data transmission
Data access
General
Practitioner
Hospital amp EPR
Hospital (Hospital Cliacutenic amp Hospital Mataroacute)Patientrsquos situation (at home)
Patient
Videoconference System amp
Patient Portal
Telemonitorin
g devices
Clinical Patient
Management
System
NurseHospital
video
interface
Interface amp
Gateway
Case Manager
Nurse
Hospital
Specialist
Call Centre amp Health coach
New medical organization cooperation
City-Hospital in Catalonia10
ANJH Paris 20 mai 2019
11
HomeCare in patients with chronic
diseases Overall Scheme
Sensors for multi-parametric monitoring
Hospital
Health call
Centre
Data communication and feedback
Data processing amp analysisData acquisition
200 400 600 800 1000 1200 1400 1600 1800 2000 2200
500
1000
1500
t [sec]
RR
[mse
c]
TiltSympthoms
200 400 600 800 1000 1200 1400 1600 1800 2000 220050
100
150
t [sec]
SBP
[mm
Hg]
200 400 600 800 1000 1200 1400 1600 1800 2000 22000
50
100
SCM
I [
]
t [sec]
200 400 600 800 1000 1200 1400 1600 1800 2000 2200
-05
0
05
Ris
k [-
-]
t [sec]
Positive VVS Risk
Medical
expertise
Intelligent
analysis
Support to diagnosis
decision amp treatment
11
ANJH Paris 20 mai 2019
12
ANJH Paris 20 mai 2019
13
J Med Syst 2017 Dec 2942(2)30 doi 101007s10916-017-0883-4 Review
14
Clinical data collection for an algorithmic medicine
Remote monitoring (RM) of renal replacement treatments14
ANJH Paris 20 mai 2019
ldquo
rdquo
Despite growing evidence for the use of RM in
the management of patients with ESRD
(including peritoneal dialysis and home
haemodialysis) this disease had the lowest
recognition of RM value in this current research
Katherine Rojahn1 Suzanne Laplante1 James Sloand1 Claire Main2 AftabIbrahim2 Janet Wild2 Nicky Sturt2 Thelga Areteou3 and K Ian Johnson3
Remote Monitoring of Chronic Diseases A Landscape Assessment of Policies in Four European Countries (United Kingdom Geremany Italy Spain)
PLoS One 2016 May 1911(5)e0155738 doi 101371journalpone0155738 eCollection 2016
ANJH Paris 20 mai 2019
15
ldquo
rdquo
The evidence regarding the quality of care
delivered by telemedicine and telenephrology
in particular compared with in-person care is
limited in USAhellip
Videoconferencing is widely used in Australia to manage kidney disease including chronic
kidney disease dialysis pediatric nephrology
and post-kidney transplantation carehellip
Rohatgi R Ross MJ Majoni SW Telenephrology current perspectives and
future directions Kidney Int 2017 Dec92(6)1328-1333 doi
101016jkint201706032 Epub 2017 Oct 12 Review
ANJH Paris 20 mai 2019
16
Remote monitoring of renal
replacement treatments in France and
in EuropePatients treated by Dialysis
ANJH Paris 20 mai 2019
17
Teledialysis in Tromsouml since 2001
TMS
Tromsoslash
Vefsn
Sandnessjoslashen
Rana
Harstad
Hammerfest
Narvik
Lofoten
Bodoslash
Kirkenes
Alta
bull Control
bull Remote visit guidance and teachingANJH Paris 20 mai 2019
18
Mapes DL Lopes AA
Satayathum S McCullough
KP Goodkin DA Locatelli F
Fukuhara S Young EW
Kurokawa K Saito A Bommer
J Wolfe RA Held PJ Port FK
Health-related quality of life
as a predictor of mortality and
hospitalization the Dialysis
Outcomes and Practice
Patterns Study (DOPPS)
Kidney Int 2003 Jul64(1)339-
49
ANJH Paris 20 mai 2019
19
Teledialysis in BrittanySt Brieuc-Lannion (since June of 2001)
ANJH Paris 20 mai 2019
20
Remote monitoring in teledialysis
Software that processes the parameters
of the session in real time
ANJH Paris 20 mai 2019
21
Software that processes the settings
for each session for a period of 6 mois
Predictive diagnosis of vascular access stenosis
ANJH Paris 20 mai 2019
22
Teleconsultation at the end of hemodialysis session
ANJH Paris 20 mai 2019
23
Validation of teledialysis process by
French Health Authority in january 2010
Janvier 2010
ANJH Paris 20 mai 2019
24
Introduction of teledialysis in a new decree
in February 2012
Home
dialysis
Satellite
dialysis
Satellite dialysis
with nurse
Heavy dialysis
center
Doctor time given by the end of session teleconsult
On-site nephrology
team
Cs month Cs et visitmonth Visitweek
Consent of the patient
Patient stabilized in dialysis treatment
Decree of
september 2002Telemedicine decreeof february 2012
ANJH Paris 20 mai 2019
25
Lighted dialysis
center (UDM)
Compliance of the dialysis population to quality indicators
Pre dialytic phosphate (mmoll)
Summary graph of the dialysis population
Patients below the normal range
Patients over the
normal range
ANJH Paris 20 mai 2019
26
Diatelic system in Peritoneal Dialysis
since 2001(1)
ANJH Paris 20 mai 2019
27
Diatelic system in Peritoneal Dialysis
since 2001(2)
Patient nurse family physician give dialysis data from home over
the internet
By secure messaging the patient expresses his ou her remarks with
the healthcare team by continuous exchange
=gt
ANJH Paris 20 mai 2019
28
ldquo
rdquo
In the nephrology setting home telemonitoring has
been evaluated in home dialysis patients but data
are scarce concerning chronic kidney disease (CKD)
patients before and after renal replacement
therapy The eNephro study is designed to assess thecost effectiveness clinicalbiological impact and
patient perception of a home telemonitoring for
CKD patients
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R
Laplaud D Noeumll C Kessler M Cost-effectiveness of home telemonitoring in chronic
kidney disease patients at different stages by a pragmatic randomized controlled
trial (eNephro) rationale and study design BMC Nephrol 2017 Apr 518(1)126
doi 101186s12882-017-0529-2
ANJH Paris 20 mai 2019
29
The future in remote monitoring of patients treated by
hemodialysis ETAPE Program led by French Ministry
of Health and Health Insurance (2018-21)
Experimentation of telemonitoring funding in hemodialysis patients outside the heavy dialysis center
A precise perimeter (autodialysis UDM homehemodialysis ()) strict eligibilityconditions Patients should be extracted from heavy dialysis center
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient Study followed by HealthInsurance information system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the healthprofessional responsible for the therapeutic accompaniment the provider of theremote monitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
30
31 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Remote monitoring of renal
replacement treatmentsPatients treated by kidney graft
ANJH Paris 20 mai 2019
32
The future in remote monitoring of patients treated by
kidney graft ETAPE Program led by French Ministry of
Health and Health Insurance (2018-21)
Experimentation remote monitoring funding of patients grafted for more than 6months
A precise perimeter strict eligibility conditions
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient followed by Health Insuranceinformation system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the health professionalresponsible for the therapeutic accompaniment the provider of the remotemonitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
33
34 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Three prospectives studies controlled and
randomized (results end 2019-2020)
Foucher Y Meurette A Daguin P Bonnaud-Antignac A Hardouin JB Chailan S Neau K Papuchon E Gaboriau S Legendre C Moreacutelon E Tessier P Giral M
A personalized follow-up of kidney transplant recipients using video conferencing basedon a 1-year scoring system predictive of long term graft failure (TELEGRAFT study) protocolfor a randomized controlled trial
BMC Nephrol 2015 Jan 28 16 6 doi 1011861471-2369-16-6
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R Laplaud D Noeumll C Kessler M
Cost-effectiveness of home telemonitoring in chronic kidney disease patients at differentstages by a pragmatic randomized controlled trial (eNephro) rationale and study design
BMC Nephrol 2017 Apr 518(1)126 doi 101186s12882-017-0529-2
Pape L de Zwaan M Tegtbur U Feldhaus F Wolff JK Schiffer L Lerch C Hellrung N KliemV Lonnemann G Nolting HD Schiffer M
The KTx360deg-study a multicenter multisectoral multimodal telemedicine-based follow-upcare model to improve care and reduce health-care costs after kidney transplantation inchildren and adults
BMC Health Serv Res 2017 Aug 23 17(1)587 doi 101186s12913-017-2545-0
ANJH Paris 20 mai 2019
35
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
ANJH Paris 20 mai 2019
5
Kalid N Zaidan AA Zaidan BB Salman OH Hashim M Muzammil HBased Real Time Remote Health Monitoring Systems A Review on Patients Prioritization and
Related Big Data Using Body Sensors information and Communication Technology
J Med Syst 2017 Dec 2942(2)30 doi 101007s10916-017-0883-4 Review
5
Health Expenditures
Growth
due to chronic diseases
in the USA
Health expenditures growth per capita
in Western Europe
Finland
France
Germany
Italy
Netherlands
Sweden
United Kingdom
EU members
before May 2004
Denmark
OMS 2011
6
ANJH Paris 20 mai 2019
6
The tools of e-Health to the 21st century
Telemedicine
Mobile Health IoT
Medical Artificial Intelligence
Internet 2000
Smartphone 2007
IBM Watson 2014
GAFAM BATX
ANJH Paris 20 mai 2019
7
Big Data
New medical organizations DocHome
ANJH Paris 20 mai 2019
8
The Health-HUB system before 2007
ANJH Paris 20 mai 2019
9
Today smartphone for Quantified self
ANJH Paris 20 mai 2019
10
Data transmission
Data access
General
Practitioner
Hospital amp EPR
Hospital (Hospital Cliacutenic amp Hospital Mataroacute)Patientrsquos situation (at home)
Patient
Videoconference System amp
Patient Portal
Telemonitorin
g devices
Clinical Patient
Management
System
NurseHospital
video
interface
Interface amp
Gateway
Case Manager
Nurse
Hospital
Specialist
Call Centre amp Health coach
New medical organization cooperation
City-Hospital in Catalonia10
ANJH Paris 20 mai 2019
11
HomeCare in patients with chronic
diseases Overall Scheme
Sensors for multi-parametric monitoring
Hospital
Health call
Centre
Data communication and feedback
Data processing amp analysisData acquisition
200 400 600 800 1000 1200 1400 1600 1800 2000 2200
500
1000
1500
t [sec]
RR
[mse
c]
TiltSympthoms
200 400 600 800 1000 1200 1400 1600 1800 2000 220050
100
150
t [sec]
SBP
[mm
Hg]
200 400 600 800 1000 1200 1400 1600 1800 2000 22000
50
100
SCM
I [
]
t [sec]
200 400 600 800 1000 1200 1400 1600 1800 2000 2200
-05
0
05
Ris
k [-
-]
t [sec]
Positive VVS Risk
Medical
expertise
Intelligent
analysis
Support to diagnosis
decision amp treatment
11
ANJH Paris 20 mai 2019
12
ANJH Paris 20 mai 2019
13
J Med Syst 2017 Dec 2942(2)30 doi 101007s10916-017-0883-4 Review
14
Clinical data collection for an algorithmic medicine
Remote monitoring (RM) of renal replacement treatments14
ANJH Paris 20 mai 2019
ldquo
rdquo
Despite growing evidence for the use of RM in
the management of patients with ESRD
(including peritoneal dialysis and home
haemodialysis) this disease had the lowest
recognition of RM value in this current research
Katherine Rojahn1 Suzanne Laplante1 James Sloand1 Claire Main2 AftabIbrahim2 Janet Wild2 Nicky Sturt2 Thelga Areteou3 and K Ian Johnson3
Remote Monitoring of Chronic Diseases A Landscape Assessment of Policies in Four European Countries (United Kingdom Geremany Italy Spain)
PLoS One 2016 May 1911(5)e0155738 doi 101371journalpone0155738 eCollection 2016
ANJH Paris 20 mai 2019
15
ldquo
rdquo
The evidence regarding the quality of care
delivered by telemedicine and telenephrology
in particular compared with in-person care is
limited in USAhellip
Videoconferencing is widely used in Australia to manage kidney disease including chronic
kidney disease dialysis pediatric nephrology
and post-kidney transplantation carehellip
Rohatgi R Ross MJ Majoni SW Telenephrology current perspectives and
future directions Kidney Int 2017 Dec92(6)1328-1333 doi
101016jkint201706032 Epub 2017 Oct 12 Review
ANJH Paris 20 mai 2019
16
Remote monitoring of renal
replacement treatments in France and
in EuropePatients treated by Dialysis
ANJH Paris 20 mai 2019
17
Teledialysis in Tromsouml since 2001
TMS
Tromsoslash
Vefsn
Sandnessjoslashen
Rana
Harstad
Hammerfest
Narvik
Lofoten
Bodoslash
Kirkenes
Alta
bull Control
bull Remote visit guidance and teachingANJH Paris 20 mai 2019
18
Mapes DL Lopes AA
Satayathum S McCullough
KP Goodkin DA Locatelli F
Fukuhara S Young EW
Kurokawa K Saito A Bommer
J Wolfe RA Held PJ Port FK
Health-related quality of life
as a predictor of mortality and
hospitalization the Dialysis
Outcomes and Practice
Patterns Study (DOPPS)
Kidney Int 2003 Jul64(1)339-
49
ANJH Paris 20 mai 2019
19
Teledialysis in BrittanySt Brieuc-Lannion (since June of 2001)
ANJH Paris 20 mai 2019
20
Remote monitoring in teledialysis
Software that processes the parameters
of the session in real time
ANJH Paris 20 mai 2019
21
Software that processes the settings
for each session for a period of 6 mois
Predictive diagnosis of vascular access stenosis
ANJH Paris 20 mai 2019
22
Teleconsultation at the end of hemodialysis session
ANJH Paris 20 mai 2019
23
Validation of teledialysis process by
French Health Authority in january 2010
Janvier 2010
ANJH Paris 20 mai 2019
24
Introduction of teledialysis in a new decree
in February 2012
Home
dialysis
Satellite
dialysis
Satellite dialysis
with nurse
Heavy dialysis
center
Doctor time given by the end of session teleconsult
On-site nephrology
team
Cs month Cs et visitmonth Visitweek
Consent of the patient
Patient stabilized in dialysis treatment
Decree of
september 2002Telemedicine decreeof february 2012
ANJH Paris 20 mai 2019
25
Lighted dialysis
center (UDM)
Compliance of the dialysis population to quality indicators
Pre dialytic phosphate (mmoll)
Summary graph of the dialysis population
Patients below the normal range
Patients over the
normal range
ANJH Paris 20 mai 2019
26
Diatelic system in Peritoneal Dialysis
since 2001(1)
ANJH Paris 20 mai 2019
27
Diatelic system in Peritoneal Dialysis
since 2001(2)
Patient nurse family physician give dialysis data from home over
the internet
By secure messaging the patient expresses his ou her remarks with
the healthcare team by continuous exchange
=gt
ANJH Paris 20 mai 2019
28
ldquo
rdquo
In the nephrology setting home telemonitoring has
been evaluated in home dialysis patients but data
are scarce concerning chronic kidney disease (CKD)
patients before and after renal replacement
therapy The eNephro study is designed to assess thecost effectiveness clinicalbiological impact and
patient perception of a home telemonitoring for
CKD patients
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R
Laplaud D Noeumll C Kessler M Cost-effectiveness of home telemonitoring in chronic
kidney disease patients at different stages by a pragmatic randomized controlled
trial (eNephro) rationale and study design BMC Nephrol 2017 Apr 518(1)126
doi 101186s12882-017-0529-2
ANJH Paris 20 mai 2019
29
The future in remote monitoring of patients treated by
hemodialysis ETAPE Program led by French Ministry
of Health and Health Insurance (2018-21)
Experimentation of telemonitoring funding in hemodialysis patients outside the heavy dialysis center
A precise perimeter (autodialysis UDM homehemodialysis ()) strict eligibilityconditions Patients should be extracted from heavy dialysis center
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient Study followed by HealthInsurance information system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the healthprofessional responsible for the therapeutic accompaniment the provider of theremote monitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
30
31 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Remote monitoring of renal
replacement treatmentsPatients treated by kidney graft
ANJH Paris 20 mai 2019
32
The future in remote monitoring of patients treated by
kidney graft ETAPE Program led by French Ministry of
Health and Health Insurance (2018-21)
Experimentation remote monitoring funding of patients grafted for more than 6months
A precise perimeter strict eligibility conditions
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient followed by Health Insuranceinformation system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the health professionalresponsible for the therapeutic accompaniment the provider of the remotemonitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
33
34 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Three prospectives studies controlled and
randomized (results end 2019-2020)
Foucher Y Meurette A Daguin P Bonnaud-Antignac A Hardouin JB Chailan S Neau K Papuchon E Gaboriau S Legendre C Moreacutelon E Tessier P Giral M
A personalized follow-up of kidney transplant recipients using video conferencing basedon a 1-year scoring system predictive of long term graft failure (TELEGRAFT study) protocolfor a randomized controlled trial
BMC Nephrol 2015 Jan 28 16 6 doi 1011861471-2369-16-6
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R Laplaud D Noeumll C Kessler M
Cost-effectiveness of home telemonitoring in chronic kidney disease patients at differentstages by a pragmatic randomized controlled trial (eNephro) rationale and study design
BMC Nephrol 2017 Apr 518(1)126 doi 101186s12882-017-0529-2
Pape L de Zwaan M Tegtbur U Feldhaus F Wolff JK Schiffer L Lerch C Hellrung N KliemV Lonnemann G Nolting HD Schiffer M
The KTx360deg-study a multicenter multisectoral multimodal telemedicine-based follow-upcare model to improve care and reduce health-care costs after kidney transplantation inchildren and adults
BMC Health Serv Res 2017 Aug 23 17(1)587 doi 101186s12913-017-2545-0
ANJH Paris 20 mai 2019
35
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
Health expenditures growth per capita
in Western Europe
Finland
France
Germany
Italy
Netherlands
Sweden
United Kingdom
EU members
before May 2004
Denmark
OMS 2011
6
ANJH Paris 20 mai 2019
6
The tools of e-Health to the 21st century
Telemedicine
Mobile Health IoT
Medical Artificial Intelligence
Internet 2000
Smartphone 2007
IBM Watson 2014
GAFAM BATX
ANJH Paris 20 mai 2019
7
Big Data
New medical organizations DocHome
ANJH Paris 20 mai 2019
8
The Health-HUB system before 2007
ANJH Paris 20 mai 2019
9
Today smartphone for Quantified self
ANJH Paris 20 mai 2019
10
Data transmission
Data access
General
Practitioner
Hospital amp EPR
Hospital (Hospital Cliacutenic amp Hospital Mataroacute)Patientrsquos situation (at home)
Patient
Videoconference System amp
Patient Portal
Telemonitorin
g devices
Clinical Patient
Management
System
NurseHospital
video
interface
Interface amp
Gateway
Case Manager
Nurse
Hospital
Specialist
Call Centre amp Health coach
New medical organization cooperation
City-Hospital in Catalonia10
ANJH Paris 20 mai 2019
11
HomeCare in patients with chronic
diseases Overall Scheme
Sensors for multi-parametric monitoring
Hospital
Health call
Centre
Data communication and feedback
Data processing amp analysisData acquisition
200 400 600 800 1000 1200 1400 1600 1800 2000 2200
500
1000
1500
t [sec]
RR
[mse
c]
TiltSympthoms
200 400 600 800 1000 1200 1400 1600 1800 2000 220050
100
150
t [sec]
SBP
[mm
Hg]
200 400 600 800 1000 1200 1400 1600 1800 2000 22000
50
100
SCM
I [
]
t [sec]
200 400 600 800 1000 1200 1400 1600 1800 2000 2200
-05
0
05
Ris
k [-
-]
t [sec]
Positive VVS Risk
Medical
expertise
Intelligent
analysis
Support to diagnosis
decision amp treatment
11
ANJH Paris 20 mai 2019
12
ANJH Paris 20 mai 2019
13
J Med Syst 2017 Dec 2942(2)30 doi 101007s10916-017-0883-4 Review
14
Clinical data collection for an algorithmic medicine
Remote monitoring (RM) of renal replacement treatments14
ANJH Paris 20 mai 2019
ldquo
rdquo
Despite growing evidence for the use of RM in
the management of patients with ESRD
(including peritoneal dialysis and home
haemodialysis) this disease had the lowest
recognition of RM value in this current research
Katherine Rojahn1 Suzanne Laplante1 James Sloand1 Claire Main2 AftabIbrahim2 Janet Wild2 Nicky Sturt2 Thelga Areteou3 and K Ian Johnson3
Remote Monitoring of Chronic Diseases A Landscape Assessment of Policies in Four European Countries (United Kingdom Geremany Italy Spain)
PLoS One 2016 May 1911(5)e0155738 doi 101371journalpone0155738 eCollection 2016
ANJH Paris 20 mai 2019
15
ldquo
rdquo
The evidence regarding the quality of care
delivered by telemedicine and telenephrology
in particular compared with in-person care is
limited in USAhellip
Videoconferencing is widely used in Australia to manage kidney disease including chronic
kidney disease dialysis pediatric nephrology
and post-kidney transplantation carehellip
Rohatgi R Ross MJ Majoni SW Telenephrology current perspectives and
future directions Kidney Int 2017 Dec92(6)1328-1333 doi
101016jkint201706032 Epub 2017 Oct 12 Review
ANJH Paris 20 mai 2019
16
Remote monitoring of renal
replacement treatments in France and
in EuropePatients treated by Dialysis
ANJH Paris 20 mai 2019
17
Teledialysis in Tromsouml since 2001
TMS
Tromsoslash
Vefsn
Sandnessjoslashen
Rana
Harstad
Hammerfest
Narvik
Lofoten
Bodoslash
Kirkenes
Alta
bull Control
bull Remote visit guidance and teachingANJH Paris 20 mai 2019
18
Mapes DL Lopes AA
Satayathum S McCullough
KP Goodkin DA Locatelli F
Fukuhara S Young EW
Kurokawa K Saito A Bommer
J Wolfe RA Held PJ Port FK
Health-related quality of life
as a predictor of mortality and
hospitalization the Dialysis
Outcomes and Practice
Patterns Study (DOPPS)
Kidney Int 2003 Jul64(1)339-
49
ANJH Paris 20 mai 2019
19
Teledialysis in BrittanySt Brieuc-Lannion (since June of 2001)
ANJH Paris 20 mai 2019
20
Remote monitoring in teledialysis
Software that processes the parameters
of the session in real time
ANJH Paris 20 mai 2019
21
Software that processes the settings
for each session for a period of 6 mois
Predictive diagnosis of vascular access stenosis
ANJH Paris 20 mai 2019
22
Teleconsultation at the end of hemodialysis session
ANJH Paris 20 mai 2019
23
Validation of teledialysis process by
French Health Authority in january 2010
Janvier 2010
ANJH Paris 20 mai 2019
24
Introduction of teledialysis in a new decree
in February 2012
Home
dialysis
Satellite
dialysis
Satellite dialysis
with nurse
Heavy dialysis
center
Doctor time given by the end of session teleconsult
On-site nephrology
team
Cs month Cs et visitmonth Visitweek
