Case Study: The Renal Remote Clinic

Background

The Renal Remote Clinic was a collaboration between East and North Hertfordshire NHS Trust and v-connect (Red Embedded Systems Ltd), funded by Devices for Dignity and SBRI. It introduced a telemedicine service for the management and support of people on renal replacement therapy — home haemodialysis, peritoneal dialysis, and stable transplant — placing the patient at the centre of their care through remote connectivity.

The catalyst was the increasing catchment area of The Lister Hospital and the need to support patients on home-based renal replacement therapy without requiring frequent travel. The vision was holistic: not a single video appointment, but an integrated approach supporting patients through the full renal replacement therapy journey.

Technology Components

The project combined: two-way audio/video via v-connect (SIP, H264, AES) via TV; recorded video content for patient education; live dialysis data from Fresenius home haemodialysis machines; data card interaction with Baxter peritoneal dialysis machines; Bluetooth physiological monitoring (weight and blood pressure, Continua Alliance certified); high-resolution imaging for fistula inspection; and integration with the hospital's existing database.

Clinical Achievements (Phase 1)

40 patients' homes connected to The Lister Hospital renal department. 13 clinics replaced with remote teleclinics. More than 50 video consultations with patients at home. Ad hoc video calls introduced during clinic hours. 5 consultants engaged (2 transplant, 3 nephrologists). Positive renal nurse engagement.

Patient and System Benefits

Patient and carer benefits: reduced travel to and from hospital; reduced economic cost for family and carers; increased patient confidence and reduced anxiety; immediacy of support; improved patient education; improved compliance and concordance with therapy and medication; family and carer engagement in care. The project saved 84 hours and 3,360 miles of patient travel during Phase 1.

System benefits: increased clinic efficiency; reduced hospital transport costs; increased nurse and consultant efficiency; reduced acute events; and improved access to patient data including home dialysis data and high-resolution images.

The Cross-Silo Attribution Problem

The project poster notes: "Due to the varying impact of the clinic and the multiple system benefits the health economics are complex and require longitudinal monitoring." Benefits (reduced A&E attendances, reduced transport costs, improved therapy compliance) fall across multiple budget lines and cannot be captured in a single cost-benefit calculation within a short timeframe. This is a direct illustration of the cross-silo attribution problem that a two-level evidence architecture must address.