Scalable Digital Platform Delivering 5 Stars
The Client
The client is a world-leading medical device company that offers full range renal-care products and services. Through its network of over 4,100 clinics, the client provides dialysis treatment to over 340,000 patients around the globe. In 2023, ~52 million dialysis treatments were delivered globally through hospitals, out-patient clinics and home-hemodialysis.
Problems Faced
The leading cause of death in dialysis patients—between 10% to 20%—is from infections at the dialysis site. This is largely avoidable if care teams have real-time patient information. The client’s native ecosystem includes several different EMR and EHR vendor solutions and knowledge bases that exchange staggering amounts of data, which makes real-time access challenging to scale.
The Objective
In continuing their tradition of patient-centric innovation, the client wanted to develop a data-driven next-gen application that could provide complete, single, composite views of patient information across all sources in their network. The goal was to power simple point-of-care apps that were capable of providing reliable near real-time contextual data at the requesting clinic, regardless of which EMR was used, or where the data was saved. After doing their independent research, they decided to power their renal care business network with an open-standards back-end to allow the seamless collection, aggregation and exchange of data. Since their network is vertically integrated, their application and data platform had to support different types of care teams—administration, ambulatory in-patient, out-patient vascular access centers, laboratories, and medical officers who needed to pull analytics and reports. They evaluated building their own home-growing IT infrastructure, and decided against allocating internal innovation efforts and technical resources to create it from scratch. They leveraged Smile Digital Health’s (Smile) Health Data Platform, as a trusted, market-ready industry solution to meet their objectives and modernize their data infrastructure.
The Solution
Smile’s FHIR-native Health Data Platform is the backend to the client’s renal care line of business. Upon this open-standards architecture, Smile developed a SMART on FHIR application with end-to-end clinical workflows which allows integrated data to be shared across multiple care teams and systems.
This enabled access to real-time data, speedier assessments and treatments. Clinicians, administrative staff, and broader care teams were able to manage patient care and infection risk thereby reducing mortality rates and adverse events within the population. The result was a dramatic increase from a 3-star CMS rating to a 5-star rating in one year.
The powerful Subscriptions feature was enabled as a way for clinicians to get notified when a patient profile changes—arrival of a new lab test, completion of the treatment or the changing risk level of a patient—so that delays and gaps in care are avoided. This improved overall patient safety and satisfaction for the client’s population base.
Based on the extensive experience from over 160 FHIR-based enterprise-level implementations, and actively innovating with HAPI FHIR and IGs (Implementation Guides), Smile was able to provide the requisite architecture and data models to the client that enabled near-infinite scale. This freed up the client’s technical and operational resources to focus on their business needs. Upon Smile’s FHIR open-standards Health Data Platform, the client’s technical team created a suite of self-maintained point-of-care apps to be used in primary treatment, as needed. They are able to operate with flexibility as well as maintain ownership and control of their data, processes and innovation.
Why SMART on FHIR?
Since apps come with their own proprietary databases, data models, and interfaces, there is a lack of standardization. As a result, each new app an organization deploys immediately becomes a legacy product that IT teams have to create custom integrations for, as well as maintain. SMART on FHIR is a set of open specifications to integrate apps with multiple EHRs, EMRs and IT systems. The client’s technical team was able to build SMART on FHIR apps that enabled a variety of use-cases—primary care, analytics, reporting and more—to exist within the same Health Data Platform infrastructure, as they all had a common back-end.
Performance
With the Smile Health Data Platform as their foundational architecture, the client expanded its network performance with:
- Over 40 million transactions committed per day
- More than 1 TB of data generated each week
- As many as 12 bundle calls (sets of evidence-based practices that improve patient care) per Clinic Dashboard
- Avg transaction response time 0.07 seconds
- Sustained peak volume of 3000 transactions per second
Benefits
The implementation of Smile’s Health Data Platform and SMART on FHIR apps built upon the architecture had an incredible impact on the client, clinicians and patients being cared for. These impacts include:
- Scale and Standardization
- Relevant, reliable, consistent access to real-time data scaled to over 6,000 renal care sites world-wide, impacting 300,000 dialysis patients.
- Widespread adoption and daily use by over 40,000 clinicians and over 150,000 treatments per day.
- Standardized end-to-end care protocols that allow seamless access to data across user networks including physicians, all client teams, and wider care networks.
- Enhanced Patient Care
- Improved CMS STAR rating from 3-stars to 5-stars within a year of deployment
- Better patient care and safety due to real-time availability of data
- The Subscription feature initiated alerts upon changes to a patient’s profile (e.g. completed lab tests) that closed care gaps
- Enhanced breadth of delivery and expansion of chair-side services
- Innovation
- Ability for the in-house team to build applications with flexibility atop the Health Data Platform for specific needs
- Designed to be future-proof, so that changes to any EHR or other source systems will not affect functionality of the platform
Conclusion
By choosing Smile’s Health Data Platform, over another vendor or building their own in-house solution, the client was able to scale their renal care platform seamlessly and create access to real-time contextual data that delivered better patient care and increased their CMS rating by 2 stars. They were able to structure and standardize staggering volumes of data generated at high velocity because they chose a proven, secure, and scalable standards-based model. In addition, their IT teams were free to solve their own business challenges, as well as build and re-use the data for their operational and research purposes without significant technical effort and time.