Consent of the patient
Patient stabilized in dialysis treatment
Decree of
september 2002Telemedicine decreeof february 2012
ANJH Paris 20 mai 2019
25
Lighted dialysis
center (UDM)
Compliance of the dialysis population to quality indicators
Pre dialytic phosphate (mmoll)
Summary graph of the dialysis population
Patients below the normal range
Patients over the
normal range
ANJH Paris 20 mai 2019
26
Diatelic system in Peritoneal Dialysis
since 2001(1)
ANJH Paris 20 mai 2019
27
Diatelic system in Peritoneal Dialysis
since 2001(2)
Patient nurse family physician give dialysis data from home over
the internet
By secure messaging the patient expresses his ou her remarks with
the healthcare team by continuous exchange
=gt
ANJH Paris 20 mai 2019
28
ldquo
rdquo
In the nephrology setting home telemonitoring has
been evaluated in home dialysis patients but data
are scarce concerning chronic kidney disease (CKD)
patients before and after renal replacement
therapy The eNephro study is designed to assess thecost effectiveness clinicalbiological impact and
patient perception of a home telemonitoring for
CKD patients
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R
Laplaud D Noeumll C Kessler M Cost-effectiveness of home telemonitoring in chronic
kidney disease patients at different stages by a pragmatic randomized controlled
trial (eNephro) rationale and study design BMC Nephrol 2017 Apr 518(1)126
doi 101186s12882-017-0529-2
ANJH Paris 20 mai 2019
29
The future in remote monitoring of patients treated by
hemodialysis ETAPE Program led by French Ministry
of Health and Health Insurance (2018-21)
Experimentation of telemonitoring funding in hemodialysis patients outside the heavy dialysis center
A precise perimeter (autodialysis UDM homehemodialysis ()) strict eligibilityconditions Patients should be extracted from heavy dialysis center
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient Study followed by HealthInsurance information system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the healthprofessional responsible for the therapeutic accompaniment the provider of theremote monitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
30
31 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Remote monitoring of renal
replacement treatmentsPatients treated by kidney graft
ANJH Paris 20 mai 2019
32
The future in remote monitoring of patients treated by
kidney graft ETAPE Program led by French Ministry of
Health and Health Insurance (2018-21)
Experimentation remote monitoring funding of patients grafted for more than 6months
A precise perimeter strict eligibility conditions
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient followed by Health Insuranceinformation system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the health professionalresponsible for the therapeutic accompaniment the provider of the remotemonitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
33
34 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Three prospectives studies controlled and
randomized (results end 2019-2020)
Foucher Y Meurette A Daguin P Bonnaud-Antignac A Hardouin JB Chailan S Neau K Papuchon E Gaboriau S Legendre C Moreacutelon E Tessier P Giral M
A personalized follow-up of kidney transplant recipients using video conferencing basedon a 1-year scoring system predictive of long term graft failure (TELEGRAFT study) protocolfor a randomized controlled trial
BMC Nephrol 2015 Jan 28 16 6 doi 1011861471-2369-16-6
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R Laplaud D Noeumll C Kessler M
Cost-effectiveness of home telemonitoring in chronic kidney disease patients at differentstages by a pragmatic randomized controlled trial (eNephro) rationale and study design
BMC Nephrol 2017 Apr 518(1)126 doi 101186s12882-017-0529-2
Pape L de Zwaan M Tegtbur U Feldhaus F Wolff JK Schiffer L Lerch C Hellrung N KliemV Lonnemann G Nolting HD Schiffer M
The KTx360deg-study a multicenter multisectoral multimodal telemedicine-based follow-upcare model to improve care and reduce health-care costs after kidney transplantation inchildren and adults
BMC Health Serv Res 2017 Aug 23 17(1)587 doi 101186s12913-017-2545-0
ANJH Paris 20 mai 2019
35
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
The tools of e-Health to the 21st century
Telemedicine
Mobile Health IoT
Medical Artificial Intelligence
Internet 2000
Smartphone 2007
IBM Watson 2014
GAFAM BATX
ANJH Paris 20 mai 2019
7
Big Data
New medical organizations DocHome
ANJH Paris 20 mai 2019
8
The Health-HUB system before 2007
ANJH Paris 20 mai 2019
9
Today smartphone for Quantified self
ANJH Paris 20 mai 2019
10
Data transmission
Data access
General
Practitioner
Hospital amp EPR
Hospital (Hospital Cliacutenic amp Hospital Mataroacute)Patientrsquos situation (at home)
Patient
Videoconference System amp
Patient Portal
Telemonitorin
g devices
Clinical Patient
Management
System
NurseHospital
video
interface
Interface amp
Gateway
Case Manager
Nurse
Hospital
Specialist
Call Centre amp Health coach
New medical organization cooperation
City-Hospital in Catalonia10
ANJH Paris 20 mai 2019
11
HomeCare in patients with chronic
diseases Overall Scheme
Sensors for multi-parametric monitoring
Hospital
Health call
Centre
Data communication and feedback
Data processing amp analysisData acquisition
200 400 600 800 1000 1200 1400 1600 1800 2000 2200
500
1000
1500
t [sec]
RR
[mse
c]
TiltSympthoms
200 400 600 800 1000 1200 1400 1600 1800 2000 220050
100
150
t [sec]
SBP
[mm
Hg]
200 400 600 800 1000 1200 1400 1600 1800 2000 22000
50
100
SCM
I [
]
t [sec]
200 400 600 800 1000 1200 1400 1600 1800 2000 2200
-05
0
05
Ris
k [-
-]
t [sec]
Positive VVS Risk
Medical
expertise
Intelligent
analysis
Support to diagnosis
decision amp treatment
11
ANJH Paris 20 mai 2019
12
ANJH Paris 20 mai 2019
13
J Med Syst 2017 Dec 2942(2)30 doi 101007s10916-017-0883-4 Review
14
Clinical data collection for an algorithmic medicine
Remote monitoring (RM) of renal replacement treatments14
ANJH Paris 20 mai 2019
ldquo
rdquo
Despite growing evidence for the use of RM in
the management of patients with ESRD
(including peritoneal dialysis and home
haemodialysis) this disease had the lowest
recognition of RM value in this current research
Katherine Rojahn1 Suzanne Laplante1 James Sloand1 Claire Main2 AftabIbrahim2 Janet Wild2 Nicky Sturt2 Thelga Areteou3 and K Ian Johnson3
Remote Monitoring of Chronic Diseases A Landscape Assessment of Policies in Four European Countries (United Kingdom Geremany Italy Spain)
PLoS One 2016 May 1911(5)e0155738 doi 101371journalpone0155738 eCollection 2016
ANJH Paris 20 mai 2019
15
ldquo
rdquo
The evidence regarding the quality of care
delivered by telemedicine and telenephrology
in particular compared with in-person care is
limited in USAhellip
Videoconferencing is widely used in Australia to manage kidney disease including chronic
kidney disease dialysis pediatric nephrology
and post-kidney transplantation carehellip
Rohatgi R Ross MJ Majoni SW Telenephrology current perspectives and
future directions Kidney Int 2017 Dec92(6)1328-1333 doi
101016jkint201706032 Epub 2017 Oct 12 Review
ANJH Paris 20 mai 2019
16
Remote monitoring of renal
replacement treatments in France and
in EuropePatients treated by Dialysis
ANJH Paris 20 mai 2019
17
Teledialysis in Tromsouml since 2001
TMS
Tromsoslash
Vefsn
Sandnessjoslashen
Rana
Harstad
Hammerfest
Narvik
Lofoten
Bodoslash
Kirkenes
Alta
bull Control
bull Remote visit guidance and teachingANJH Paris 20 mai 2019
18
Mapes DL Lopes AA
Satayathum S McCullough
KP Goodkin DA Locatelli F
Fukuhara S Young EW
Kurokawa K Saito A Bommer
J Wolfe RA Held PJ Port FK
Health-related quality of life
as a predictor of mortality and
hospitalization the Dialysis
Outcomes and Practice
Patterns Study (DOPPS)
Kidney Int 2003 Jul64(1)339-
49
ANJH Paris 20 mai 2019
19
Teledialysis in BrittanySt Brieuc-Lannion (since June of 2001)
ANJH Paris 20 mai 2019
20
Remote monitoring in teledialysis
Software that processes the parameters
of the session in real time
ANJH Paris 20 mai 2019
21
Software that processes the settings
for each session for a period of 6 mois
Predictive diagnosis of vascular access stenosis
ANJH Paris 20 mai 2019
22
Teleconsultation at the end of hemodialysis session
ANJH Paris 20 mai 2019
23
Validation of teledialysis process by
French Health Authority in january 2010
Janvier 2010
ANJH Paris 20 mai 2019
24
Introduction of teledialysis in a new decree
in February 2012
Home
dialysis
Satellite
dialysis
Satellite dialysis
with nurse
Heavy dialysis
center
Doctor time given by the end of session teleconsult
On-site nephrology
team
Cs month Cs et visitmonth Visitweek
Consent of the patient
Patient stabilized in dialysis treatment
Decree of
september 2002Telemedicine decreeof february 2012
ANJH Paris 20 mai 2019
25
Lighted dialysis
center (UDM)
Compliance of the dialysis population to quality indicators
Pre dialytic phosphate (mmoll)
Summary graph of the dialysis population
Patients below the normal range
Patients over the
normal range
ANJH Paris 20 mai 2019
26
Diatelic system in Peritoneal Dialysis
since 2001(1)
ANJH Paris 20 mai 2019
27
Diatelic system in Peritoneal Dialysis
since 2001(2)
Patient nurse family physician give dialysis data from home over
the internet
By secure messaging the patient expresses his ou her remarks with
the healthcare team by continuous exchange
=gt
ANJH Paris 20 mai 2019
28
ldquo
rdquo
In the nephrology setting home telemonitoring has
been evaluated in home dialysis patients but data
are scarce concerning chronic kidney disease (CKD)
patients before and after renal replacement
therapy The eNephro study is designed to assess thecost effectiveness clinicalbiological impact and
patient perception of a home telemonitoring for
CKD patients
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R
Laplaud D Noeumll C Kessler M Cost-effectiveness of home telemonitoring in chronic
kidney disease patients at different stages by a pragmatic randomized controlled
trial (eNephro) rationale and study design BMC Nephrol 2017 Apr 518(1)126
doi 101186s12882-017-0529-2
ANJH Paris 20 mai 2019
29
The future in remote monitoring of patients treated by
hemodialysis ETAPE Program led by French Ministry
of Health and Health Insurance (2018-21)
Experimentation of telemonitoring funding in hemodialysis patients outside the heavy dialysis center
A precise perimeter (autodialysis UDM homehemodialysis ()) strict eligibilityconditions Patients should be extracted from heavy dialysis center
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient Study followed by HealthInsurance information system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the healthprofessional responsible for the therapeutic accompaniment the provider of theremote monitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
30
31 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Remote monitoring of renal
replacement treatmentsPatients treated by kidney graft
ANJH Paris 20 mai 2019
32
The future in remote monitoring of patients treated by
kidney graft ETAPE Program led by French Ministry of
Health and Health Insurance (2018-21)
Experimentation remote monitoring funding of patients grafted for more than 6months
A precise perimeter strict eligibility conditions
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient followed by Health Insuranceinformation system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the health professionalresponsible for the therapeutic accompaniment the provider of the remotemonitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
33
34 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Three prospectives studies controlled and
randomized (results end 2019-2020)
Foucher Y Meurette A Daguin P Bonnaud-Antignac A Hardouin JB Chailan S Neau K Papuchon E Gaboriau S Legendre C Moreacutelon E Tessier P Giral M
A personalized follow-up of kidney transplant recipients using video conferencing basedon a 1-year scoring system predictive of long term graft failure (TELEGRAFT study) protocolfor a randomized controlled trial
BMC Nephrol 2015 Jan 28 16 6 doi 1011861471-2369-16-6
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R Laplaud D Noeumll C Kessler M
Cost-effectiveness of home telemonitoring in chronic kidney disease patients at differentstages by a pragmatic randomized controlled trial (eNephro) rationale and study design
BMC Nephrol 2017 Apr 518(1)126 doi 101186s12882-017-0529-2
Pape L de Zwaan M Tegtbur U Feldhaus F Wolff JK Schiffer L Lerch C Hellrung N KliemV Lonnemann G Nolting HD Schiffer M
The KTx360deg-study a multicenter multisectoral multimodal telemedicine-based follow-upcare model to improve care and reduce health-care costs after kidney transplantation inchildren and adults
BMC Health Serv Res 2017 Aug 23 17(1)587 doi 101186s12913-017-2545-0
ANJH Paris 20 mai 2019
35
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
New medical organizations DocHome
ANJH Paris 20 mai 2019
8
The Health-HUB system before 2007
ANJH Paris 20 mai 2019
9
Today smartphone for Quantified self
ANJH Paris 20 mai 2019
10
Data transmission
Data access
General
Practitioner
Hospital amp EPR
Hospital (Hospital Cliacutenic amp Hospital Mataroacute)Patientrsquos situation (at home)
Patient
Videoconference System amp
Patient Portal
Telemonitorin
g devices
Clinical Patient
Management
System
NurseHospital
video
interface
Interface amp
Gateway
Case Manager
Nurse
Hospital
Specialist
Call Centre amp Health coach
New medical organization cooperation
City-Hospital in Catalonia10
ANJH Paris 20 mai 2019
11
HomeCare in patients with chronic
diseases Overall Scheme
Sensors for multi-parametric monitoring
Hospital
Health call
Centre
Data communication and feedback
Data processing amp analysisData acquisition
200 400 600 800 1000 1200 1400 1600 1800 2000 2200
500
1000
1500
t [sec]
RR
[mse
c]
TiltSympthoms
200 400 600 800 1000 1200 1400 1600 1800 2000 220050
100
150
t [sec]
SBP
[mm
Hg]
200 400 600 800 1000 1200 1400 1600 1800 2000 22000
50
100
SCM
I [
]
t [sec]
200 400 600 800 1000 1200 1400 1600 1800 2000 2200
-05
0
05
Ris
k [-
-]
t [sec]
Positive VVS Risk
Medical
expertise
Intelligent
analysis
Support to diagnosis
decision amp treatment
11
ANJH Paris 20 mai 2019
12
ANJH Paris 20 mai 2019
13
J Med Syst 2017 Dec 2942(2)30 doi 101007s10916-017-0883-4 Review
14
Clinical data collection for an algorithmic medicine
Remote monitoring (RM) of renal replacement treatments14
ANJH Paris 20 mai 2019
ldquo
rdquo
Despite growing evidence for the use of RM in
the management of patients with ESRD
(including peritoneal dialysis and home
haemodialysis) this disease had the lowest
recognition of RM value in this current research
Katherine Rojahn1 Suzanne Laplante1 James Sloand1 Claire Main2 AftabIbrahim2 Janet Wild2 Nicky Sturt2 Thelga Areteou3 and K Ian Johnson3
Remote Monitoring of Chronic Diseases A Landscape Assessment of Policies in Four European Countries (United Kingdom Geremany Italy Spain)
PLoS One 2016 May 1911(5)e0155738 doi 101371journalpone0155738 eCollection 2016
ANJH Paris 20 mai 2019
15
ldquo
rdquo
The evidence regarding the quality of care
delivered by telemedicine and telenephrology
in particular compared with in-person care is
limited in USAhellip
Videoconferencing is widely used in Australia to manage kidney disease including chronic
kidney disease dialysis pediatric nephrology
and post-kidney transplantation carehellip
Rohatgi R Ross MJ Majoni SW Telenephrology current perspectives and
future directions Kidney Int 2017 Dec92(6)1328-1333 doi
101016jkint201706032 Epub 2017 Oct 12 Review
ANJH Paris 20 mai 2019
16
Remote monitoring of renal
replacement treatments in France and
in EuropePatients treated by Dialysis
ANJH Paris 20 mai 2019
17
Teledialysis in Tromsouml since 2001
TMS
Tromsoslash
Vefsn
Sandnessjoslashen
Rana
Harstad
Hammerfest
Narvik
Lofoten
Bodoslash
Kirkenes
Alta
bull Control
bull Remote visit guidance and teachingANJH Paris 20 mai 2019
18
Mapes DL Lopes AA
Satayathum S McCullough
KP Goodkin DA Locatelli F
Fukuhara S Young EW
Kurokawa K Saito A Bommer
J Wolfe RA Held PJ Port FK
Health-related quality of life
as a predictor of mortality and
hospitalization the Dialysis
Outcomes and Practice
Patterns Study (DOPPS)
Kidney Int 2003 Jul64(1)339-
49
ANJH Paris 20 mai 2019
19
Teledialysis in BrittanySt Brieuc-Lannion (since June of 2001)
ANJH Paris 20 mai 2019
20
Remote monitoring in teledialysis
Software that processes the parameters
of the session in real time
ANJH Paris 20 mai 2019
21
Software that processes the settings
for each session for a period of 6 mois
Predictive diagnosis of vascular access stenosis
ANJH Paris 20 mai 2019
22
Teleconsultation at the end of hemodialysis session
ANJH Paris 20 mai 2019
23
Validation of teledialysis process by
French Health Authority in january 2010
Janvier 2010
ANJH Paris 20 mai 2019
24
Introduction of teledialysis in a new decree
in February 2012
Home
dialysis
Satellite
dialysis
Satellite dialysis
with nurse
Heavy dialysis
center
Doctor time given by the end of session teleconsult
On-site nephrology
team
Cs month Cs et visitmonth Visitweek
Consent of the patient
Patient stabilized in dialysis treatment
Decree of
september 2002Telemedicine decreeof february 2012
ANJH Paris 20 mai 2019
25
Lighted dialysis
center (UDM)
Compliance of the dialysis population to quality indicators
Pre dialytic phosphate (mmoll)
Summary graph of the dialysis population
Patients below the normal range
Patients over the
normal range
ANJH Paris 20 mai 2019
26
Diatelic system in Peritoneal Dialysis
since 2001(1)
ANJH Paris 20 mai 2019
27
Diatelic system in Peritoneal Dialysis
since 2001(2)
Patient nurse family physician give dialysis data from home over
the internet
By secure messaging the patient expresses his ou her remarks with
the healthcare team by continuous exchange
=gt
ANJH Paris 20 mai 2019
28
ldquo
rdquo
In the nephrology setting home telemonitoring has
been evaluated in home dialysis patients but data
are scarce concerning chronic kidney disease (CKD)
patients before and after renal replacement
therapy The eNephro study is designed to assess thecost effectiveness clinicalbiological impact and
patient perception of a home telemonitoring for
CKD patients
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R
Laplaud D Noeumll C Kessler M Cost-effectiveness of home telemonitoring in chronic
kidney disease patients at different stages by a pragmatic randomized controlled
trial (eNephro) rationale and study design BMC Nephrol 2017 Apr 518(1)126
doi 101186s12882-017-0529-2
ANJH Paris 20 mai 2019
29
The future in remote monitoring of patients treated by
hemodialysis ETAPE Program led by French Ministry
of Health and Health Insurance (2018-21)
Experimentation of telemonitoring funding in hemodialysis patients outside the heavy dialysis center
A precise perimeter (autodialysis UDM homehemodialysis ()) strict eligibilityconditions Patients should be extracted from heavy dialysis center
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient Study followed by HealthInsurance information system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the healthprofessional responsible for the therapeutic accompaniment the provider of theremote monitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
30
31 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Remote monitoring of renal
replacement treatmentsPatients treated by kidney graft
ANJH Paris 20 mai 2019
32
The future in remote monitoring of patients treated by
kidney graft ETAPE Program led by French Ministry of
Health and Health Insurance (2018-21)
Experimentation remote monitoring funding of patients grafted for more than 6months
A precise perimeter strict eligibility conditions
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient followed by Health Insuranceinformation system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the health professionalresponsible for the therapeutic accompaniment the provider of the remotemonitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
33
34 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Three prospectives studies controlled and
randomized (results end 2019-2020)
Foucher Y Meurette A Daguin P Bonnaud-Antignac A Hardouin JB Chailan S Neau K Papuchon E Gaboriau S Legendre C Moreacutelon E Tessier P Giral M
A personalized follow-up of kidney transplant recipients using video conferencing basedon a 1-year scoring system predictive of long term graft failure (TELEGRAFT study) protocolfor a randomized controlled trial
BMC Nephrol 2015 Jan 28 16 6 doi 1011861471-2369-16-6
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R Laplaud D Noeumll C Kessler M
Cost-effectiveness of home telemonitoring in chronic kidney disease patients at differentstages by a pragmatic randomized controlled trial (eNephro) rationale and study design
BMC Nephrol 2017 Apr 518(1)126 doi 101186s12882-017-0529-2
Pape L de Zwaan M Tegtbur U Feldhaus F Wolff JK Schiffer L Lerch C Hellrung N KliemV Lonnemann G Nolting HD Schiffer M
The KTx360deg-study a multicenter multisectoral multimodal telemedicine-based follow-upcare model to improve care and reduce health-care costs after kidney transplantation inchildren and adults
BMC Health Serv Res 2017 Aug 23 17(1)587 doi 101186s12913-017-2545-0
ANJH Paris 20 mai 2019
35
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
The Health-HUB system before 2007
ANJH Paris 20 mai 2019
9
Today smartphone for Quantified self
ANJH Paris 20 mai 2019
10
Data transmission
Data access
General
Practitioner
Hospital amp EPR
Hospital (Hospital Cliacutenic amp Hospital Mataroacute)Patientrsquos situation (at home)
Patient
Videoconference System amp
Patient Portal
Telemonitorin
g devices
Clinical Patient
Management
System
NurseHospital
video
interface
Interface amp
Gateway
Case Manager
Nurse
Hospital
Specialist
Call Centre amp Health coach
New medical organization cooperation
City-Hospital in Catalonia10
ANJH Paris 20 mai 2019
11
HomeCare in patients with chronic
diseases Overall Scheme
Sensors for multi-parametric monitoring
