2. End Stage Renal Disease (ESRD)
• 600,000 patients undergoing hemodialysis
• Incur $32 Billion in healthcare expenditures
Life Expectancy
Healthy 50 Year Old 27 years
50 year old dialysis
patient
7 years
Inadequate Fluid
Volume Management is
a critical component of
cardiovascular mortality
Dialysis patients experience higher morbidity & mortality rates
due to cardiovascular disease
3. Hemodialysis
Current Options:
1. Manual measurement
2. Hemocrit Monitor – improves fluid
volume management via blood
volume monitoring during
hemodialysis CRIT-LINE® III
Limitations
Manual Measurement Hemocrit Monitor
Inadequate High unit cost
Knowledge Intensive
(Physician consultations)
Ongoing maintenance
Training intensive Training Intensive
Low adoption
Facility use only Facility use only
4. HemoRemoteView
HemoRemoteView – web/mobile app that allows
dialysis patients, providers, and physicians to measure
& manage fluid volumes in real-time
• SPO2 saturation captured and converted
into hemoglobin concentrations that can
be used for volume management
• Display and disseminate measurements
• Home: patient self-manage fluid
volume and targets
• Dialysis Center: provider captures
current stats and aggregates with
historical information for optimum
dialysis management
5. HemoRemoteView – Dialysis Center
Samsung
Galaxy Note 4
for data collection
Physician’s
smart phone
Dialysis Center
6. HemoRemoteView - Home
Samsung Galaxy Note 4
Dialysis Center - Samsung
Galaxy Note 4 & Web App
Physician’s
smart phone
Healthcare proxy
Text Alert
Text Alert
Text Alert
7. HemoRemoteView - Home
Samsung Galaxy Note 4
Dialysis Center - Samsung
Galaxy Note 4 & Web App
Physician’s
smart phone
Healthcare proxy
Text Alert
Text Alert
Text Alert
ALERT: LIMIT
LIQUID INTAKE
8. Business Model
Pricing:
Dialysis Centers
Patients & Physicians
Customers:
One-time App Purchase
SaaS Licensing
• $20 price
• 70% gross margin
• Data aggregation & trend
analysis of patient fluid volume
levels over time
• Enterprise based licensing
model
9. Team Members
Louis Ercolani, MD
Nephrologist
MGH
Nilesh Sawant
Software Developer
Fresenius Medical Care
Shreyas Mahimkar
Software Developer
Novartis
Stacy Humphrey, MBA
Healthcare Software
Technology Management
Bohan Liu
Pediatric Researcher
MGH
Ben Ho
Web Applications Developer
Partners: EMI
Business/ Clinical Development Software Development
11. “For wavelengths of 660, 805 and 940 nm, the relations between O.D. of whole blood
and hematocrit predicted by Twersky's equation, Loewinger's equation and photon
diffusion equation fitted to the data obtained.”
“We found a good correlation between SpO2 and SaO2 in a wide range of the oxygen
saturation, i.e. SaO2 26-100%. After haemodilution the correlation was improved in
the range 86-100%, but not in the range 26-85%.”
“Correlations coefficients of 0.89 (0.86), 0.77 (0.71) and 0.69 (0.43) were obtained
for the tissue hemoglobin concentration (oxygen saturation) values extracted using
the full spectral Monte Carlo and the ratiometric analysis, for clinical measurements
in head and neck, breast and cervical tissues, respectively.”
Pulse Oximetry Validation Studies
12. End Stage Renal Disease (ESRD)
2012 USRDS Annual Data Report, Volume 2 ESRD
Total Medicare ESRD Expenditures, By Modality
Estimated Number of Point
Prevalent ESRD Patients
More than 600,000 patients are on hemodialysis, accounting for $33 B
in healthcare expenditures
2
13. ESRD Life Expectancy
2012 USRDS Annual Data Report, Volume 2 ESRD
Experience higher morbidity and mortality rates due to cardiovascular disease
Life Expectancy
Healthy 50 Year Old 27 years
50 year old dialysis
patient
7 years
Inadequate Volume Fluid Management is a critical component to
cardiovascular morbidity and mortality
14. Market Segmentation By Age
Incident Counts & Adjusted
Rates of ESRD
2012 USRDS Annual Data Report, Volume 2 ESRD; Arbitron Inc. and Edison Research
Smartphone Ownership
Highest incidence among 45-64
year old patients
51% of Americans, aged 45-54, and 34% of Americans,
aged 55-64, have smartphones
Editor's Notes
90K patients per year die from dialysis complications
It’s because of those limitations and the fact that 90K lives are lost each year due to dialysis complications that we spent this hackathon developing HemoRemoteView.
HemoRemoteView is an app that allows the patient, the provider, and the monitoring physician to measure and manage fluid volumes in real-time.
It utilizes the oxygen saturation sensor (pulse oximetry) on the Samsung Galaxy Note 4 to capture oxygen saturation levels [either continuous or at certain intervals] and converts those stats into hemoglobin concentrations.
Let’s walk through HemoRemoteView in action….
During a dialysis visit, hemoglobin concentrations are captured for each patient via the Galaxy Note 4 and uploaded into the web-based dashboard application. This allows the nurse or tech to assess current levels and compare to previous visits. If levels are above or below targets, the nurse/tech can send the information electronically to the monitoring physician for immediate review and response. In many cases, this can avoid unnecessary patient transfer to the ED.
While at home in-between visits, the patient can periodically monitor their hemoglobin concentrations to assess their fluid intake. If their hemoglobin concentrations exceed targets, an in-app message can alert the patient to reduce their fluid intake. The app can also be set up to send an alert to a healthcare proxy or to the physician to make them aware of the situation and take needed action.
While at home in-between visits, the patient can periodically monitor their hemoglobin concentrations to assess their fluid intake. If their hemoglobin levels exceed targets, an in-app message can alert the patient to reduce their fluid intake. The app can also be set up to send an alert to a healthcare proxy or to the physician to make them aware of the situation and take needed action.
We’ve identified two customer segment groups. The physician and patient will share the same UI experience and we will sell the app through the iStore and Android store. The dialysis center is the other customer segment. There are 5K dialysis centers in a concentrated market , and here we’re looking at a SaaS enterprise licensing model to reflect the data aggregation and trend analysis capabilities provided.
And here is the team behind HemoRemoteView. We’re made up of clinical, business and software development experts.