Hospital
Health call
Centre
Data communication and feedback
Data processing amp analysisData acquisition
200 400 600 800 1000 1200 1400 1600 1800 2000 2200
500
1000
1500
t [sec]
RR
[mse
c]
TiltSympthoms
200 400 600 800 1000 1200 1400 1600 1800 2000 220050
100
150
t [sec]
SBP
[mm
Hg]
200 400 600 800 1000 1200 1400 1600 1800 2000 22000
50
100
SCM
I [
]
t [sec]
200 400 600 800 1000 1200 1400 1600 1800 2000 2200
-05
0
05
Ris
k [-
-]
t [sec]
Positive VVS Risk
Medical
expertise
Intelligent
analysis
Support to diagnosis
decision amp treatment
11
ANJH Paris 20 mai 2019
12
ANJH Paris 20 mai 2019
13
J Med Syst 2017 Dec 2942(2)30 doi 101007s10916-017-0883-4 Review
14
Clinical data collection for an algorithmic medicine
Remote monitoring (RM) of renal replacement treatments14
ANJH Paris 20 mai 2019
ldquo
rdquo
Despite growing evidence for the use of RM in
the management of patients with ESRD
(including peritoneal dialysis and home
haemodialysis) this disease had the lowest
recognition of RM value in this current research
Katherine Rojahn1 Suzanne Laplante1 James Sloand1 Claire Main2 AftabIbrahim2 Janet Wild2 Nicky Sturt2 Thelga Areteou3 and K Ian Johnson3
Remote Monitoring of Chronic Diseases A Landscape Assessment of Policies in Four European Countries (United Kingdom Geremany Italy Spain)
PLoS One 2016 May 1911(5)e0155738 doi 101371journalpone0155738 eCollection 2016
ANJH Paris 20 mai 2019
15
ldquo
rdquo
The evidence regarding the quality of care
delivered by telemedicine and telenephrology
in particular compared with in-person care is
limited in USAhellip
Videoconferencing is widely used in Australia to manage kidney disease including chronic
kidney disease dialysis pediatric nephrology
and post-kidney transplantation carehellip
Rohatgi R Ross MJ Majoni SW Telenephrology current perspectives and
future directions Kidney Int 2017 Dec92(6)1328-1333 doi
101016jkint201706032 Epub 2017 Oct 12 Review
ANJH Paris 20 mai 2019
16
Remote monitoring of renal
replacement treatments in France and
in EuropePatients treated by Dialysis
ANJH Paris 20 mai 2019
17
Teledialysis in Tromsouml since 2001
TMS
Tromsoslash
Vefsn
Sandnessjoslashen
Rana
Harstad
Hammerfest
Narvik
Lofoten
Bodoslash
Kirkenes
Alta
bull Control
bull Remote visit guidance and teachingANJH Paris 20 mai 2019
18
Mapes DL Lopes AA
Satayathum S McCullough
KP Goodkin DA Locatelli F
Fukuhara S Young EW
Kurokawa K Saito A Bommer
J Wolfe RA Held PJ Port FK
Health-related quality of life
as a predictor of mortality and
hospitalization the Dialysis
Outcomes and Practice
Patterns Study (DOPPS)
Kidney Int 2003 Jul64(1)339-
49
ANJH Paris 20 mai 2019
19
Teledialysis in BrittanySt Brieuc-Lannion (since June of 2001)
ANJH Paris 20 mai 2019
20
Remote monitoring in teledialysis
Software that processes the parameters
of the session in real time
ANJH Paris 20 mai 2019
21
Software that processes the settings
for each session for a period of 6 mois
Predictive diagnosis of vascular access stenosis
ANJH Paris 20 mai 2019
22
Teleconsultation at the end of hemodialysis session
ANJH Paris 20 mai 2019
23
Validation of teledialysis process by
French Health Authority in january 2010
Janvier 2010
ANJH Paris 20 mai 2019
24
Introduction of teledialysis in a new decree
in February 2012
Home
dialysis
Satellite
dialysis
Satellite dialysis
with nurse
Heavy dialysis
center
Doctor time given by the end of session teleconsult
On-site nephrology
team
Cs month Cs et visitmonth Visitweek
Consent of the patient
Patient stabilized in dialysis treatment
Decree of
september 2002Telemedicine decreeof february 2012
ANJH Paris 20 mai 2019
25
Lighted dialysis
center (UDM)
Compliance of the dialysis population to quality indicators
Pre dialytic phosphate (mmoll)
Summary graph of the dialysis population
Patients below the normal range
Patients over the
normal range
ANJH Paris 20 mai 2019
26
Diatelic system in Peritoneal Dialysis
since 2001(1)
ANJH Paris 20 mai 2019
27
Diatelic system in Peritoneal Dialysis
since 2001(2)
Patient nurse family physician give dialysis data from home over
the internet
By secure messaging the patient expresses his ou her remarks with
the healthcare team by continuous exchange
=gt
ANJH Paris 20 mai 2019
28
ldquo
rdquo
In the nephrology setting home telemonitoring has
been evaluated in home dialysis patients but data
are scarce concerning chronic kidney disease (CKD)
patients before and after renal replacement
therapy The eNephro study is designed to assess thecost effectiveness clinicalbiological impact and
patient perception of a home telemonitoring for
CKD patients
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R
Laplaud D Noeumll C Kessler M Cost-effectiveness of home telemonitoring in chronic
kidney disease patients at different stages by a pragmatic randomized controlled
trial (eNephro) rationale and study design BMC Nephrol 2017 Apr 518(1)126
doi 101186s12882-017-0529-2
ANJH Paris 20 mai 2019
29
The future in remote monitoring of patients treated by
hemodialysis ETAPE Program led by French Ministry
of Health and Health Insurance (2018-21)
Experimentation of telemonitoring funding in hemodialysis patients outside the heavy dialysis center
A precise perimeter (autodialysis UDM homehemodialysis ()) strict eligibilityconditions Patients should be extracted from heavy dialysis center
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient Study followed by HealthInsurance information system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the healthprofessional responsible for the therapeutic accompaniment the provider of theremote monitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
30
31 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Remote monitoring of renal
replacement treatmentsPatients treated by kidney graft
ANJH Paris 20 mai 2019
32
The future in remote monitoring of patients treated by
kidney graft ETAPE Program led by French Ministry of
Health and Health Insurance (2018-21)
Experimentation remote monitoring funding of patients grafted for more than 6months
A precise perimeter strict eligibility conditions
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient followed by Health Insuranceinformation system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the health professionalresponsible for the therapeutic accompaniment the provider of the remotemonitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
33
34 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Three prospectives studies controlled and
randomized (results end 2019-2020)
Foucher Y Meurette A Daguin P Bonnaud-Antignac A Hardouin JB Chailan S Neau K Papuchon E Gaboriau S Legendre C Moreacutelon E Tessier P Giral M
A personalized follow-up of kidney transplant recipients using video conferencing basedon a 1-year scoring system predictive of long term graft failure (TELEGRAFT study) protocolfor a randomized controlled trial
BMC Nephrol 2015 Jan 28 16 6 doi 1011861471-2369-16-6
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R Laplaud D Noeumll C Kessler M
Cost-effectiveness of home telemonitoring in chronic kidney disease patients at differentstages by a pragmatic randomized controlled trial (eNephro) rationale and study design
BMC Nephrol 2017 Apr 518(1)126 doi 101186s12882-017-0529-2
Pape L de Zwaan M Tegtbur U Feldhaus F Wolff JK Schiffer L Lerch C Hellrung N KliemV Lonnemann G Nolting HD Schiffer M
The KTx360deg-study a multicenter multisectoral multimodal telemedicine-based follow-upcare model to improve care and reduce health-care costs after kidney transplantation inchildren and adults
BMC Health Serv Res 2017 Aug 23 17(1)587 doi 101186s12913-017-2545-0
ANJH Paris 20 mai 2019
35
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
Today smartphone for Quantified self
ANJH Paris 20 mai 2019
10
Data transmission
Data access
General
Practitioner
Hospital amp EPR
Hospital (Hospital Cliacutenic amp Hospital Mataroacute)Patientrsquos situation (at home)
Patient
Videoconference System amp
Patient Portal
Telemonitorin
g devices
Clinical Patient
Management
System
NurseHospital
video
interface
Interface amp
Gateway
Case Manager
Nurse
Hospital
Specialist
Call Centre amp Health coach
New medical organization cooperation
City-Hospital in Catalonia10
ANJH Paris 20 mai 2019
11
HomeCare in patients with chronic
diseases Overall Scheme
Sensors for multi-parametric monitoring
Hospital
Health call
Centre
Data communication and feedback
Data processing amp analysisData acquisition
200 400 600 800 1000 1200 1400 1600 1800 2000 2200
500
1000
1500
t [sec]
RR
[mse
c]
TiltSympthoms
200 400 600 800 1000 1200 1400 1600 1800 2000 220050
100
150
t [sec]
SBP
[mm
Hg]
200 400 600 800 1000 1200 1400 1600 1800 2000 22000
50
100
SCM
I [
]
t [sec]
200 400 600 800 1000 1200 1400 1600 1800 2000 2200
-05
0
05
Ris
k [-
-]
t [sec]
Positive VVS Risk
Medical
expertise
Intelligent
analysis
Support to diagnosis
decision amp treatment
11
ANJH Paris 20 mai 2019
12
ANJH Paris 20 mai 2019
13
J Med Syst 2017 Dec 2942(2)30 doi 101007s10916-017-0883-4 Review
14
Clinical data collection for an algorithmic medicine
Remote monitoring (RM) of renal replacement treatments14
ANJH Paris 20 mai 2019
ldquo
rdquo
Despite growing evidence for the use of RM in
the management of patients with ESRD
(including peritoneal dialysis and home
haemodialysis) this disease had the lowest
recognition of RM value in this current research
Katherine Rojahn1 Suzanne Laplante1 James Sloand1 Claire Main2 AftabIbrahim2 Janet Wild2 Nicky Sturt2 Thelga Areteou3 and K Ian Johnson3
Remote Monitoring of Chronic Diseases A Landscape Assessment of Policies in Four European Countries (United Kingdom Geremany Italy Spain)
PLoS One 2016 May 1911(5)e0155738 doi 101371journalpone0155738 eCollection 2016
ANJH Paris 20 mai 2019
15
ldquo
rdquo
The evidence regarding the quality of care
delivered by telemedicine and telenephrology
in particular compared with in-person care is
limited in USAhellip
Videoconferencing is widely used in Australia to manage kidney disease including chronic
kidney disease dialysis pediatric nephrology
and post-kidney transplantation carehellip
Rohatgi R Ross MJ Majoni SW Telenephrology current perspectives and
future directions Kidney Int 2017 Dec92(6)1328-1333 doi
101016jkint201706032 Epub 2017 Oct 12 Review
ANJH Paris 20 mai 2019
16
Remote monitoring of renal
replacement treatments in France and
in EuropePatients treated by Dialysis
ANJH Paris 20 mai 2019
17
Teledialysis in Tromsouml since 2001
TMS
Tromsoslash
Vefsn
Sandnessjoslashen
Rana
Harstad
Hammerfest
Narvik
Lofoten
Bodoslash
Kirkenes
Alta
bull Control
bull Remote visit guidance and teachingANJH Paris 20 mai 2019
18
Mapes DL Lopes AA
Satayathum S McCullough
KP Goodkin DA Locatelli F
Fukuhara S Young EW
Kurokawa K Saito A Bommer
J Wolfe RA Held PJ Port FK
Health-related quality of life
as a predictor of mortality and
hospitalization the Dialysis
Outcomes and Practice
Patterns Study (DOPPS)
Kidney Int 2003 Jul64(1)339-
49
ANJH Paris 20 mai 2019
19
Teledialysis in BrittanySt Brieuc-Lannion (since June of 2001)
ANJH Paris 20 mai 2019
20
Remote monitoring in teledialysis
Software that processes the parameters
of the session in real time
ANJH Paris 20 mai 2019
21
Software that processes the settings
for each session for a period of 6 mois
Predictive diagnosis of vascular access stenosis
ANJH Paris 20 mai 2019
22
Teleconsultation at the end of hemodialysis session
ANJH Paris 20 mai 2019
23
Validation of teledialysis process by
French Health Authority in january 2010
Janvier 2010
ANJH Paris 20 mai 2019
24
Introduction of teledialysis in a new decree
in February 2012
Home
dialysis
Satellite
dialysis
Satellite dialysis
with nurse
Heavy dialysis
center
Doctor time given by the end of session teleconsult
On-site nephrology
team
Cs month Cs et visitmonth Visitweek
Consent of the patient
Patient stabilized in dialysis treatment
Decree of
september 2002Telemedicine decreeof february 2012
ANJH Paris 20 mai 2019
25
Lighted dialysis
center (UDM)
Compliance of the dialysis population to quality indicators
Pre dialytic phosphate (mmoll)
Summary graph of the dialysis population
Patients below the normal range
Patients over the
normal range
ANJH Paris 20 mai 2019
26
Diatelic system in Peritoneal Dialysis
since 2001(1)
ANJH Paris 20 mai 2019
27
Diatelic system in Peritoneal Dialysis
since 2001(2)
Patient nurse family physician give dialysis data from home over
the internet
By secure messaging the patient expresses his ou her remarks with
the healthcare team by continuous exchange
=gt
ANJH Paris 20 mai 2019
28
ldquo
rdquo
In the nephrology setting home telemonitoring has
been evaluated in home dialysis patients but data
are scarce concerning chronic kidney disease (CKD)
patients before and after renal replacement
therapy The eNephro study is designed to assess thecost effectiveness clinicalbiological impact and
patient perception of a home telemonitoring for
CKD patients
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R
Laplaud D Noeumll C Kessler M Cost-effectiveness of home telemonitoring in chronic
kidney disease patients at different stages by a pragmatic randomized controlled
trial (eNephro) rationale and study design BMC Nephrol 2017 Apr 518(1)126
doi 101186s12882-017-0529-2
ANJH Paris 20 mai 2019
29
The future in remote monitoring of patients treated by
hemodialysis ETAPE Program led by French Ministry
of Health and Health Insurance (2018-21)
Experimentation of telemonitoring funding in hemodialysis patients outside the heavy dialysis center
A precise perimeter (autodialysis UDM homehemodialysis ()) strict eligibilityconditions Patients should be extracted from heavy dialysis center
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient Study followed by HealthInsurance information system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the healthprofessional responsible for the therapeutic accompaniment the provider of theremote monitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
30
31 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Remote monitoring of renal
replacement treatmentsPatients treated by kidney graft
ANJH Paris 20 mai 2019
32
The future in remote monitoring of patients treated by
kidney graft ETAPE Program led by French Ministry of
Health and Health Insurance (2018-21)
Experimentation remote monitoring funding of patients grafted for more than 6months
A precise perimeter strict eligibility conditions
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient followed by Health Insuranceinformation system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the health professionalresponsible for the therapeutic accompaniment the provider of the remotemonitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
33
34 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Three prospectives studies controlled and
randomized (results end 2019-2020)
Foucher Y Meurette A Daguin P Bonnaud-Antignac A Hardouin JB Chailan S Neau K Papuchon E Gaboriau S Legendre C Moreacutelon E Tessier P Giral M
A personalized follow-up of kidney transplant recipients using video conferencing basedon a 1-year scoring system predictive of long term graft failure (TELEGRAFT study) protocolfor a randomized controlled trial
BMC Nephrol 2015 Jan 28 16 6 doi 1011861471-2369-16-6
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R Laplaud D Noeumll C Kessler M
Cost-effectiveness of home telemonitoring in chronic kidney disease patients at differentstages by a pragmatic randomized controlled trial (eNephro) rationale and study design
BMC Nephrol 2017 Apr 518(1)126 doi 101186s12882-017-0529-2
Pape L de Zwaan M Tegtbur U Feldhaus F Wolff JK Schiffer L Lerch C Hellrung N KliemV Lonnemann G Nolting HD Schiffer M
The KTx360deg-study a multicenter multisectoral multimodal telemedicine-based follow-upcare model to improve care and reduce health-care costs after kidney transplantation inchildren and adults
BMC Health Serv Res 2017 Aug 23 17(1)587 doi 101186s12913-017-2545-0
ANJH Paris 20 mai 2019
35
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
Data transmission
Data access
General
Practitioner
Hospital amp EPR
Hospital (Hospital Cliacutenic amp Hospital Mataroacute)Patientrsquos situation (at home)
Patient
Videoconference System amp
Patient Portal
Telemonitorin
g devices
Clinical Patient
Management
System
NurseHospital
video
interface
Interface amp
Gateway
Case Manager
Nurse
Hospital
Specialist
Call Centre amp Health coach
New medical organization cooperation
City-Hospital in Catalonia10
ANJH Paris 20 mai 2019
11
HomeCare in patients with chronic
diseases Overall Scheme
Sensors for multi-parametric monitoring
Hospital
Health call
Centre
Data communication and feedback
Data processing amp analysisData acquisition
200 400 600 800 1000 1200 1400 1600 1800 2000 2200
500
1000
1500
t [sec]
RR
[mse
c]
TiltSympthoms
200 400 600 800 1000 1200 1400 1600 1800 2000 220050
100
150
t [sec]
SBP
[mm
Hg]
200 400 600 800 1000 1200 1400 1600 1800 2000 22000
50
100
SCM
I [
]
t [sec]
200 400 600 800 1000 1200 1400 1600 1800 2000 2200
-05
0
05
Ris
k [-
-]
t [sec]
Positive VVS Risk
Medical
expertise
Intelligent
analysis
Support to diagnosis
decision amp treatment
11
ANJH Paris 20 mai 2019
12
ANJH Paris 20 mai 2019
13
J Med Syst 2017 Dec 2942(2)30 doi 101007s10916-017-0883-4 Review
14
Clinical data collection for an algorithmic medicine
Remote monitoring (RM) of renal replacement treatments14
ANJH Paris 20 mai 2019
ldquo
rdquo
Despite growing evidence for the use of RM in
the management of patients with ESRD
(including peritoneal dialysis and home
haemodialysis) this disease had the lowest
recognition of RM value in this current research
Katherine Rojahn1 Suzanne Laplante1 James Sloand1 Claire Main2 AftabIbrahim2 Janet Wild2 Nicky Sturt2 Thelga Areteou3 and K Ian Johnson3
Remote Monitoring of Chronic Diseases A Landscape Assessment of Policies in Four European Countries (United Kingdom Geremany Italy Spain)
PLoS One 2016 May 1911(5)e0155738 doi 101371journalpone0155738 eCollection 2016
ANJH Paris 20 mai 2019
15
ldquo
rdquo
The evidence regarding the quality of care
delivered by telemedicine and telenephrology
in particular compared with in-person care is
limited in USAhellip
Videoconferencing is widely used in Australia to manage kidney disease including chronic
kidney disease dialysis pediatric nephrology
and post-kidney transplantation carehellip
Rohatgi R Ross MJ Majoni SW Telenephrology current perspectives and
future directions Kidney Int 2017 Dec92(6)1328-1333 doi
101016jkint201706032 Epub 2017 Oct 12 Review
ANJH Paris 20 mai 2019
16
Remote monitoring of renal
replacement treatments in France and
in EuropePatients treated by Dialysis
ANJH Paris 20 mai 2019
17
Teledialysis in Tromsouml since 2001
TMS
Tromsoslash
Vefsn
Sandnessjoslashen
Rana
Harstad
Hammerfest
Narvik
Lofoten
Bodoslash
Kirkenes
Alta
bull Control
bull Remote visit guidance and teachingANJH Paris 20 mai 2019
18
Mapes DL Lopes AA
Satayathum S McCullough
KP Goodkin DA Locatelli F
Fukuhara S Young EW
Kurokawa K Saito A Bommer
J Wolfe RA Held PJ Port FK
Health-related quality of life
as a predictor of mortality and
hospitalization the Dialysis
Outcomes and Practice
Patterns Study (DOPPS)
Kidney Int 2003 Jul64(1)339-
49
ANJH Paris 20 mai 2019
19
Teledialysis in BrittanySt Brieuc-Lannion (since June of 2001)
ANJH Paris 20 mai 2019
20
Remote monitoring in teledialysis
Software that processes the parameters
of the session in real time
ANJH Paris 20 mai 2019
21
Software that processes the settings
for each session for a period of 6 mois
Predictive diagnosis of vascular access stenosis
ANJH Paris 20 mai 2019
22
Teleconsultation at the end of hemodialysis session
ANJH Paris 20 mai 2019
23
Validation of teledialysis process by
French Health Authority in january 2010
Janvier 2010
ANJH Paris 20 mai 2019
24
Introduction of teledialysis in a new decree
in February 2012
Home
dialysis
Satellite
dialysis
Satellite dialysis
with nurse
Heavy dialysis
center
Doctor time given by the end of session teleconsult
On-site nephrology
team
Cs month Cs et visitmonth Visitweek
Consent of the patient
Patient stabilized in dialysis treatment
Decree of
september 2002Telemedicine decreeof february 2012
ANJH Paris 20 mai 2019
25
Lighted dialysis
center (UDM)
Compliance of the dialysis population to quality indicators
Pre dialytic phosphate (mmoll)
Summary graph of the dialysis population
Patients below the normal range
Patients over the
normal range
ANJH Paris 20 mai 2019
26
Diatelic system in Peritoneal Dialysis
since 2001(1)
ANJH Paris 20 mai 2019
27
Diatelic system in Peritoneal Dialysis
since 2001(2)
Patient nurse family physician give dialysis data from home over
the internet
By secure messaging the patient expresses his ou her remarks with
the healthcare team by continuous exchange
=gt
ANJH Paris 20 mai 2019
28
ldquo
rdquo
In the nephrology setting home telemonitoring has
been evaluated in home dialysis patients but data
are scarce concerning chronic kidney disease (CKD)
patients before and after renal replacement
therapy The eNephro study is designed to assess thecost effectiveness clinicalbiological impact and
patient perception of a home telemonitoring for
CKD patients
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R
Laplaud D Noeumll C Kessler M Cost-effectiveness of home telemonitoring in chronic
kidney disease patients at different stages by a pragmatic randomized controlled
trial (eNephro) rationale and study design BMC Nephrol 2017 Apr 518(1)126
doi 101186s12882-017-0529-2
ANJH Paris 20 mai 2019
29
The future in remote monitoring of patients treated by
hemodialysis ETAPE Program led by French Ministry
of Health and Health Insurance (2018-21)
Experimentation of telemonitoring funding in hemodialysis patients outside the heavy dialysis center
A precise perimeter (autodialysis UDM homehemodialysis ()) strict eligibilityconditions Patients should be extracted from heavy dialysis center
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient Study followed by HealthInsurance information system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the healthprofessional responsible for the therapeutic accompaniment the provider of theremote monitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
30
31 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Remote monitoring of renal
replacement treatmentsPatients treated by kidney graft
ANJH Paris 20 mai 2019
32
The future in remote monitoring of patients treated by
kidney graft ETAPE Program led by French Ministry of
Health and Health Insurance (2018-21)
Experimentation remote monitoring funding of patients grafted for more than 6months
A precise perimeter strict eligibility conditions
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient followed by Health Insuranceinformation system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the health professionalresponsible for the therapeutic accompaniment the provider of the remotemonitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
33
34 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Three prospectives studies controlled and
randomized (results end 2019-2020)
Foucher Y Meurette A Daguin P Bonnaud-Antignac A Hardouin JB Chailan S Neau K Papuchon E Gaboriau S Legendre C Moreacutelon E Tessier P Giral M
A personalized follow-up of kidney transplant recipients using video conferencing basedon a 1-year scoring system predictive of long term graft failure (TELEGRAFT study) protocolfor a randomized controlled trial
BMC Nephrol 2015 Jan 28 16 6 doi 1011861471-2369-16-6
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R Laplaud D Noeumll C Kessler M
Cost-effectiveness of home telemonitoring in chronic kidney disease patients at differentstages by a pragmatic randomized controlled trial (eNephro) rationale and study design
BMC Nephrol 2017 Apr 518(1)126 doi 101186s12882-017-0529-2
Pape L de Zwaan M Tegtbur U Feldhaus F Wolff JK Schiffer L Lerch C Hellrung N KliemV Lonnemann G Nolting HD Schiffer M
The KTx360deg-study a multicenter multisectoral multimodal telemedicine-based follow-upcare model to improve care and reduce health-care costs after kidney transplantation inchildren and adults
BMC Health Serv Res 2017 Aug 23 17(1)587 doi 101186s12913-017-2545-0
ANJH Paris 20 mai 2019
35
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
HomeCare in patients with chronic
diseases Overall Scheme
Sensors for multi-parametric monitoring
Hospital
Health call
Centre
Data communication and feedback
Data processing amp analysisData acquisition
200 400 600 800 1000 1200 1400 1600 1800 2000 2200
500
1000
1500
t [sec]
RR
[mse
c]
TiltSympthoms
200 400 600 800 1000 1200 1400 1600 1800 2000 220050
100
150
t [sec]
SBP
[mm
Hg]
200 400 600 800 1000 1200 1400 1600 1800 2000 22000
50
100
SCM
I [
]
t [sec]
200 400 600 800 1000 1200 1400 1600 1800 2000 2200
-05
0
05
Ris
k [-
-]
t [sec]
Positive VVS Risk
Medical
expertise
Intelligent
analysis
Support to diagnosis
decision amp treatment
11
ANJH Paris 20 mai 2019
12
ANJH Paris 20 mai 2019
13
J Med Syst 2017 Dec 2942(2)30 doi 101007s10916-017-0883-4 Review
14
Clinical data collection for an algorithmic medicine
Remote monitoring (RM) of renal replacement treatments14
ANJH Paris 20 mai 2019
ldquo
rdquo
Despite growing evidence for the use of RM in
the management of patients with ESRD
(including peritoneal dialysis and home
haemodialysis) this disease had the lowest
recognition of RM value in this current research
Katherine Rojahn1 Suzanne Laplante1 James Sloand1 Claire Main2 AftabIbrahim2 Janet Wild2 Nicky Sturt2 Thelga Areteou3 and K Ian Johnson3
Remote Monitoring of Chronic Diseases A Landscape Assessment of Policies in Four European Countries (United Kingdom Geremany Italy Spain)
PLoS One 2016 May 1911(5)e0155738 doi 101371journalpone0155738 eCollection 2016
ANJH Paris 20 mai 2019
15
ldquo
rdquo
The evidence regarding the quality of care
delivered by telemedicine and telenephrology
in particular compared with in-person care is
limited in USAhellip
Videoconferencing is widely used in Australia to manage kidney disease including chronic
kidney disease dialysis pediatric nephrology
and post-kidney transplantation carehellip
Rohatgi R Ross MJ Majoni SW Telenephrology current perspectives and
future directions Kidney Int 2017 Dec92(6)1328-1333 doi
101016jkint201706032 Epub 2017 Oct 12 Review
ANJH Paris 20 mai 2019
16
Remote monitoring of renal
replacement treatments in France and
in EuropePatients treated by Dialysis
ANJH Paris 20 mai 2019
17
Teledialysis in Tromsouml since 2001
TMS
Tromsoslash
Vefsn
Sandnessjoslashen
Rana
Harstad
Hammerfest
Narvik
Lofoten
Bodoslash
Kirkenes
Alta
bull Control
bull Remote visit guidance and teachingANJH Paris 20 mai 2019
18
Mapes DL Lopes AA
Satayathum S McCullough
KP Goodkin DA Locatelli F
Fukuhara S Young EW
Kurokawa K Saito A Bommer
J Wolfe RA Held PJ Port FK
Health-related quality of life
as a predictor of mortality and
hospitalization the Dialysis
Outcomes and Practice
Patterns Study (DOPPS)
Kidney Int 2003 Jul64(1)339-
49
ANJH Paris 20 mai 2019
19
Teledialysis in BrittanySt Brieuc-Lannion (since June of 2001)
ANJH Paris 20 mai 2019
20
Remote monitoring in teledialysis
Software that processes the parameters
of the session in real time
ANJH Paris 20 mai 2019
21
Software that processes the settings
for each session for a period of 6 mois
Predictive diagnosis of vascular access stenosis
ANJH Paris 20 mai 2019
22
Teleconsultation at the end of hemodialysis session
ANJH Paris 20 mai 2019
23
Validation of teledialysis process by
French Health Authority in january 2010
Janvier 2010
ANJH Paris 20 mai 2019
24
Introduction of teledialysis in a new decree
in February 2012
Home
dialysis
Satellite
dialysis
Satellite dialysis
with nurse
Heavy dialysis
center
Doctor time given by the end of session teleconsult
On-site nephrology
team
Cs month Cs et visitmonth Visitweek
Consent of the patient
Patient stabilized in dialysis treatment
Decree of
september 2002Telemedicine decreeof february 2012
ANJH Paris 20 mai 2019
25
Lighted dialysis
center (UDM)
Compliance of the dialysis population to quality indicators
Pre dialytic phosphate (mmoll)
Summary graph of the dialysis population
Patients below the normal range
Patients over the
normal range
ANJH Paris 20 mai 2019
26
Diatelic system in Peritoneal Dialysis
since 2001(1)
ANJH Paris 20 mai 2019
27
Diatelic system in Peritoneal Dialysis
since 2001(2)
Patient nurse family physician give dialysis data from home over
the internet
By secure messaging the patient expresses his ou her remarks with
the healthcare team by continuous exchange
=gt
ANJH Paris 20 mai 2019
28
ldquo
rdquo
In the nephrology setting home telemonitoring has
been evaluated in home dialysis patients but data
are scarce concerning chronic kidney disease (CKD)
patients before and after renal replacement
therapy The eNephro study is designed to assess thecost effectiveness clinicalbiological impact and
patient perception of a home telemonitoring for
CKD patients
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R
Laplaud D Noeumll C Kessler M Cost-effectiveness of home telemonitoring in chronic
kidney disease patients at different stages by a pragmatic randomized controlled
trial (eNephro) rationale and study design BMC Nephrol 2017 Apr 518(1)126
doi 101186s12882-017-0529-2
ANJH Paris 20 mai 2019
29
The future in remote monitoring of patients treated by
hemodialysis ETAPE Program led by French Ministry
of Health and Health Insurance (2018-21)
Experimentation of telemonitoring funding in hemodialysis patients outside the heavy dialysis center
A precise perimeter (autodialysis UDM homehemodialysis ()) strict eligibilityconditions Patients should be extracted from heavy dialysis center
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient Study followed by HealthInsurance information system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the healthprofessional responsible for the therapeutic accompaniment the provider of theremote monitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
30
31 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Remote monitoring of renal
replacement treatmentsPatients treated by kidney graft
ANJH Paris 20 mai 2019
32
The future in remote monitoring of patients treated by
kidney graft ETAPE Program led by French Ministry of
Health and Health Insurance (2018-21)
Experimentation remote monitoring funding of patients grafted for more than 6months
A precise perimeter strict eligibility conditions
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient followed by Health Insuranceinformation system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the health professionalresponsible for the therapeutic accompaniment the provider of the remotemonitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
33
34 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Three prospectives studies controlled and
randomized (results end 2019-2020)
Foucher Y Meurette A Daguin P Bonnaud-Antignac A Hardouin JB Chailan S Neau K Papuchon E Gaboriau S Legendre C Moreacutelon E Tessier P Giral M
A personalized follow-up of kidney transplant recipients using video conferencing basedon a 1-year scoring system predictive of long term graft failure (TELEGRAFT study) protocolfor a randomized controlled trial
BMC Nephrol 2015 Jan 28 16 6 doi 1011861471-2369-16-6
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R Laplaud D Noeumll C Kessler M
Cost-effectiveness of home telemonitoring in chronic kidney disease patients at differentstages by a pragmatic randomized controlled trial (eNephro) rationale and study design
BMC Nephrol 2017 Apr 518(1)126 doi 101186s12882-017-0529-2
Pape L de Zwaan M Tegtbur U Feldhaus F Wolff JK Schiffer L Lerch C Hellrung N KliemV Lonnemann G Nolting HD Schiffer M
The KTx360deg-study a multicenter multisectoral multimodal telemedicine-based follow-upcare model to improve care and reduce health-care costs after kidney transplantation inchildren and adults
BMC Health Serv Res 2017 Aug 23 17(1)587 doi 101186s12913-017-2545-0
ANJH Paris 20 mai 2019
35
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
ANJH Paris 20 mai 2019
13
J Med Syst 2017 Dec 2942(2)30 doi 101007s10916-017-0883-4 Review
14
Clinical data collection for an algorithmic medicine
Remote monitoring (RM) of renal replacement treatments14
ANJH Paris 20 mai 2019
ldquo
rdquo
Despite growing evidence for the use of RM in
the management of patients with ESRD
(including peritoneal dialysis and home
haemodialysis) this disease had the lowest
recognition of RM value in this current research
Katherine Rojahn1 Suzanne Laplante1 James Sloand1 Claire Main2 AftabIbrahim2 Janet Wild2 Nicky Sturt2 Thelga Areteou3 and K Ian Johnson3
Remote Monitoring of Chronic Diseases A Landscape Assessment of Policies in Four European Countries (United Kingdom Geremany Italy Spain)
PLoS One 2016 May 1911(5)e0155738 doi 101371journalpone0155738 eCollection 2016
ANJH Paris 20 mai 2019
15
ldquo
rdquo
The evidence regarding the quality of care
delivered by telemedicine and telenephrology
in particular compared with in-person care is
limited in USAhellip
Videoconferencing is widely used in Australia to manage kidney disease including chronic
kidney disease dialysis pediatric nephrology
and post-kidney transplantation carehellip
Rohatgi R Ross MJ Majoni SW Telenephrology current perspectives and
future directions Kidney Int 2017 Dec92(6)1328-1333 doi
101016jkint201706032 Epub 2017 Oct 12 Review
ANJH Paris 20 mai 2019
16
Remote monitoring of renal
replacement treatments in France and
in EuropePatients treated by Dialysis
ANJH Paris 20 mai 2019
17
Teledialysis in Tromsouml since 2001
TMS
Tromsoslash
Vefsn
Sandnessjoslashen
Rana
Harstad
Hammerfest
Narvik
Lofoten
Bodoslash
Kirkenes
Alta
bull Control
bull Remote visit guidance and teachingANJH Paris 20 mai 2019
18
Mapes DL Lopes AA
Satayathum S McCullough
KP Goodkin DA Locatelli F
Fukuhara S Young EW
Kurokawa K Saito A Bommer
J Wolfe RA Held PJ Port FK
Health-related quality of life
as a predictor of mortality and
hospitalization the Dialysis
Outcomes and Practice
Patterns Study (DOPPS)
Kidney Int 2003 Jul64(1)339-
49
ANJH Paris 20 mai 2019
19
Teledialysis in BrittanySt Brieuc-Lannion (since June of 2001)
ANJH Paris 20 mai 2019
20
Remote monitoring in teledialysis
Software that processes the parameters
of the session in real time
ANJH Paris 20 mai 2019
21
Software that processes the settings
for each session for a period of 6 mois
Predictive diagnosis of vascular access stenosis
ANJH Paris 20 mai 2019
22
Teleconsultation at the end of hemodialysis session
ANJH Paris 20 mai 2019
23
Validation of teledialysis process by
French Health Authority in january 2010
Janvier 2010
ANJH Paris 20 mai 2019
24
Introduction of teledialysis in a new decree
in February 2012
Home
dialysis
Satellite
dialysis
Satellite dialysis
with nurse
Heavy dialysis
center
Doctor time given by the end of session teleconsult
On-site nephrology
team
Cs month Cs et visitmonth Visitweek
Consent of the patient
Patient stabilized in dialysis treatment
Decree of
september 2002Telemedicine decreeof february 2012
ANJH Paris 20 mai 2019
25
Lighted dialysis
center (UDM)
Compliance of the dialysis population to quality indicators
Pre dialytic phosphate (mmoll)
Summary graph of the dialysis population
Patients below the normal range
Patients over the
normal range
ANJH Paris 20 mai 2019
26
Diatelic system in Peritoneal Dialysis
since 2001(1)
ANJH Paris 20 mai 2019
27
Diatelic system in Peritoneal Dialysis
since 2001(2)
Patient nurse family physician give dialysis data from home over
the internet
By secure messaging the patient expresses his ou her remarks with
the healthcare team by continuous exchange
=gt
ANJH Paris 20 mai 2019
28
ldquo
rdquo
In the nephrology setting home telemonitoring has
been evaluated in home dialysis patients but data
are scarce concerning chronic kidney disease (CKD)
patients before and after renal replacement
therapy The eNephro study is designed to assess thecost effectiveness clinicalbiological impact and
patient perception of a home telemonitoring for
CKD patients
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R
Laplaud D Noeumll C Kessler M Cost-effectiveness of home telemonitoring in chronic
kidney disease patients at different stages by a pragmatic randomized controlled
trial (eNephro) rationale and study design BMC Nephrol 2017 Apr 518(1)126
doi 101186s12882-017-0529-2
ANJH Paris 20 mai 2019
29
The future in remote monitoring of patients treated by
hemodialysis ETAPE Program led by French Ministry
of Health and Health Insurance (2018-21)
Experimentation of telemonitoring funding in hemodialysis patients outside the heavy dialysis center
A precise perimeter (autodialysis UDM homehemodialysis ()) strict eligibilityconditions Patients should be extracted from heavy dialysis center
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient Study followed by HealthInsurance information system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the healthprofessional responsible for the therapeutic accompaniment the provider of theremote monitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
30
31 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Remote monitoring of renal
replacement treatmentsPatients treated by kidney graft
ANJH Paris 20 mai 2019
32
The future in remote monitoring of patients treated by
kidney graft ETAPE Program led by French Ministry of
Health and Health Insurance (2018-21)
Experimentation remote monitoring funding of patients grafted for more than 6months
A precise perimeter strict eligibility conditions
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient followed by Health Insuranceinformation system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the health professionalresponsible for the therapeutic accompaniment the provider of the remotemonitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
33
34 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Three prospectives studies controlled and
randomized (results end 2019-2020)
Foucher Y Meurette A Daguin P Bonnaud-Antignac A Hardouin JB Chailan S Neau K Papuchon E Gaboriau S Legendre C Moreacutelon E Tessier P Giral M
A personalized follow-up of kidney transplant recipients using video conferencing basedon a 1-year scoring system predictive of long term graft failure (TELEGRAFT study) protocolfor a randomized controlled trial
BMC Nephrol 2015 Jan 28 16 6 doi 1011861471-2369-16-6
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R Laplaud D Noeumll C Kessler M
Cost-effectiveness of home telemonitoring in chronic kidney disease patients at differentstages by a pragmatic randomized controlled trial (eNephro) rationale and study design
BMC Nephrol 2017 Apr 518(1)126 doi 101186s12882-017-0529-2
Pape L de Zwaan M Tegtbur U Feldhaus F Wolff JK Schiffer L Lerch C Hellrung N KliemV Lonnemann G Nolting HD Schiffer M
The KTx360deg-study a multicenter multisectoral multimodal telemedicine-based follow-upcare model to improve care and reduce health-care costs after kidney transplantation inchildren and adults
BMC Health Serv Res 2017 Aug 23 17(1)587 doi 101186s12913-017-2545-0
ANJH Paris 20 mai 2019
35
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
Remote monitoring (RM) of renal replacement treatments14
ANJH Paris 20 mai 2019
ldquo
rdquo
Despite growing evidence for the use of RM in
the management of patients with ESRD
(including peritoneal dialysis and home
haemodialysis) this disease had the lowest
recognition of RM value in this current research
Katherine Rojahn1 Suzanne Laplante1 James Sloand1 Claire Main2 AftabIbrahim2 Janet Wild2 Nicky Sturt2 Thelga Areteou3 and K Ian Johnson3
Remote Monitoring of Chronic Diseases A Landscape Assessment of Policies in Four European Countries (United Kingdom Geremany Italy Spain)
PLoS One 2016 May 1911(5)e0155738 doi 101371journalpone0155738 eCollection 2016
ANJH Paris 20 mai 2019
15
ldquo
rdquo
The evidence regarding the quality of care
delivered by telemedicine and telenephrology
in particular compared with in-person care is
limited in USAhellip
Videoconferencing is widely used in Australia to manage kidney disease including chronic
kidney disease dialysis pediatric nephrology
and post-kidney transplantation carehellip
Rohatgi R Ross MJ Majoni SW Telenephrology current perspectives and
future directions Kidney Int 2017 Dec92(6)1328-1333 doi
101016jkint201706032 Epub 2017 Oct 12 Review
ANJH Paris 20 mai 2019
16
Remote monitoring of renal
replacement treatments in France and
in EuropePatients treated by Dialysis
ANJH Paris 20 mai 2019
17
Teledialysis in Tromsouml since 2001
TMS
Tromsoslash
Vefsn
Sandnessjoslashen
Rana
Harstad
Hammerfest
Narvik
Lofoten
Bodoslash
Kirkenes
Alta
bull Control
bull Remote visit guidance and teachingANJH Paris 20 mai 2019
18
Mapes DL Lopes AA
Satayathum S McCullough
KP Goodkin DA Locatelli F
Fukuhara S Young EW
Kurokawa K Saito A Bommer
J Wolfe RA Held PJ Port FK
Health-related quality of life
as a predictor of mortality and
hospitalization the Dialysis
Outcomes and Practice
Patterns Study (DOPPS)
Kidney Int 2003 Jul64(1)339-
49
ANJH Paris 20 mai 2019
19
Teledialysis in BrittanySt Brieuc-Lannion (since June of 2001)
ANJH Paris 20 mai 2019
20
Remote monitoring in teledialysis
Software that processes the parameters
of the session in real time
ANJH Paris 20 mai 2019
21
Software that processes the settings
for each session for a period of 6 mois
Predictive diagnosis of vascular access stenosis
ANJH Paris 20 mai 2019
22
Teleconsultation at the end of hemodialysis session
ANJH Paris 20 mai 2019
23
Validation of teledialysis process by
French Health Authority in january 2010
Janvier 2010
ANJH Paris 20 mai 2019
24
Introduction of teledialysis in a new decree
in February 2012
Home
dialysis
Satellite
dialysis
Satellite dialysis
with nurse
Heavy dialysis
center
Doctor time given by the end of session teleconsult
On-site nephrology
team
Cs month Cs et visitmonth Visitweek
Consent of the patient
Patient stabilized in dialysis treatment
Decree of
september 2002Telemedicine decreeof february 2012
ANJH Paris 20 mai 2019
25
Lighted dialysis
center (UDM)
Compliance of the dialysis population to quality indicators
Pre dialytic phosphate (mmoll)
Summary graph of the dialysis population
Patients below the normal range
Patients over the
normal range
ANJH Paris 20 mai 2019
26
Diatelic system in Peritoneal Dialysis
since 2001(1)
ANJH Paris 20 mai 2019
27
Diatelic system in Peritoneal Dialysis
since 2001(2)
Patient nurse family physician give dialysis data from home over
the internet
By secure messaging the patient expresses his ou her remarks with
the healthcare team by continuous exchange
=gt
ANJH Paris 20 mai 2019
28
ldquo
rdquo
In the nephrology setting home telemonitoring has
been evaluated in home dialysis patients but data
are scarce concerning chronic kidney disease (CKD)
patients before and after renal replacement
therapy The eNephro study is designed to assess thecost effectiveness clinicalbiological impact and
patient perception of a home telemonitoring for
CKD patients
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R
Laplaud D Noeumll C Kessler M Cost-effectiveness of home telemonitoring in chronic
kidney disease patients at different stages by a pragmatic randomized controlled
trial (eNephro) rationale and study design BMC Nephrol 2017 Apr 518(1)126
doi 101186s12882-017-0529-2
ANJH Paris 20 mai 2019
29
The future in remote monitoring of patients treated by
hemodialysis ETAPE Program led by French Ministry
of Health and Health Insurance (2018-21)
Experimentation of telemonitoring funding in hemodialysis patients outside the heavy dialysis center
A precise perimeter (autodialysis UDM homehemodialysis ()) strict eligibilityconditions Patients should be extracted from heavy dialysis center
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient Study followed by HealthInsurance information system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the healthprofessional responsible for the therapeutic accompaniment the provider of theremote monitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
30
31 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Remote monitoring of renal
replacement treatmentsPatients treated by kidney graft
ANJH Paris 20 mai 2019
32
The future in remote monitoring of patients treated by
kidney graft ETAPE Program led by French Ministry of
Health and Health Insurance (2018-21)
Experimentation remote monitoring funding of patients grafted for more than 6months
A precise perimeter strict eligibility conditions
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient followed by Health Insuranceinformation system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the health professionalresponsible for the therapeutic accompaniment the provider of the remotemonitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
33
34 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Three prospectives studies controlled and
randomized (results end 2019-2020)
Foucher Y Meurette A Daguin P Bonnaud-Antignac A Hardouin JB Chailan S Neau K Papuchon E Gaboriau S Legendre C Moreacutelon E Tessier P Giral M
A personalized follow-up of kidney transplant recipients using video conferencing basedon a 1-year scoring system predictive of long term graft failure (TELEGRAFT study) protocolfor a randomized controlled trial
BMC Nephrol 2015 Jan 28 16 6 doi 1011861471-2369-16-6
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R Laplaud D Noeumll C Kessler M
Cost-effectiveness of home telemonitoring in chronic kidney disease patients at differentstages by a pragmatic randomized controlled trial (eNephro) rationale and study design
BMC Nephrol 2017 Apr 518(1)126 doi 101186s12882-017-0529-2
Pape L de Zwaan M Tegtbur U Feldhaus F Wolff JK Schiffer L Lerch C Hellrung N KliemV Lonnemann G Nolting HD Schiffer M
The KTx360deg-study a multicenter multisectoral multimodal telemedicine-based follow-upcare model to improve care and reduce health-care costs after kidney transplantation inchildren and adults
BMC Health Serv Res 2017 Aug 23 17(1)587 doi 101186s12913-017-2545-0
ANJH Paris 20 mai 2019
35
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
ldquo
rdquo
Despite growing evidence for the use of RM in
the management of patients with ESRD
(including peritoneal dialysis and home
haemodialysis) this disease had the lowest
recognition of RM value in this current research
Katherine Rojahn1 Suzanne Laplante1 James Sloand1 Claire Main2 AftabIbrahim2 Janet Wild2 Nicky Sturt2 Thelga Areteou3 and K Ian Johnson3
Remote Monitoring of Chronic Diseases A Landscape Assessment of Policies in Four European Countries (United Kingdom Geremany Italy Spain)
PLoS One 2016 May 1911(5)e0155738 doi 101371journalpone0155738 eCollection 2016
ANJH Paris 20 mai 2019
15
ldquo
rdquo
The evidence regarding the quality of care
delivered by telemedicine and telenephrology
in particular compared with in-person care is
limited in USAhellip
Videoconferencing is widely used in Australia to manage kidney disease including chronic
kidney disease dialysis pediatric nephrology
and post-kidney transplantation carehellip
Rohatgi R Ross MJ Majoni SW Telenephrology current perspectives and
future directions Kidney Int 2017 Dec92(6)1328-1333 doi
101016jkint201706032 Epub 2017 Oct 12 Review
ANJH Paris 20 mai 2019
16
Remote monitoring of renal
replacement treatments in France and
in EuropePatients treated by Dialysis
ANJH Paris 20 mai 2019
17
Teledialysis in Tromsouml since 2001
TMS
Tromsoslash
Vefsn
Sandnessjoslashen
Rana
Harstad
Hammerfest
Narvik
Lofoten
Bodoslash
Kirkenes
Alta
bull Control
bull Remote visit guidance and teachingANJH Paris 20 mai 2019
18
Mapes DL Lopes AA
Satayathum S McCullough
KP Goodkin DA Locatelli F
Fukuhara S Young EW
Kurokawa K Saito A Bommer
J Wolfe RA Held PJ Port FK
Health-related quality of life
as a predictor of mortality and
hospitalization the Dialysis
Outcomes and Practice
Patterns Study (DOPPS)
Kidney Int 2003 Jul64(1)339-
49
ANJH Paris 20 mai 2019
19
Teledialysis in BrittanySt Brieuc-Lannion (since June of 2001)
ANJH Paris 20 mai 2019
20
Remote monitoring in teledialysis
Software that processes the parameters
of the session in real time
ANJH Paris 20 mai 2019
21
Software that processes the settings
for each session for a period of 6 mois
Predictive diagnosis of vascular access stenosis
ANJH Paris 20 mai 2019
22
Teleconsultation at the end of hemodialysis session
ANJH Paris 20 mai 2019
23
Validation of teledialysis process by
French Health Authority in january 2010
Janvier 2010
ANJH Paris 20 mai 2019
24
Introduction of teledialysis in a new decree
in February 2012
Home
dialysis
Satellite
dialysis
Satellite dialysis
with nurse
Heavy dialysis
center
Doctor time given by the end of session teleconsult
On-site nephrology
team
Cs month Cs et visitmonth Visitweek
Consent of the patient
Patient stabilized in dialysis treatment
Decree of
september 2002Telemedicine decreeof february 2012
ANJH Paris 20 mai 2019
25
Lighted dialysis
center (UDM)
Compliance of the dialysis population to quality indicators
Pre dialytic phosphate (mmoll)
Summary graph of the dialysis population
Patients below the normal range
Patients over the
normal range
ANJH Paris 20 mai 2019
26
Diatelic system in Peritoneal Dialysis
since 2001(1)
ANJH Paris 20 mai 2019
27
Diatelic system in Peritoneal Dialysis
since 2001(2)
Patient nurse family physician give dialysis data from home over
the internet
By secure messaging the patient expresses his ou her remarks with
the healthcare team by continuous exchange
=gt
ANJH Paris 20 mai 2019
28
ldquo
rdquo
In the nephrology setting home telemonitoring has
been evaluated in home dialysis patients but data
are scarce concerning chronic kidney disease (CKD)
patients before and after renal replacement
therapy The eNephro study is designed to assess thecost effectiveness clinicalbiological impact and
patient perception of a home telemonitoring for
CKD patients
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R
Laplaud D Noeumll C Kessler M Cost-effectiveness of home telemonitoring in chronic
kidney disease patients at different stages by a pragmatic randomized controlled
trial (eNephro) rationale and study design BMC Nephrol 2017 Apr 518(1)126
doi 101186s12882-017-0529-2
ANJH Paris 20 mai 2019
29
The future in remote monitoring of patients treated by
hemodialysis ETAPE Program led by French Ministry
of Health and Health Insurance (2018-21)
Experimentation of telemonitoring funding in hemodialysis patients outside the heavy dialysis center
A precise perimeter (autodialysis UDM homehemodialysis ()) strict eligibilityconditions Patients should be extracted from heavy dialysis center
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient Study followed by HealthInsurance information system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the healthprofessional responsible for the therapeutic accompaniment the provider of theremote monitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
30
31 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Remote monitoring of renal
replacement treatmentsPatients treated by kidney graft
ANJH Paris 20 mai 2019
32
The future in remote monitoring of patients treated by
kidney graft ETAPE Program led by French Ministry of
Health and Health Insurance (2018-21)
Experimentation remote monitoring funding of patients grafted for more than 6months
A precise perimeter strict eligibility conditions
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient followed by Health Insuranceinformation system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the health professionalresponsible for the therapeutic accompaniment the provider of the remotemonitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
33
34 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Three prospectives studies controlled and
randomized (results end 2019-2020)
Foucher Y Meurette A Daguin P Bonnaud-Antignac A Hardouin JB Chailan S Neau K Papuchon E Gaboriau S Legendre C Moreacutelon E Tessier P Giral M
A personalized follow-up of kidney transplant recipients using video conferencing basedon a 1-year scoring system predictive of long term graft failure (TELEGRAFT study) protocolfor a randomized controlled trial
BMC Nephrol 2015 Jan 28 16 6 doi 1011861471-2369-16-6
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R Laplaud D Noeumll C Kessler M
Cost-effectiveness of home telemonitoring in chronic kidney disease patients at differentstages by a pragmatic randomized controlled trial (eNephro) rationale and study design
BMC Nephrol 2017 Apr 518(1)126 doi 101186s12882-017-0529-2
Pape L de Zwaan M Tegtbur U Feldhaus F Wolff JK Schiffer L Lerch C Hellrung N KliemV Lonnemann G Nolting HD Schiffer M
The KTx360deg-study a multicenter multisectoral multimodal telemedicine-based follow-upcare model to improve care and reduce health-care costs after kidney transplantation inchildren and adults
BMC Health Serv Res 2017 Aug 23 17(1)587 doi 101186s12913-017-2545-0
ANJH Paris 20 mai 2019
35
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
ldquo
rdquo
The evidence regarding the quality of care
delivered by telemedicine and telenephrology
in particular compared with in-person care is
limited in USAhellip
Videoconferencing is widely used in Australia to manage kidney disease including chronic
kidney disease dialysis pediatric nephrology
and post-kidney transplantation carehellip
Rohatgi R Ross MJ Majoni SW Telenephrology current perspectives and
future directions Kidney Int 2017 Dec92(6)1328-1333 doi
101016jkint201706032 Epub 2017 Oct 12 Review
ANJH Paris 20 mai 2019
16
Remote monitoring of renal
replacement treatments in France and
in EuropePatients treated by Dialysis
ANJH Paris 20 mai 2019
17
Teledialysis in Tromsouml since 2001
TMS
Tromsoslash
Vefsn
Sandnessjoslashen
Rana
Harstad
Hammerfest
Narvik
Lofoten
Bodoslash
Kirkenes
Alta
bull Control
bull Remote visit guidance and teachingANJH Paris 20 mai 2019
18
Mapes DL Lopes AA
Satayathum S McCullough
KP Goodkin DA Locatelli F
Fukuhara S Young EW
Kurokawa K Saito A Bommer
J Wolfe RA Held PJ Port FK
Health-related quality of life
as a predictor of mortality and
hospitalization the Dialysis
Outcomes and Practice
Patterns Study (DOPPS)
Kidney Int 2003 Jul64(1)339-
49
ANJH Paris 20 mai 2019
19
Teledialysis in BrittanySt Brieuc-Lannion (since June of 2001)
ANJH Paris 20 mai 2019
20
Remote monitoring in teledialysis
Software that processes the parameters
of the session in real time
ANJH Paris 20 mai 2019
21
Software that processes the settings
for each session for a period of 6 mois
Predictive diagnosis of vascular access stenosis
ANJH Paris 20 mai 2019
22
Teleconsultation at the end of hemodialysis session
ANJH Paris 20 mai 2019
23
Validation of teledialysis process by
French Health Authority in january 2010
Janvier 2010
ANJH Paris 20 mai 2019
24
Introduction of teledialysis in a new decree
in February 2012
Home
dialysis
Satellite
dialysis
Satellite dialysis
with nurse
Heavy dialysis
center
Doctor time given by the end of session teleconsult
On-site nephrology
team
Cs month Cs et visitmonth Visitweek
Consent of the patient
Patient stabilized in dialysis treatment
Decree of
september 2002Telemedicine decreeof february 2012
ANJH Paris 20 mai 2019
25
Lighted dialysis
center (UDM)
Compliance of the dialysis population to quality indicators
Pre dialytic phosphate (mmoll)
Summary graph of the dialysis population
Patients below the normal range
Patients over the
normal range
ANJH Paris 20 mai 2019
26
Diatelic system in Peritoneal Dialysis
since 2001(1)
ANJH Paris 20 mai 2019
27
Diatelic system in Peritoneal Dialysis
since 2001(2)
Patient nurse family physician give dialysis data from home over
the internet
By secure messaging the patient expresses his ou her remarks with
the healthcare team by continuous exchange
=gt
ANJH Paris 20 mai 2019
28
ldquo
rdquo
In the nephrology setting home telemonitoring has
been evaluated in home dialysis patients but data
are scarce concerning chronic kidney disease (CKD)
patients before and after renal replacement
therapy The eNephro study is designed to assess thecost effectiveness clinicalbiological impact and
patient perception of a home telemonitoring for
CKD patients
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R
Laplaud D Noeumll C Kessler M Cost-effectiveness of home telemonitoring in chronic
kidney disease patients at different stages by a pragmatic randomized controlled
trial (eNephro) rationale and study design BMC Nephrol 2017 Apr 518(1)126
doi 101186s12882-017-0529-2
ANJH Paris 20 mai 2019
29
The future in remote monitoring of patients treated by
hemodialysis ETAPE Program led by French Ministry
of Health and Health Insurance (2018-21)
Experimentation of telemonitoring funding in hemodialysis patients outside the heavy dialysis center
A precise perimeter (autodialysis UDM homehemodialysis ()) strict eligibilityconditions Patients should be extracted from heavy dialysis center
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient Study followed by HealthInsurance information system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the healthprofessional responsible for the therapeutic accompaniment the provider of theremote monitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
30
31 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Remote monitoring of renal
replacement treatmentsPatients treated by kidney graft
ANJH Paris 20 mai 2019
32
The future in remote monitoring of patients treated by
kidney graft ETAPE Program led by French Ministry of
Health and Health Insurance (2018-21)
Experimentation remote monitoring funding of patients grafted for more than 6months
A precise perimeter strict eligibility conditions
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient followed by Health Insuranceinformation system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the health professionalresponsible for the therapeutic accompaniment the provider of the remotemonitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
33
34 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Three prospectives studies controlled and
randomized (results end 2019-2020)
Foucher Y Meurette A Daguin P Bonnaud-Antignac A Hardouin JB Chailan S Neau K Papuchon E Gaboriau S Legendre C Moreacutelon E Tessier P Giral M
A personalized follow-up of kidney transplant recipients using video conferencing basedon a 1-year scoring system predictive of long term graft failure (TELEGRAFT study) protocolfor a randomized controlled trial
BMC Nephrol 2015 Jan 28 16 6 doi 1011861471-2369-16-6
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R Laplaud D Noeumll C Kessler M
Cost-effectiveness of home telemonitoring in chronic kidney disease patients at differentstages by a pragmatic randomized controlled trial (eNephro) rationale and study design
BMC Nephrol 2017 Apr 518(1)126 doi 101186s12882-017-0529-2
Pape L de Zwaan M Tegtbur U Feldhaus F Wolff JK Schiffer L Lerch C Hellrung N KliemV Lonnemann G Nolting HD Schiffer M
The KTx360deg-study a multicenter multisectoral multimodal telemedicine-based follow-upcare model to improve care and reduce health-care costs after kidney transplantation inchildren and adults
BMC Health Serv Res 2017 Aug 23 17(1)587 doi 101186s12913-017-2545-0
ANJH Paris 20 mai 2019
35
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
Remote monitoring of renal
replacement treatments in France and
in EuropePatients treated by Dialysis
ANJH Paris 20 mai 2019
17
Teledialysis in Tromsouml since 2001
TMS
Tromsoslash
Vefsn
Sandnessjoslashen
Rana
Harstad
Hammerfest
Narvik
Lofoten
Bodoslash
Kirkenes
Alta
bull Control
bull Remote visit guidance and teachingANJH Paris 20 mai 2019
18
Mapes DL Lopes AA
Satayathum S McCullough
KP Goodkin DA Locatelli F
Fukuhara S Young EW
Kurokawa K Saito A Bommer
J Wolfe RA Held PJ Port FK
Health-related quality of life
as a predictor of mortality and
hospitalization the Dialysis
Outcomes and Practice
Patterns Study (DOPPS)
Kidney Int 2003 Jul64(1)339-
49
ANJH Paris 20 mai 2019
19
Teledialysis in BrittanySt Brieuc-Lannion (since June of 2001)
ANJH Paris 20 mai 2019
20
Remote monitoring in teledialysis
Software that processes the parameters
of the session in real time
ANJH Paris 20 mai 2019
21
Software that processes the settings
for each session for a period of 6 mois
Predictive diagnosis of vascular access stenosis
ANJH Paris 20 mai 2019
22
Teleconsultation at the end of hemodialysis session
ANJH Paris 20 mai 2019
23
Validation of teledialysis process by
French Health Authority in january 2010
Janvier 2010
ANJH Paris 20 mai 2019
24
Introduction of teledialysis in a new decree
in February 2012
Home
dialysis
Satellite
dialysis
Satellite dialysis
with nurse
Heavy dialysis
center
Doctor time given by the end of session teleconsult
On-site nephrology
team
Cs month Cs et visitmonth Visitweek
Consent of the patient
Patient stabilized in dialysis treatment
Decree of
september 2002Telemedicine decreeof february 2012
ANJH Paris 20 mai 2019
25
Lighted dialysis
center (UDM)
Compliance of the dialysis population to quality indicators
Pre dialytic phosphate (mmoll)
Summary graph of the dialysis population
Patients below the normal range
Patients over the
normal range
ANJH Paris 20 mai 2019
26
Diatelic system in Peritoneal Dialysis
since 2001(1)
ANJH Paris 20 mai 2019
27
Diatelic system in Peritoneal Dialysis
since 2001(2)
Patient nurse family physician give dialysis data from home over
the internet
By secure messaging the patient expresses his ou her remarks with
the healthcare team by continuous exchange
=gt
ANJH Paris 20 mai 2019
28
ldquo
rdquo
In the nephrology setting home telemonitoring has
been evaluated in home dialysis patients but data
are scarce concerning chronic kidney disease (CKD)
patients before and after renal replacement
therapy The eNephro study is designed to assess thecost effectiveness clinicalbiological impact and
patient perception of a home telemonitoring for
CKD patients
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R
Laplaud D Noeumll C Kessler M Cost-effectiveness of home telemonitoring in chronic
kidney disease patients at different stages by a pragmatic randomized controlled
trial (eNephro) rationale and study design BMC Nephrol 2017 Apr 518(1)126
doi 101186s12882-017-0529-2
ANJH Paris 20 mai 2019
29
The future in remote monitoring of patients treated by
hemodialysis ETAPE Program led by French Ministry
of Health and Health Insurance (2018-21)
Experimentation of telemonitoring funding in hemodialysis patients outside the heavy dialysis center
A precise perimeter (autodialysis UDM homehemodialysis ()) strict eligibilityconditions Patients should be extracted from heavy dialysis center
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient Study followed by HealthInsurance information system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the healthprofessional responsible for the therapeutic accompaniment the provider of theremote monitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
30
31 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Remote monitoring of renal
replacement treatmentsPatients treated by kidney graft
ANJH Paris 20 mai 2019
32
The future in remote monitoring of patients treated by
kidney graft ETAPE Program led by French Ministry of
Health and Health Insurance (2018-21)
Experimentation remote monitoring funding of patients grafted for more than 6months
A precise perimeter strict eligibility conditions
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient followed by Health Insuranceinformation system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the health professionalresponsible for the therapeutic accompaniment the provider of the remotemonitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
33
34 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Three prospectives studies controlled and
randomized (results end 2019-2020)
Foucher Y Meurette A Daguin P Bonnaud-Antignac A Hardouin JB Chailan S Neau K Papuchon E Gaboriau S Legendre C Moreacutelon E Tessier P Giral M
A personalized follow-up of kidney transplant recipients using video conferencing basedon a 1-year scoring system predictive of long term graft failure (TELEGRAFT study) protocolfor a randomized controlled trial
BMC Nephrol 2015 Jan 28 16 6 doi 1011861471-2369-16-6
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R Laplaud D Noeumll C Kessler M
Cost-effectiveness of home telemonitoring in chronic kidney disease patients at differentstages by a pragmatic randomized controlled trial (eNephro) rationale and study design
BMC Nephrol 2017 Apr 518(1)126 doi 101186s12882-017-0529-2
Pape L de Zwaan M Tegtbur U Feldhaus F Wolff JK Schiffer L Lerch C Hellrung N KliemV Lonnemann G Nolting HD Schiffer M
The KTx360deg-study a multicenter multisectoral multimodal telemedicine-based follow-upcare model to improve care and reduce health-care costs after kidney transplantation inchildren and adults
BMC Health Serv Res 2017 Aug 23 17(1)587 doi 101186s12913-017-2545-0
ANJH Paris 20 mai 2019
35
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
Teledialysis in Tromsouml since 2001
TMS
Tromsoslash
Vefsn
Sandnessjoslashen
Rana
Harstad
Hammerfest
Narvik
Lofoten
Bodoslash
Kirkenes
Alta
bull Control
bull Remote visit guidance and teachingANJH Paris 20 mai 2019
18
Mapes DL Lopes AA
Satayathum S McCullough
KP Goodkin DA Locatelli F
Fukuhara S Young EW
Kurokawa K Saito A Bommer
J Wolfe RA Held PJ Port FK
Health-related quality of life
as a predictor of mortality and
hospitalization the Dialysis
Outcomes and Practice
Patterns Study (DOPPS)
Kidney Int 2003 Jul64(1)339-
49
ANJH Paris 20 mai 2019
19
Teledialysis in BrittanySt Brieuc-Lannion (since June of 2001)
ANJH Paris 20 mai 2019
20
Remote monitoring in teledialysis
Software that processes the parameters
of the session in real time
ANJH Paris 20 mai 2019
21
Software that processes the settings
for each session for a period of 6 mois
Predictive diagnosis of vascular access stenosis
ANJH Paris 20 mai 2019
22
Teleconsultation at the end of hemodialysis session
ANJH Paris 20 mai 2019
23
Validation of teledialysis process by
French Health Authority in january 2010
Janvier 2010
ANJH Paris 20 mai 2019
24
Introduction of teledialysis in a new decree
in February 2012
Home
dialysis
Satellite
dialysis
Satellite dialysis
with nurse
Heavy dialysis
center
Doctor time given by the end of session teleconsult
On-site nephrology
team
Cs month Cs et visitmonth Visitweek
Consent of the patient
Patient stabilized in dialysis treatment
Decree of
september 2002Telemedicine decreeof february 2012
ANJH Paris 20 mai 2019
25
Lighted dialysis
center (UDM)
Compliance of the dialysis population to quality indicators
Pre dialytic phosphate (mmoll)
Summary graph of the dialysis population
Patients below the normal range
Patients over the
normal range
ANJH Paris 20 mai 2019
26
Diatelic system in Peritoneal Dialysis
since 2001(1)
ANJH Paris 20 mai 2019
27
Diatelic system in Peritoneal Dialysis
since 2001(2)
Patient nurse family physician give dialysis data from home over
the internet
By secure messaging the patient expresses his ou her remarks with
the healthcare team by continuous exchange
=gt
ANJH Paris 20 mai 2019
28
ldquo
rdquo
In the nephrology setting home telemonitoring has
been evaluated in home dialysis patients but data
are scarce concerning chronic kidney disease (CKD)
patients before and after renal replacement
therapy The eNephro study is designed to assess thecost effectiveness clinicalbiological impact and
patient perception of a home telemonitoring for
CKD patients
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R
Laplaud D Noeumll C Kessler M Cost-effectiveness of home telemonitoring in chronic
kidney disease patients at different stages by a pragmatic randomized controlled
trial (eNephro) rationale and study design BMC Nephrol 2017 Apr 518(1)126
doi 101186s12882-017-0529-2
ANJH Paris 20 mai 2019
29
The future in remote monitoring of patients treated by
hemodialysis ETAPE Program led by French Ministry
of Health and Health Insurance (2018-21)
Experimentation of telemonitoring funding in hemodialysis patients outside the heavy dialysis center
A precise perimeter (autodialysis UDM homehemodialysis ()) strict eligibilityconditions Patients should be extracted from heavy dialysis center
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient Study followed by HealthInsurance information system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the healthprofessional responsible for the therapeutic accompaniment the provider of theremote monitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
30
31 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Remote monitoring of renal
replacement treatmentsPatients treated by kidney graft
ANJH Paris 20 mai 2019
32
The future in remote monitoring of patients treated by
kidney graft ETAPE Program led by French Ministry of
Health and Health Insurance (2018-21)
Experimentation remote monitoring funding of patients grafted for more than 6months
A precise perimeter strict eligibility conditions
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient followed by Health Insuranceinformation system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the health professionalresponsible for the therapeutic accompaniment the provider of the remotemonitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
33
34 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Three prospectives studies controlled and
randomized (results end 2019-2020)
Foucher Y Meurette A Daguin P Bonnaud-Antignac A Hardouin JB Chailan S Neau K Papuchon E Gaboriau S Legendre C Moreacutelon E Tessier P Giral M
A personalized follow-up of kidney transplant recipients using video conferencing basedon a 1-year scoring system predictive of long term graft failure (TELEGRAFT study) protocolfor a randomized controlled trial
BMC Nephrol 2015 Jan 28 16 6 doi 1011861471-2369-16-6
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R Laplaud D Noeumll C Kessler M
Cost-effectiveness of home telemonitoring in chronic kidney disease patients at differentstages by a pragmatic randomized controlled trial (eNephro) rationale and study design
BMC Nephrol 2017 Apr 518(1)126 doi 101186s12882-017-0529-2
Pape L de Zwaan M Tegtbur U Feldhaus F Wolff JK Schiffer L Lerch C Hellrung N KliemV Lonnemann G Nolting HD Schiffer M
The KTx360deg-study a multicenter multisectoral multimodal telemedicine-based follow-upcare model to improve care and reduce health-care costs after kidney transplantation inchildren and adults
BMC Health Serv Res 2017 Aug 23 17(1)587 doi 101186s12913-017-2545-0
ANJH Paris 20 mai 2019
35
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
Mapes DL Lopes AA
Satayathum S McCullough
KP Goodkin DA Locatelli F
Fukuhara S Young EW
Kurokawa K Saito A Bommer
J Wolfe RA Held PJ Port FK
Health-related quality of life
as a predictor of mortality and
hospitalization the Dialysis
Outcomes and Practice
Patterns Study (DOPPS)
Kidney Int 2003 Jul64(1)339-
49
ANJH Paris 20 mai 2019
19
Teledialysis in BrittanySt Brieuc-Lannion (since June of 2001)
ANJH Paris 20 mai 2019
20
Remote monitoring in teledialysis
Software that processes the parameters
of the session in real time
ANJH Paris 20 mai 2019
21
Software that processes the settings
for each session for a period of 6 mois
Predictive diagnosis of vascular access stenosis
ANJH Paris 20 mai 2019
22
Teleconsultation at the end of hemodialysis session
ANJH Paris 20 mai 2019
23
Validation of teledialysis process by
French Health Authority in january 2010
Janvier 2010
ANJH Paris 20 mai 2019
24
Introduction of teledialysis in a new decree
in February 2012
Home
dialysis
Satellite
dialysis
Satellite dialysis
with nurse
Heavy dialysis
center
Doctor time given by the end of session teleconsult
On-site nephrology
team
Cs month Cs et visitmonth Visitweek
Consent of the patient
Patient stabilized in dialysis treatment
Decree of
september 2002Telemedicine decreeof february 2012
ANJH Paris 20 mai 2019
25
Lighted dialysis
center (UDM)
Compliance of the dialysis population to quality indicators
Pre dialytic phosphate (mmoll)
Summary graph of the dialysis population
Patients below the normal range
Patients over the
normal range
ANJH Paris 20 mai 2019
26
Diatelic system in Peritoneal Dialysis
since 2001(1)
ANJH Paris 20 mai 2019
27
Diatelic system in Peritoneal Dialysis
since 2001(2)
Patient nurse family physician give dialysis data from home over
the internet
By secure messaging the patient expresses his ou her remarks with
the healthcare team by continuous exchange
=gt
ANJH Paris 20 mai 2019
28
ldquo
rdquo
In the nephrology setting home telemonitoring has
been evaluated in home dialysis patients but data
are scarce concerning chronic kidney disease (CKD)
patients before and after renal replacement
therapy The eNephro study is designed to assess thecost effectiveness clinicalbiological impact and
patient perception of a home telemonitoring for
CKD patients
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R
Laplaud D Noeumll C Kessler M Cost-effectiveness of home telemonitoring in chronic
kidney disease patients at different stages by a pragmatic randomized controlled
trial (eNephro) rationale and study design BMC Nephrol 2017 Apr 518(1)126
doi 101186s12882-017-0529-2
ANJH Paris 20 mai 2019
29
The future in remote monitoring of patients treated by
hemodialysis ETAPE Program led by French Ministry
of Health and Health Insurance (2018-21)
Experimentation of telemonitoring funding in hemodialysis patients outside the heavy dialysis center
A precise perimeter (autodialysis UDM homehemodialysis ()) strict eligibilityconditions Patients should be extracted from heavy dialysis center
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient Study followed by HealthInsurance information system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the healthprofessional responsible for the therapeutic accompaniment the provider of theremote monitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
30
31 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Remote monitoring of renal
replacement treatmentsPatients treated by kidney graft
ANJH Paris 20 mai 2019
32
The future in remote monitoring of patients treated by
kidney graft ETAPE Program led by French Ministry of
Health and Health Insurance (2018-21)
Experimentation remote monitoring funding of patients grafted for more than 6months
A precise perimeter strict eligibility conditions
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient followed by Health Insuranceinformation system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the health professionalresponsible for the therapeutic accompaniment the provider of the remotemonitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
33
34 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Three prospectives studies controlled and
randomized (results end 2019-2020)
Foucher Y Meurette A Daguin P Bonnaud-Antignac A Hardouin JB Chailan S Neau K Papuchon E Gaboriau S Legendre C Moreacutelon E Tessier P Giral M
A personalized follow-up of kidney transplant recipients using video conferencing basedon a 1-year scoring system predictive of long term graft failure (TELEGRAFT study) protocolfor a randomized controlled trial
BMC Nephrol 2015 Jan 28 16 6 doi 1011861471-2369-16-6
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R Laplaud D Noeumll C Kessler M
Cost-effectiveness of home telemonitoring in chronic kidney disease patients at differentstages by a pragmatic randomized controlled trial (eNephro) rationale and study design
BMC Nephrol 2017 Apr 518(1)126 doi 101186s12882-017-0529-2
Pape L de Zwaan M Tegtbur U Feldhaus F Wolff JK Schiffer L Lerch C Hellrung N KliemV Lonnemann G Nolting HD Schiffer M
The KTx360deg-study a multicenter multisectoral multimodal telemedicine-based follow-upcare model to improve care and reduce health-care costs after kidney transplantation inchildren and adults
BMC Health Serv Res 2017 Aug 23 17(1)587 doi 101186s12913-017-2545-0
ANJH Paris 20 mai 2019
35
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
Teledialysis in BrittanySt Brieuc-Lannion (since June of 2001)
ANJH Paris 20 mai 2019
20
Remote monitoring in teledialysis
Software that processes the parameters
of the session in real time
ANJH Paris 20 mai 2019
21
Software that processes the settings
for each session for a period of 6 mois
Predictive diagnosis of vascular access stenosis
ANJH Paris 20 mai 2019
22
Teleconsultation at the end of hemodialysis session
ANJH Paris 20 mai 2019
23
Validation of teledialysis process by
French Health Authority in january 2010
Janvier 2010
ANJH Paris 20 mai 2019
24
Introduction of teledialysis in a new decree
in February 2012
Home
dialysis
Satellite
dialysis
Satellite dialysis
with nurse
Heavy dialysis
center
Doctor time given by the end of session teleconsult
On-site nephrology
team
Cs month Cs et visitmonth Visitweek
Consent of the patient
Patient stabilized in dialysis treatment
Decree of
september 2002Telemedicine decreeof february 2012
ANJH Paris 20 mai 2019
25
Lighted dialysis
center (UDM)
Compliance of the dialysis population to quality indicators
Pre dialytic phosphate (mmoll)
Summary graph of the dialysis population
Patients below the normal range
Patients over the
normal range
ANJH Paris 20 mai 2019
26
Diatelic system in Peritoneal Dialysis
since 2001(1)
ANJH Paris 20 mai 2019
27
Diatelic system in Peritoneal Dialysis
since 2001(2)
Patient nurse family physician give dialysis data from home over
the internet
By secure messaging the patient expresses his ou her remarks with
the healthcare team by continuous exchange
=gt
ANJH Paris 20 mai 2019
28
ldquo
rdquo
In the nephrology setting home telemonitoring has
been evaluated in home dialysis patients but data
are scarce concerning chronic kidney disease (CKD)
patients before and after renal replacement
therapy The eNephro study is designed to assess thecost effectiveness clinicalbiological impact and
patient perception of a home telemonitoring for
CKD patients
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R
Laplaud D Noeumll C Kessler M Cost-effectiveness of home telemonitoring in chronic
kidney disease patients at different stages by a pragmatic randomized controlled
trial (eNephro) rationale and study design BMC Nephrol 2017 Apr 518(1)126
doi 101186s12882-017-0529-2
ANJH Paris 20 mai 2019
29
The future in remote monitoring of patients treated by
hemodialysis ETAPE Program led by French Ministry
of Health and Health Insurance (2018-21)
Experimentation of telemonitoring funding in hemodialysis patients outside the heavy dialysis center
A precise perimeter (autodialysis UDM homehemodialysis ()) strict eligibilityconditions Patients should be extracted from heavy dialysis center
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient Study followed by HealthInsurance information system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the healthprofessional responsible for the therapeutic accompaniment the provider of theremote monitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
30
31 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Remote monitoring of renal
replacement treatmentsPatients treated by kidney graft
ANJH Paris 20 mai 2019
32
The future in remote monitoring of patients treated by
kidney graft ETAPE Program led by French Ministry of
Health and Health Insurance (2018-21)
Experimentation remote monitoring funding of patients grafted for more than 6months
A precise perimeter strict eligibility conditions
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient followed by Health Insuranceinformation system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the health professionalresponsible for the therapeutic accompaniment the provider of the remotemonitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
33
34 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Three prospectives studies controlled and
randomized (results end 2019-2020)
Foucher Y Meurette A Daguin P Bonnaud-Antignac A Hardouin JB Chailan S Neau K Papuchon E Gaboriau S Legendre C Moreacutelon E Tessier P Giral M
A personalized follow-up of kidney transplant recipients using video conferencing basedon a 1-year scoring system predictive of long term graft failure (TELEGRAFT study) protocolfor a randomized controlled trial
BMC Nephrol 2015 Jan 28 16 6 doi 1011861471-2369-16-6
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R Laplaud D Noeumll C Kessler M
Cost-effectiveness of home telemonitoring in chronic kidney disease patients at differentstages by a pragmatic randomized controlled trial (eNephro) rationale and study design
BMC Nephrol 2017 Apr 518(1)126 doi 101186s12882-017-0529-2
Pape L de Zwaan M Tegtbur U Feldhaus F Wolff JK Schiffer L Lerch C Hellrung N KliemV Lonnemann G Nolting HD Schiffer M
The KTx360deg-study a multicenter multisectoral multimodal telemedicine-based follow-upcare model to improve care and reduce health-care costs after kidney transplantation inchildren and adults
BMC Health Serv Res 2017 Aug 23 17(1)587 doi 101186s12913-017-2545-0
ANJH Paris 20 mai 2019
35
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
Remote monitoring in teledialysis
Software that processes the parameters
of the session in real time
ANJH Paris 20 mai 2019
21
Software that processes the settings
for each session for a period of 6 mois
Predictive diagnosis of vascular access stenosis
ANJH Paris 20 mai 2019
22
Teleconsultation at the end of hemodialysis session
ANJH Paris 20 mai 2019
23
Validation of teledialysis process by
French Health Authority in january 2010
Janvier 2010
ANJH Paris 20 mai 2019
24
Introduction of teledialysis in a new decree
in February 2012
Home
dialysis
Satellite
dialysis
Satellite dialysis
with nurse
Heavy dialysis
center
Doctor time given by the end of session teleconsult
On-site nephrology
team
Cs month Cs et visitmonth Visitweek
Consent of the patient
Patient stabilized in dialysis treatment
Decree of
september 2002Telemedicine decreeof february 2012
ANJH Paris 20 mai 2019
25
Lighted dialysis
center (UDM)
Compliance of the dialysis population to quality indicators
Pre dialytic phosphate (mmoll)
Summary graph of the dialysis population
Patients below the normal range
Patients over the
normal range
ANJH Paris 20 mai 2019
26
Diatelic system in Peritoneal Dialysis
since 2001(1)
ANJH Paris 20 mai 2019
27
Diatelic system in Peritoneal Dialysis
since 2001(2)
Patient nurse family physician give dialysis data from home over
the internet
By secure messaging the patient expresses his ou her remarks with
the healthcare team by continuous exchange
=gt
ANJH Paris 20 mai 2019
28
ldquo
rdquo
In the nephrology setting home telemonitoring has
been evaluated in home dialysis patients but data
are scarce concerning chronic kidney disease (CKD)
patients before and after renal replacement
therapy The eNephro study is designed to assess thecost effectiveness clinicalbiological impact and
patient perception of a home telemonitoring for
CKD patients
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R
Laplaud D Noeumll C Kessler M Cost-effectiveness of home telemonitoring in chronic
kidney disease patients at different stages by a pragmatic randomized controlled
trial (eNephro) rationale and study design BMC Nephrol 2017 Apr 518(1)126
doi 101186s12882-017-0529-2
ANJH Paris 20 mai 2019
29
The future in remote monitoring of patients treated by
hemodialysis ETAPE Program led by French Ministry
of Health and Health Insurance (2018-21)
Experimentation of telemonitoring funding in hemodialysis patients outside the heavy dialysis center
A precise perimeter (autodialysis UDM homehemodialysis ()) strict eligibilityconditions Patients should be extracted from heavy dialysis center
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient Study followed by HealthInsurance information system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the healthprofessional responsible for the therapeutic accompaniment the provider of theremote monitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
30
31 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Remote monitoring of renal
replacement treatmentsPatients treated by kidney graft
ANJH Paris 20 mai 2019
32
The future in remote monitoring of patients treated by
kidney graft ETAPE Program led by French Ministry of
Health and Health Insurance (2018-21)
Experimentation remote monitoring funding of patients grafted for more than 6months
A precise perimeter strict eligibility conditions
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient followed by Health Insuranceinformation system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the health professionalresponsible for the therapeutic accompaniment the provider of the remotemonitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
33
34 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Three prospectives studies controlled and
randomized (results end 2019-2020)
Foucher Y Meurette A Daguin P Bonnaud-Antignac A Hardouin JB Chailan S Neau K Papuchon E Gaboriau S Legendre C Moreacutelon E Tessier P Giral M
A personalized follow-up of kidney transplant recipients using video conferencing basedon a 1-year scoring system predictive of long term graft failure (TELEGRAFT study) protocolfor a randomized controlled trial
BMC Nephrol 2015 Jan 28 16 6 doi 1011861471-2369-16-6
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R Laplaud D Noeumll C Kessler M
Cost-effectiveness of home telemonitoring in chronic kidney disease patients at differentstages by a pragmatic randomized controlled trial (eNephro) rationale and study design
BMC Nephrol 2017 Apr 518(1)126 doi 101186s12882-017-0529-2
Pape L de Zwaan M Tegtbur U Feldhaus F Wolff JK Schiffer L Lerch C Hellrung N KliemV Lonnemann G Nolting HD Schiffer M
The KTx360deg-study a multicenter multisectoral multimodal telemedicine-based follow-upcare model to improve care and reduce health-care costs after kidney transplantation inchildren and adults
BMC Health Serv Res 2017 Aug 23 17(1)587 doi 101186s12913-017-2545-0
ANJH Paris 20 mai 2019
35
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
Predictive diagnosis of vascular access stenosis
ANJH Paris 20 mai 2019
22
Teleconsultation at the end of hemodialysis session
ANJH Paris 20 mai 2019
23
Validation of teledialysis process by
French Health Authority in january 2010
Janvier 2010
ANJH Paris 20 mai 2019
24
Introduction of teledialysis in a new decree
in February 2012
Home
dialysis
Satellite
dialysis
Satellite dialysis
with nurse
Heavy dialysis
center
Doctor time given by the end of session teleconsult
On-site nephrology
team
Cs month Cs et visitmonth Visitweek
Consent of the patient
Patient stabilized in dialysis treatment
Decree of
september 2002Telemedicine decreeof february 2012
ANJH Paris 20 mai 2019
25
Lighted dialysis
center (UDM)
Compliance of the dialysis population to quality indicators
Pre dialytic phosphate (mmoll)
Summary graph of the dialysis population
Patients below the normal range
Patients over the
normal range
ANJH Paris 20 mai 2019
26
Diatelic system in Peritoneal Dialysis
since 2001(1)
ANJH Paris 20 mai 2019
27
Diatelic system in Peritoneal Dialysis
since 2001(2)
Patient nurse family physician give dialysis data from home over
the internet
By secure messaging the patient expresses his ou her remarks with
the healthcare team by continuous exchange
=gt
ANJH Paris 20 mai 2019
28
ldquo
rdquo
In the nephrology setting home telemonitoring has
been evaluated in home dialysis patients but data
are scarce concerning chronic kidney disease (CKD)
patients before and after renal replacement
therapy The eNephro study is designed to assess thecost effectiveness clinicalbiological impact and
patient perception of a home telemonitoring for
CKD patients
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R
Laplaud D Noeumll C Kessler M Cost-effectiveness of home telemonitoring in chronic
kidney disease patients at different stages by a pragmatic randomized controlled
trial (eNephro) rationale and study design BMC Nephrol 2017 Apr 518(1)126
doi 101186s12882-017-0529-2
ANJH Paris 20 mai 2019
29
The future in remote monitoring of patients treated by
hemodialysis ETAPE Program led by French Ministry
of Health and Health Insurance (2018-21)
Experimentation of telemonitoring funding in hemodialysis patients outside the heavy dialysis center
A precise perimeter (autodialysis UDM homehemodialysis ()) strict eligibilityconditions Patients should be extracted from heavy dialysis center
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient Study followed by HealthInsurance information system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the healthprofessional responsible for the therapeutic accompaniment the provider of theremote monitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
30
31 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Remote monitoring of renal
replacement treatmentsPatients treated by kidney graft
ANJH Paris 20 mai 2019
32
The future in remote monitoring of patients treated by
kidney graft ETAPE Program led by French Ministry of
Health and Health Insurance (2018-21)
Experimentation remote monitoring funding of patients grafted for more than 6months
A precise perimeter strict eligibility conditions
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient followed by Health Insuranceinformation system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the health professionalresponsible for the therapeutic accompaniment the provider of the remotemonitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
33
34 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Three prospectives studies controlled and
randomized (results end 2019-2020)
Foucher Y Meurette A Daguin P Bonnaud-Antignac A Hardouin JB Chailan S Neau K Papuchon E Gaboriau S Legendre C Moreacutelon E Tessier P Giral M
A personalized follow-up of kidney transplant recipients using video conferencing basedon a 1-year scoring system predictive of long term graft failure (TELEGRAFT study) protocolfor a randomized controlled trial
BMC Nephrol 2015 Jan 28 16 6 doi 1011861471-2369-16-6
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R Laplaud D Noeumll C Kessler M
Cost-effectiveness of home telemonitoring in chronic kidney disease patients at differentstages by a pragmatic randomized controlled trial (eNephro) rationale and study design
BMC Nephrol 2017 Apr 518(1)126 doi 101186s12882-017-0529-2
Pape L de Zwaan M Tegtbur U Feldhaus F Wolff JK Schiffer L Lerch C Hellrung N KliemV Lonnemann G Nolting HD Schiffer M
The KTx360deg-study a multicenter multisectoral multimodal telemedicine-based follow-upcare model to improve care and reduce health-care costs after kidney transplantation inchildren and adults
BMC Health Serv Res 2017 Aug 23 17(1)587 doi 101186s12913-017-2545-0
ANJH Paris 20 mai 2019
35
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
Teleconsultation at the end of hemodialysis session
ANJH Paris 20 mai 2019
23
Validation of teledialysis process by
French Health Authority in january 2010
Janvier 2010
ANJH Paris 20 mai 2019
24
Introduction of teledialysis in a new decree
in February 2012
Home
dialysis
Satellite
dialysis
Satellite dialysis
with nurse
Heavy dialysis
center
Doctor time given by the end of session teleconsult
On-site nephrology
team
Cs month Cs et visitmonth Visitweek
Consent of the patient
Patient stabilized in dialysis treatment
Decree of
september 2002Telemedicine decreeof february 2012
ANJH Paris 20 mai 2019
25
Lighted dialysis
center (UDM)
Compliance of the dialysis population to quality indicators
Pre dialytic phosphate (mmoll)
Summary graph of the dialysis population
Patients below the normal range
Patients over the
normal range
ANJH Paris 20 mai 2019
26
Diatelic system in Peritoneal Dialysis
since 2001(1)
ANJH Paris 20 mai 2019
27
Diatelic system in Peritoneal Dialysis
since 2001(2)
Patient nurse family physician give dialysis data from home over
the internet
By secure messaging the patient expresses his ou her remarks with
the healthcare team by continuous exchange
=gt
ANJH Paris 20 mai 2019
28
ldquo
rdquo
In the nephrology setting home telemonitoring has
been evaluated in home dialysis patients but data
are scarce concerning chronic kidney disease (CKD)
patients before and after renal replacement
therapy The eNephro study is designed to assess thecost effectiveness clinicalbiological impact and
patient perception of a home telemonitoring for
CKD patients
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R
Laplaud D Noeumll C Kessler M Cost-effectiveness of home telemonitoring in chronic
kidney disease patients at different stages by a pragmatic randomized controlled
trial (eNephro) rationale and study design BMC Nephrol 2017 Apr 518(1)126
doi 101186s12882-017-0529-2
ANJH Paris 20 mai 2019
29
The future in remote monitoring of patients treated by
hemodialysis ETAPE Program led by French Ministry
of Health and Health Insurance (2018-21)
Experimentation of telemonitoring funding in hemodialysis patients outside the heavy dialysis center
A precise perimeter (autodialysis UDM homehemodialysis ()) strict eligibilityconditions Patients should be extracted from heavy dialysis center
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient Study followed by HealthInsurance information system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the healthprofessional responsible for the therapeutic accompaniment the provider of theremote monitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
30
31 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Remote monitoring of renal
replacement treatmentsPatients treated by kidney graft
ANJH Paris 20 mai 2019
32
The future in remote monitoring of patients treated by
kidney graft ETAPE Program led by French Ministry of
Health and Health Insurance (2018-21)
Experimentation remote monitoring funding of patients grafted for more than 6months
A precise perimeter strict eligibility conditions
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient followed by Health Insuranceinformation system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the health professionalresponsible for the therapeutic accompaniment the provider of the remotemonitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
33
34 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Three prospectives studies controlled and
randomized (results end 2019-2020)
Foucher Y Meurette A Daguin P Bonnaud-Antignac A Hardouin JB Chailan S Neau K Papuchon E Gaboriau S Legendre C Moreacutelon E Tessier P Giral M
A personalized follow-up of kidney transplant recipients using video conferencing basedon a 1-year scoring system predictive of long term graft failure (TELEGRAFT study) protocolfor a randomized controlled trial
BMC Nephrol 2015 Jan 28 16 6 doi 1011861471-2369-16-6
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R Laplaud D Noeumll C Kessler M
Cost-effectiveness of home telemonitoring in chronic kidney disease patients at differentstages by a pragmatic randomized controlled trial (eNephro) rationale and study design
BMC Nephrol 2017 Apr 518(1)126 doi 101186s12882-017-0529-2
Pape L de Zwaan M Tegtbur U Feldhaus F Wolff JK Schiffer L Lerch C Hellrung N KliemV Lonnemann G Nolting HD Schiffer M
The KTx360deg-study a multicenter multisectoral multimodal telemedicine-based follow-upcare model to improve care and reduce health-care costs after kidney transplantation inchildren and adults
BMC Health Serv Res 2017 Aug 23 17(1)587 doi 101186s12913-017-2545-0
ANJH Paris 20 mai 2019
35
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
Validation of teledialysis process by
French Health Authority in january 2010
Janvier 2010
ANJH Paris 20 mai 2019
24
Introduction of teledialysis in a new decree
in February 2012
Home
dialysis
Satellite
dialysis
Satellite dialysis
with nurse
Heavy dialysis
center
Doctor time given by the end of session teleconsult
On-site nephrology
team
Cs month Cs et visitmonth Visitweek
Consent of the patient
Patient stabilized in dialysis treatment
Decree of
september 2002Telemedicine decreeof february 2012
ANJH Paris 20 mai 2019
25
Lighted dialysis
center (UDM)
Compliance of the dialysis population to quality indicators
Pre dialytic phosphate (mmoll)
Summary graph of the dialysis population
Patients below the normal range
Patients over the
normal range
ANJH Paris 20 mai 2019
26
Diatelic system in Peritoneal Dialysis
since 2001(1)
ANJH Paris 20 mai 2019
27
Diatelic system in Peritoneal Dialysis
since 2001(2)
Patient nurse family physician give dialysis data from home over
the internet
By secure messaging the patient expresses his ou her remarks with
the healthcare team by continuous exchange
=gt
ANJH Paris 20 mai 2019
28
ldquo
rdquo
In the nephrology setting home telemonitoring has
been evaluated in home dialysis patients but data
are scarce concerning chronic kidney disease (CKD)
patients before and after renal replacement
therapy The eNephro study is designed to assess thecost effectiveness clinicalbiological impact and
patient perception of a home telemonitoring for
CKD patients
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R
Laplaud D Noeumll C Kessler M Cost-effectiveness of home telemonitoring in chronic
kidney disease patients at different stages by a pragmatic randomized controlled
trial (eNephro) rationale and study design BMC Nephrol 2017 Apr 518(1)126
doi 101186s12882-017-0529-2
ANJH Paris 20 mai 2019
29
The future in remote monitoring of patients treated by
hemodialysis ETAPE Program led by French Ministry
of Health and Health Insurance (2018-21)
Experimentation of telemonitoring funding in hemodialysis patients outside the heavy dialysis center
A precise perimeter (autodialysis UDM homehemodialysis ()) strict eligibilityconditions Patients should be extracted from heavy dialysis center
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient Study followed by HealthInsurance information system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the healthprofessional responsible for the therapeutic accompaniment the provider of theremote monitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
30
31 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Remote monitoring of renal
replacement treatmentsPatients treated by kidney graft
ANJH Paris 20 mai 2019
32
The future in remote monitoring of patients treated by
kidney graft ETAPE Program led by French Ministry of
Health and Health Insurance (2018-21)
Experimentation remote monitoring funding of patients grafted for more than 6months
A precise perimeter strict eligibility conditions
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient followed by Health Insuranceinformation system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the health professionalresponsible for the therapeutic accompaniment the provider of the remotemonitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
33
34 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Three prospectives studies controlled and
randomized (results end 2019-2020)
Foucher Y Meurette A Daguin P Bonnaud-Antignac A Hardouin JB Chailan S Neau K Papuchon E Gaboriau S Legendre C Moreacutelon E Tessier P Giral M
A personalized follow-up of kidney transplant recipients using video conferencing basedon a 1-year scoring system predictive of long term graft failure (TELEGRAFT study) protocolfor a randomized controlled trial
BMC Nephrol 2015 Jan 28 16 6 doi 1011861471-2369-16-6
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R Laplaud D Noeumll C Kessler M
Cost-effectiveness of home telemonitoring in chronic kidney disease patients at differentstages by a pragmatic randomized controlled trial (eNephro) rationale and study design
BMC Nephrol 2017 Apr 518(1)126 doi 101186s12882-017-0529-2
Pape L de Zwaan M Tegtbur U Feldhaus F Wolff JK Schiffer L Lerch C Hellrung N KliemV Lonnemann G Nolting HD Schiffer M
The KTx360deg-study a multicenter multisectoral multimodal telemedicine-based follow-upcare model to improve care and reduce health-care costs after kidney transplantation inchildren and adults
BMC Health Serv Res 2017 Aug 23 17(1)587 doi 101186s12913-017-2545-0
ANJH Paris 20 mai 2019
35
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
Introduction of teledialysis in a new decree
in February 2012
Home
dialysis
Satellite
dialysis
Satellite dialysis
with nurse
Heavy dialysis
center
Doctor time given by the end of session teleconsult
On-site nephrology
team
Cs month Cs et visitmonth Visitweek
Consent of the patient
Patient stabilized in dialysis treatment
Decree of
september 2002Telemedicine decreeof february 2012
ANJH Paris 20 mai 2019
25
Lighted dialysis
center (UDM)
Compliance of the dialysis population to quality indicators
Pre dialytic phosphate (mmoll)
Summary graph of the dialysis population
Patients below the normal range
Patients over the
normal range
ANJH Paris 20 mai 2019
26
Diatelic system in Peritoneal Dialysis
since 2001(1)
ANJH Paris 20 mai 2019
27
Diatelic system in Peritoneal Dialysis
since 2001(2)
Patient nurse family physician give dialysis data from home over
the internet
By secure messaging the patient expresses his ou her remarks with
the healthcare team by continuous exchange
=gt
ANJH Paris 20 mai 2019
28
ldquo
rdquo
In the nephrology setting home telemonitoring has
been evaluated in home dialysis patients but data
are scarce concerning chronic kidney disease (CKD)
patients before and after renal replacement
therapy The eNephro study is designed to assess thecost effectiveness clinicalbiological impact and
patient perception of a home telemonitoring for
CKD patients
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R
Laplaud D Noeumll C Kessler M Cost-effectiveness of home telemonitoring in chronic
kidney disease patients at different stages by a pragmatic randomized controlled
trial (eNephro) rationale and study design BMC Nephrol 2017 Apr 518(1)126
doi 101186s12882-017-0529-2
ANJH Paris 20 mai 2019
29
The future in remote monitoring of patients treated by
hemodialysis ETAPE Program led by French Ministry
of Health and Health Insurance (2018-21)
Experimentation of telemonitoring funding in hemodialysis patients outside the heavy dialysis center
A precise perimeter (autodialysis UDM homehemodialysis ()) strict eligibilityconditions Patients should be extracted from heavy dialysis center
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient Study followed by HealthInsurance information system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the healthprofessional responsible for the therapeutic accompaniment the provider of theremote monitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
30
31 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Remote monitoring of renal
replacement treatmentsPatients treated by kidney graft
ANJH Paris 20 mai 2019
32
The future in remote monitoring of patients treated by
kidney graft ETAPE Program led by French Ministry of
Health and Health Insurance (2018-21)
Experimentation remote monitoring funding of patients grafted for more than 6months
A precise perimeter strict eligibility conditions
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient followed by Health Insuranceinformation system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the health professionalresponsible for the therapeutic accompaniment the provider of the remotemonitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
33
34 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Three prospectives studies controlled and
randomized (results end 2019-2020)
Foucher Y Meurette A Daguin P Bonnaud-Antignac A Hardouin JB Chailan S Neau K Papuchon E Gaboriau S Legendre C Moreacutelon E Tessier P Giral M
A personalized follow-up of kidney transplant recipients using video conferencing basedon a 1-year scoring system predictive of long term graft failure (TELEGRAFT study) protocolfor a randomized controlled trial
BMC Nephrol 2015 Jan 28 16 6 doi 1011861471-2369-16-6
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R Laplaud D Noeumll C Kessler M
Cost-effectiveness of home telemonitoring in chronic kidney disease patients at differentstages by a pragmatic randomized controlled trial (eNephro) rationale and study design
BMC Nephrol 2017 Apr 518(1)126 doi 101186s12882-017-0529-2
Pape L de Zwaan M Tegtbur U Feldhaus F Wolff JK Schiffer L Lerch C Hellrung N KliemV Lonnemann G Nolting HD Schiffer M
The KTx360deg-study a multicenter multisectoral multimodal telemedicine-based follow-upcare model to improve care and reduce health-care costs after kidney transplantation inchildren and adults
BMC Health Serv Res 2017 Aug 23 17(1)587 doi 101186s12913-017-2545-0
ANJH Paris 20 mai 2019
35
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
Compliance of the dialysis population to quality indicators
Pre dialytic phosphate (mmoll)
Summary graph of the dialysis population
Patients below the normal range
Patients over the
normal range
ANJH Paris 20 mai 2019
26
Diatelic system in Peritoneal Dialysis
since 2001(1)
ANJH Paris 20 mai 2019
27
Diatelic system in Peritoneal Dialysis
since 2001(2)
Patient nurse family physician give dialysis data from home over
the internet
By secure messaging the patient expresses his ou her remarks with
the healthcare team by continuous exchange
=gt
ANJH Paris 20 mai 2019
28
ldquo
rdquo
In the nephrology setting home telemonitoring has
been evaluated in home dialysis patients but data
are scarce concerning chronic kidney disease (CKD)
patients before and after renal replacement
therapy The eNephro study is designed to assess thecost effectiveness clinicalbiological impact and
patient perception of a home telemonitoring for
CKD patients
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R
Laplaud D Noeumll C Kessler M Cost-effectiveness of home telemonitoring in chronic
kidney disease patients at different stages by a pragmatic randomized controlled
trial (eNephro) rationale and study design BMC Nephrol 2017 Apr 518(1)126
doi 101186s12882-017-0529-2
ANJH Paris 20 mai 2019
29
The future in remote monitoring of patients treated by
hemodialysis ETAPE Program led by French Ministry
of Health and Health Insurance (2018-21)
Experimentation of telemonitoring funding in hemodialysis patients outside the heavy dialysis center
A precise perimeter (autodialysis UDM homehemodialysis ()) strict eligibilityconditions Patients should be extracted from heavy dialysis center
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient Study followed by HealthInsurance information system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the healthprofessional responsible for the therapeutic accompaniment the provider of theremote monitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
30
31 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Remote monitoring of renal
replacement treatmentsPatients treated by kidney graft
ANJH Paris 20 mai 2019
32
The future in remote monitoring of patients treated by
kidney graft ETAPE Program led by French Ministry of
Health and Health Insurance (2018-21)
Experimentation remote monitoring funding of patients grafted for more than 6months
A precise perimeter strict eligibility conditions
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient followed by Health Insuranceinformation system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the health professionalresponsible for the therapeutic accompaniment the provider of the remotemonitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
33
34 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Three prospectives studies controlled and
randomized (results end 2019-2020)
Foucher Y Meurette A Daguin P Bonnaud-Antignac A Hardouin JB Chailan S Neau K Papuchon E Gaboriau S Legendre C Moreacutelon E Tessier P Giral M
A personalized follow-up of kidney transplant recipients using video conferencing basedon a 1-year scoring system predictive of long term graft failure (TELEGRAFT study) protocolfor a randomized controlled trial
BMC Nephrol 2015 Jan 28 16 6 doi 1011861471-2369-16-6
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R Laplaud D Noeumll C Kessler M
Cost-effectiveness of home telemonitoring in chronic kidney disease patients at differentstages by a pragmatic randomized controlled trial (eNephro) rationale and study design
BMC Nephrol 2017 Apr 518(1)126 doi 101186s12882-017-0529-2
Pape L de Zwaan M Tegtbur U Feldhaus F Wolff JK Schiffer L Lerch C Hellrung N KliemV Lonnemann G Nolting HD Schiffer M
The KTx360deg-study a multicenter multisectoral multimodal telemedicine-based follow-upcare model to improve care and reduce health-care costs after kidney transplantation inchildren and adults
BMC Health Serv Res 2017 Aug 23 17(1)587 doi 101186s12913-017-2545-0
ANJH Paris 20 mai 2019
35
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
Diatelic system in Peritoneal Dialysis
since 2001(1)
ANJH Paris 20 mai 2019
27
Diatelic system in Peritoneal Dialysis
since 2001(2)
Patient nurse family physician give dialysis data from home over
the internet
By secure messaging the patient expresses his ou her remarks with
the healthcare team by continuous exchange
=gt
ANJH Paris 20 mai 2019
28
ldquo
rdquo
In the nephrology setting home telemonitoring has
been evaluated in home dialysis patients but data
are scarce concerning chronic kidney disease (CKD)
patients before and after renal replacement
therapy The eNephro study is designed to assess thecost effectiveness clinicalbiological impact and
patient perception of a home telemonitoring for
CKD patients
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R
Laplaud D Noeumll C Kessler M Cost-effectiveness of home telemonitoring in chronic
kidney disease patients at different stages by a pragmatic randomized controlled
trial (eNephro) rationale and study design BMC Nephrol 2017 Apr 518(1)126
doi 101186s12882-017-0529-2
ANJH Paris 20 mai 2019
29
The future in remote monitoring of patients treated by
hemodialysis ETAPE Program led by French Ministry
of Health and Health Insurance (2018-21)
Experimentation of telemonitoring funding in hemodialysis patients outside the heavy dialysis center
A precise perimeter (autodialysis UDM homehemodialysis ()) strict eligibilityconditions Patients should be extracted from heavy dialysis center
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient Study followed by HealthInsurance information system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the healthprofessional responsible for the therapeutic accompaniment the provider of theremote monitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
30
31 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Remote monitoring of renal
replacement treatmentsPatients treated by kidney graft
ANJH Paris 20 mai 2019
32
The future in remote monitoring of patients treated by
kidney graft ETAPE Program led by French Ministry of
Health and Health Insurance (2018-21)
Experimentation remote monitoring funding of patients grafted for more than 6months
A precise perimeter strict eligibility conditions
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient followed by Health Insuranceinformation system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the health professionalresponsible for the therapeutic accompaniment the provider of the remotemonitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
33
34 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Three prospectives studies controlled and
randomized (results end 2019-2020)
Foucher Y Meurette A Daguin P Bonnaud-Antignac A Hardouin JB Chailan S Neau K Papuchon E Gaboriau S Legendre C Moreacutelon E Tessier P Giral M
A personalized follow-up of kidney transplant recipients using video conferencing basedon a 1-year scoring system predictive of long term graft failure (TELEGRAFT study) protocolfor a randomized controlled trial
BMC Nephrol 2015 Jan 28 16 6 doi 1011861471-2369-16-6
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R Laplaud D Noeumll C Kessler M
Cost-effectiveness of home telemonitoring in chronic kidney disease patients at differentstages by a pragmatic randomized controlled trial (eNephro) rationale and study design
BMC Nephrol 2017 Apr 518(1)126 doi 101186s12882-017-0529-2
Pape L de Zwaan M Tegtbur U Feldhaus F Wolff JK Schiffer L Lerch C Hellrung N KliemV Lonnemann G Nolting HD Schiffer M
The KTx360deg-study a multicenter multisectoral multimodal telemedicine-based follow-upcare model to improve care and reduce health-care costs after kidney transplantation inchildren and adults
BMC Health Serv Res 2017 Aug 23 17(1)587 doi 101186s12913-017-2545-0
ANJH Paris 20 mai 2019
35
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
Diatelic system in Peritoneal Dialysis
since 2001(2)
Patient nurse family physician give dialysis data from home over
the internet
By secure messaging the patient expresses his ou her remarks with
the healthcare team by continuous exchange
=gt
ANJH Paris 20 mai 2019
28
ldquo
rdquo
In the nephrology setting home telemonitoring has
been evaluated in home dialysis patients but data
are scarce concerning chronic kidney disease (CKD)
patients before and after renal replacement
therapy The eNephro study is designed to assess thecost effectiveness clinicalbiological impact and
patient perception of a home telemonitoring for
CKD patients
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R
Laplaud D Noeumll C Kessler M Cost-effectiveness of home telemonitoring in chronic
kidney disease patients at different stages by a pragmatic randomized controlled
trial (eNephro) rationale and study design BMC Nephrol 2017 Apr 518(1)126
doi 101186s12882-017-0529-2
ANJH Paris 20 mai 2019
29
The future in remote monitoring of patients treated by
hemodialysis ETAPE Program led by French Ministry
of Health and Health Insurance (2018-21)
Experimentation of telemonitoring funding in hemodialysis patients outside the heavy dialysis center
A precise perimeter (autodialysis UDM homehemodialysis ()) strict eligibilityconditions Patients should be extracted from heavy dialysis center
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient Study followed by HealthInsurance information system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the healthprofessional responsible for the therapeutic accompaniment the provider of theremote monitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
30
31 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Remote monitoring of renal
replacement treatmentsPatients treated by kidney graft
ANJH Paris 20 mai 2019
32
The future in remote monitoring of patients treated by
kidney graft ETAPE Program led by French Ministry of
Health and Health Insurance (2018-21)
Experimentation remote monitoring funding of patients grafted for more than 6months
A precise perimeter strict eligibility conditions
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient followed by Health Insuranceinformation system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the health professionalresponsible for the therapeutic accompaniment the provider of the remotemonitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
33
34 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Three prospectives studies controlled and
randomized (results end 2019-2020)
Foucher Y Meurette A Daguin P Bonnaud-Antignac A Hardouin JB Chailan S Neau K Papuchon E Gaboriau S Legendre C Moreacutelon E Tessier P Giral M
A personalized follow-up of kidney transplant recipients using video conferencing basedon a 1-year scoring system predictive of long term graft failure (TELEGRAFT study) protocolfor a randomized controlled trial
BMC Nephrol 2015 Jan 28 16 6 doi 1011861471-2369-16-6
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R Laplaud D Noeumll C Kessler M
Cost-effectiveness of home telemonitoring in chronic kidney disease patients at differentstages by a pragmatic randomized controlled trial (eNephro) rationale and study design
BMC Nephrol 2017 Apr 518(1)126 doi 101186s12882-017-0529-2
Pape L de Zwaan M Tegtbur U Feldhaus F Wolff JK Schiffer L Lerch C Hellrung N KliemV Lonnemann G Nolting HD Schiffer M
The KTx360deg-study a multicenter multisectoral multimodal telemedicine-based follow-upcare model to improve care and reduce health-care costs after kidney transplantation inchildren and adults
BMC Health Serv Res 2017 Aug 23 17(1)587 doi 101186s12913-017-2545-0
ANJH Paris 20 mai 2019
35
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
ldquo
rdquo
In the nephrology setting home telemonitoring has
been evaluated in home dialysis patients but data
are scarce concerning chronic kidney disease (CKD)
patients before and after renal replacement
therapy The eNephro study is designed to assess thecost effectiveness clinicalbiological impact and
patient perception of a home telemonitoring for
CKD patients
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R
Laplaud D Noeumll C Kessler M Cost-effectiveness of home telemonitoring in chronic
kidney disease patients at different stages by a pragmatic randomized controlled
trial (eNephro) rationale and study design BMC Nephrol 2017 Apr 518(1)126
doi 101186s12882-017-0529-2
ANJH Paris 20 mai 2019
29
The future in remote monitoring of patients treated by
hemodialysis ETAPE Program led by French Ministry
of Health and Health Insurance (2018-21)
Experimentation of telemonitoring funding in hemodialysis patients outside the heavy dialysis center
A precise perimeter (autodialysis UDM homehemodialysis ()) strict eligibilityconditions Patients should be extracted from heavy dialysis center
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient Study followed by HealthInsurance information system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the healthprofessional responsible for the therapeutic accompaniment the provider of theremote monitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
30
31 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Remote monitoring of renal
replacement treatmentsPatients treated by kidney graft
ANJH Paris 20 mai 2019
32
The future in remote monitoring of patients treated by
kidney graft ETAPE Program led by French Ministry of
Health and Health Insurance (2018-21)
Experimentation remote monitoring funding of patients grafted for more than 6months
A precise perimeter strict eligibility conditions
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient followed by Health Insuranceinformation system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the health professionalresponsible for the therapeutic accompaniment the provider of the remotemonitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
33
34 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Three prospectives studies controlled and
randomized (results end 2019-2020)
Foucher Y Meurette A Daguin P Bonnaud-Antignac A Hardouin JB Chailan S Neau K Papuchon E Gaboriau S Legendre C Moreacutelon E Tessier P Giral M
A personalized follow-up of kidney transplant recipients using video conferencing basedon a 1-year scoring system predictive of long term graft failure (TELEGRAFT study) protocolfor a randomized controlled trial
BMC Nephrol 2015 Jan 28 16 6 doi 1011861471-2369-16-6
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R Laplaud D Noeumll C Kessler M
Cost-effectiveness of home telemonitoring in chronic kidney disease patients at differentstages by a pragmatic randomized controlled trial (eNephro) rationale and study design
BMC Nephrol 2017 Apr 518(1)126 doi 101186s12882-017-0529-2
Pape L de Zwaan M Tegtbur U Feldhaus F Wolff JK Schiffer L Lerch C Hellrung N KliemV Lonnemann G Nolting HD Schiffer M
The KTx360deg-study a multicenter multisectoral multimodal telemedicine-based follow-upcare model to improve care and reduce health-care costs after kidney transplantation inchildren and adults
BMC Health Serv Res 2017 Aug 23 17(1)587 doi 101186s12913-017-2545-0
ANJH Paris 20 mai 2019
35
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
The future in remote monitoring of patients treated by
hemodialysis ETAPE Program led by French Ministry
of Health and Health Insurance (2018-21)
Experimentation of telemonitoring funding in hemodialysis patients outside the heavy dialysis center
A precise perimeter (autodialysis UDM homehemodialysis ()) strict eligibilityconditions Patients should be extracted from heavy dialysis center
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient Study followed by HealthInsurance information system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the healthprofessional responsible for the therapeutic accompaniment the provider of theremote monitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
30
31 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Remote monitoring of renal
replacement treatmentsPatients treated by kidney graft
ANJH Paris 20 mai 2019
32
The future in remote monitoring of patients treated by
kidney graft ETAPE Program led by French Ministry of
Health and Health Insurance (2018-21)
Experimentation remote monitoring funding of patients grafted for more than 6months
A precise perimeter strict eligibility conditions
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient followed by Health Insuranceinformation system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the health professionalresponsible for the therapeutic accompaniment the provider of the remotemonitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
33
34 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Three prospectives studies controlled and
randomized (results end 2019-2020)
Foucher Y Meurette A Daguin P Bonnaud-Antignac A Hardouin JB Chailan S Neau K Papuchon E Gaboriau S Legendre C Moreacutelon E Tessier P Giral M
A personalized follow-up of kidney transplant recipients using video conferencing basedon a 1-year scoring system predictive of long term graft failure (TELEGRAFT study) protocolfor a randomized controlled trial
BMC Nephrol 2015 Jan 28 16 6 doi 1011861471-2369-16-6
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R Laplaud D Noeumll C Kessler M
Cost-effectiveness of home telemonitoring in chronic kidney disease patients at differentstages by a pragmatic randomized controlled trial (eNephro) rationale and study design
BMC Nephrol 2017 Apr 518(1)126 doi 101186s12882-017-0529-2
Pape L de Zwaan M Tegtbur U Feldhaus F Wolff JK Schiffer L Lerch C Hellrung N KliemV Lonnemann G Nolting HD Schiffer M
The KTx360deg-study a multicenter multisectoral multimodal telemedicine-based follow-upcare model to improve care and reduce health-care costs after kidney transplantation inchildren and adults
BMC Health Serv Res 2017 Aug 23 17(1)587 doi 101186s12913-017-2545-0
ANJH Paris 20 mai 2019
35
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
31 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Remote monitoring of renal
replacement treatmentsPatients treated by kidney graft
ANJH Paris 20 mai 2019
32
The future in remote monitoring of patients treated by
kidney graft ETAPE Program led by French Ministry of
Health and Health Insurance (2018-21)
Experimentation remote monitoring funding of patients grafted for more than 6months
A precise perimeter strict eligibility conditions
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient followed by Health Insuranceinformation system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the health professionalresponsible for the therapeutic accompaniment the provider of the remotemonitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
33
34 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Three prospectives studies controlled and
randomized (results end 2019-2020)
Foucher Y Meurette A Daguin P Bonnaud-Antignac A Hardouin JB Chailan S Neau K Papuchon E Gaboriau S Legendre C Moreacutelon E Tessier P Giral M
A personalized follow-up of kidney transplant recipients using video conferencing basedon a 1-year scoring system predictive of long term graft failure (TELEGRAFT study) protocolfor a randomized controlled trial
BMC Nephrol 2015 Jan 28 16 6 doi 1011861471-2369-16-6
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R Laplaud D Noeumll C Kessler M
Cost-effectiveness of home telemonitoring in chronic kidney disease patients at differentstages by a pragmatic randomized controlled trial (eNephro) rationale and study design
BMC Nephrol 2017 Apr 518(1)126 doi 101186s12882-017-0529-2
Pape L de Zwaan M Tegtbur U Feldhaus F Wolff JK Schiffer L Lerch C Hellrung N KliemV Lonnemann G Nolting HD Schiffer M
The KTx360deg-study a multicenter multisectoral multimodal telemedicine-based follow-upcare model to improve care and reduce health-care costs after kidney transplantation inchildren and adults
BMC Health Serv Res 2017 Aug 23 17(1)587 doi 101186s12913-017-2545-0
ANJH Paris 20 mai 2019
35
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
Remote monitoring of renal
replacement treatmentsPatients treated by kidney graft
ANJH Paris 20 mai 2019
32
The future in remote monitoring of patients treated by
kidney graft ETAPE Program led by French Ministry of
Health and Health Insurance (2018-21)
Experimentation remote monitoring funding of patients grafted for more than 6months
A precise perimeter strict eligibility conditions
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient followed by Health Insuranceinformation system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the health professionalresponsible for the therapeutic accompaniment the provider of the remotemonitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
33
34 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Three prospectives studies controlled and
randomized (results end 2019-2020)
Foucher Y Meurette A Daguin P Bonnaud-Antignac A Hardouin JB Chailan S Neau K Papuchon E Gaboriau S Legendre C Moreacutelon E Tessier P Giral M
A personalized follow-up of kidney transplant recipients using video conferencing basedon a 1-year scoring system predictive of long term graft failure (TELEGRAFT study) protocolfor a randomized controlled trial
BMC Nephrol 2015 Jan 28 16 6 doi 1011861471-2369-16-6
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R Laplaud D Noeumll C Kessler M
Cost-effectiveness of home telemonitoring in chronic kidney disease patients at differentstages by a pragmatic randomized controlled trial (eNephro) rationale and study design
BMC Nephrol 2017 Apr 518(1)126 doi 101186s12882-017-0529-2
Pape L de Zwaan M Tegtbur U Feldhaus F Wolff JK Schiffer L Lerch C Hellrung N KliemV Lonnemann G Nolting HD Schiffer M
The KTx360deg-study a multicenter multisectoral multimodal telemedicine-based follow-upcare model to improve care and reduce health-care costs after kidney transplantation inchildren and adults
BMC Health Serv Res 2017 Aug 23 17(1)587 doi 101186s12913-017-2545-0
ANJH Paris 20 mai 2019
35
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
The future in remote monitoring of patients treated by
kidney graft ETAPE Program led by French Ministry of
Health and Health Insurance (2018-21)
Experimentation remote monitoring funding of patients grafted for more than 6months
A precise perimeter strict eligibility conditions
A minimum number of monitoring parameters for each session
Targets for reduction of expenditures per patient followed by Health Insuranceinformation system (SNIIRAM)
Remuneration of three actors the prescriber nephrologist the health professionalresponsible for the therapeutic accompaniment the provider of the remotemonitoring service
If the target is exceeded 50 of th profits are donated to the three actors
Prescription may be renewed after six months
Results in september 2021
ANJH Paris 20 mai 2019
33
34 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Three prospectives studies controlled and
randomized (results end 2019-2020)
Foucher Y Meurette A Daguin P Bonnaud-Antignac A Hardouin JB Chailan S Neau K Papuchon E Gaboriau S Legendre C Moreacutelon E Tessier P Giral M
A personalized follow-up of kidney transplant recipients using video conferencing basedon a 1-year scoring system predictive of long term graft failure (TELEGRAFT study) protocolfor a randomized controlled trial
BMC Nephrol 2015 Jan 28 16 6 doi 1011861471-2369-16-6
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R Laplaud D Noeumll C Kessler M
Cost-effectiveness of home telemonitoring in chronic kidney disease patients at differentstages by a pragmatic randomized controlled trial (eNephro) rationale and study design
BMC Nephrol 2017 Apr 518(1)126 doi 101186s12882-017-0529-2
Pape L de Zwaan M Tegtbur U Feldhaus F Wolff JK Schiffer L Lerch C Hellrung N KliemV Lonnemann G Nolting HD Schiffer M
The KTx360deg-study a multicenter multisectoral multimodal telemedicine-based follow-upcare model to improve care and reduce health-care costs after kidney transplantation inchildren and adults
BMC Health Serv Res 2017 Aug 23 17(1)587 doi 101186s12913-017-2545-0
ANJH Paris 20 mai 2019
35
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
34 ANJH Paris 20 mai 2019
Remuneration and interest of the actors
Three prospectives studies controlled and
randomized (results end 2019-2020)
Foucher Y Meurette A Daguin P Bonnaud-Antignac A Hardouin JB Chailan S Neau K Papuchon E Gaboriau S Legendre C Moreacutelon E Tessier P Giral M
A personalized follow-up of kidney transplant recipients using video conferencing basedon a 1-year scoring system predictive of long term graft failure (TELEGRAFT study) protocolfor a randomized controlled trial
BMC Nephrol 2015 Jan 28 16 6 doi 1011861471-2369-16-6
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R Laplaud D Noeumll C Kessler M
Cost-effectiveness of home telemonitoring in chronic kidney disease patients at differentstages by a pragmatic randomized controlled trial (eNephro) rationale and study design
BMC Nephrol 2017 Apr 518(1)126 doi 101186s12882-017-0529-2
Pape L de Zwaan M Tegtbur U Feldhaus F Wolff JK Schiffer L Lerch C Hellrung N KliemV Lonnemann G Nolting HD Schiffer M
The KTx360deg-study a multicenter multisectoral multimodal telemedicine-based follow-upcare model to improve care and reduce health-care costs after kidney transplantation inchildren and adults
BMC Health Serv Res 2017 Aug 23 17(1)587 doi 101186s12913-017-2545-0
ANJH Paris 20 mai 2019
35
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
Three prospectives studies controlled and
randomized (results end 2019-2020)
Foucher Y Meurette A Daguin P Bonnaud-Antignac A Hardouin JB Chailan S Neau K Papuchon E Gaboriau S Legendre C Moreacutelon E Tessier P Giral M
A personalized follow-up of kidney transplant recipients using video conferencing basedon a 1-year scoring system predictive of long term graft failure (TELEGRAFT study) protocolfor a randomized controlled trial
BMC Nephrol 2015 Jan 28 16 6 doi 1011861471-2369-16-6
Thilly N Chanliau J Frimat L Combe C Merville P Chauveau P Bataille P Azar R Laplaud D Noeumll C Kessler M
Cost-effectiveness of home telemonitoring in chronic kidney disease patients at differentstages by a pragmatic randomized controlled trial (eNephro) rationale and study design
BMC Nephrol 2017 Apr 518(1)126 doi 101186s12882-017-0529-2
Pape L de Zwaan M Tegtbur U Feldhaus F Wolff JK Schiffer L Lerch C Hellrung N KliemV Lonnemann G Nolting HD Schiffer M
The KTx360deg-study a multicenter multisectoral multimodal telemedicine-based follow-upcare model to improve care and reduce health-care costs after kidney transplantation inchildren and adults
BMC Health Serv Res 2017 Aug 23 17(1)587 doi 101186s12913-017-2545-0
ANJH Paris 20 mai 2019
35
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
Conclusions
In the 21st century home telemonitoring has developed
considerably over recent years in most chronic diseases in order
to improve communication between healthcare professionals
and patients and to promote early detection of deteriorating
health status
Nephrologists have been precursors to home care some forty
years ago they have to develop them again with the use of
digital tools
Medical Artificial Intelligence will help healthcare professionals
deliver quality home care to patients with chronic kidney
disease
ANJH Paris 20 mai 2019
36
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
37 ANJH Paris 20 mai 2019
Thankrsquos
for your
attention
