See more projectsA Digital Platform for Renal Care

A Digital Platform for Renal Care

Healthcare
Wai Chuen Chan

Wai Chuen Chan

Managing Director at RenalWorks

"Regular sprints and reviews held with Andersen helped us obtain a compliant solution."

A Digital Platform for Renal Care

About the company

RenalWorks, a Singapore-based company, aims to enhance the care provided to patients with end-stage kidney disease. The company sought to upgrade its EHR system in order to offer a white-label cloud-based clinical and administrative data management software solution, affordable yet comprehensive, for nephrology and dialysis. This initiative totally aligned with their motto – "A dialysis EHR in every clinic in the world." The system was expected to enable the capture and storage of hemodialysis data, quickly record, access, and manage crucial information during dialysis sessions. The customer also requested that this data would be available in real-time in both the clinic and remotely for patient care, thereby streamlining the overall care process.

Location:Singapore
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About the project

The prevalence of chronic kidney disease is currently on the rise all over the world, and especially in Asia. The anticipated substantial increase in end-stage renal disease (ESRD) across the region, with annual growth rates exceeding 10%, poses challenges to dialysis clinics. The demand is surging, while the quality cannot be compromised.

Individuals living with ESRD have to undergo hemodialysis (a several hour-long procedure for blood purification executed via complex machines) 2–3 times a week. Comprehensive data from these treatment sessions must be documented and securely stored in patient records. Helping with this challenge via a white-label SaaS clinical data management solution was the main reason behind the joint project carried out by RenalWorks and Andersen.

RenalWorks identified the key areas requiring attention for the new product as follows:

  • Implementing an offline mode and data synchronization for resilience against power outages;
  • Securing top-notch system usability;
  • Simplifying documentation around the treatment process;
  • Introducing a module for recurring billing.
Duration6 months
Technologies
Java
React
AWS
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Java, React, and AWS were chosen for their maturity, rich features, strong community support, and compliance with healthcare standards. These proven technologies offer tactical agility during development and cost-effective post-launch maintenance. They strike an ideal balance between developer productivity, compliant architecture, and long-term total cost of ownership.

By leveraging these technologies, we implemented several vital features. Among them were:

  1. Micro-front-ends. The monolithic structure was split into separate repositories using Webpack Module Federation. This required extensive code rewriting to enable interaction between modules, establish dependencies, configure deployment, and address security challenges. A dynamic global data store was created by our team to allow new modules to plug in additional storage on the fly. Routing and permissions were also modularized.
  2. Offline capabilities. Andersen developed an offline mode initial version to enable data entry from dialysis machines even during Internet disruptions. Using IndexedDB transactions as an intermediary layer, data is saved locally before syncing with the server when connections resume. This demonstrates the potential for full offline support in the future.
  3. Patient calendar. Grids were used by us to enable powerful and adaptable organizational features catered to different clinics’ scheduling needs and event types. Thanks to this feature, patient treatments and appointments are seamlessly coordinated.
  4. Testing. A proxy server using Node and MSW was set up for more robust front-end testing. By manipulating server responses, real application requests can be made with substituted data to validate functionality and flows.

Solution

Andersen's experts, in close collaboration with RenalWorks, developed a white-label SaaS data management software platform that was named RenalGenie.

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App functionality

Key capabilities include:

  • Storing and displaying patient health records;
  • Documenting treatments, charges, and billing details;
  • Managing staff workloads;
  • Configuring user roles and access levels;
  • Scheduling laboratory tests and injections;
  • Tracking treatment plans;
  • Automated notifications for planned procedures and updates;
  • Easy system configuration across clinics and branches.
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Challenges

When working on this data management system project, our team successfully considered and overcame several specific challenges:

  1. Complex requirements gathering: Compiling all necessary clinical, operational, and billing workflows proved challenging due to the uniqueness of these processes, as they demanded in-depth clinical knowledge and expertise. Constant cross-checks and validation were required because of the peculiarity of the medical domain and hemodialysis practice;
  2. Rigorous testing, which is demanded due to the possible high cost of any future bugs or mistakes in clinical practice;
  3. Excellent usability in specific clinical settings (such as during medical procedures, when gloves are often worn, as well as many others);
  4. Managing two teams (RenalWorks' in-house team and Andersen's allocated team);
  5. Team coordination spanning time zones. The blended onshore/offshore structure introduced some responsiveness issues across time zones;
  6. Custom billing module development from scratch to align with specific reimbursement rules.

Critical success factors were:

  1. Excellent Product Owner from RenalWorks' side, with software development and extensive clinical background and first-hand hemodialysis experience from clinical, administrative, and business perspectives, showing the utmost involvement in communication with Andersen's team;
  2. As the requirements’ collection process was complex, the involvement of a seasoned Project Manager and a Business Analyst with medical education was key;
  3. A comprehensive Discovery phase provided the project with a clear vision of the future solution, identifying key functionalities and potential challenges and laying the foundation for subsequent successful development;
  4. The continuous refinement and clarification of requirements throughout the development process. Given the intricate nuances of the healthcare domain, having professionals with medical education and practical experience proved crucial. Their insights and domain knowledge contributed to a seamless collaboration between the technical team and medical experts;
  5. Focus on usability by all team members guided by an experienced UI/UX specialist with cross-domain expertise;
  6. Two-tier model of project management, where a healthcare-experienced Project Manager oversaw the technological processes. Meanwhile, a Delivery Manager ensured that specialists were getting timely support to resolve any bottlenecks, involving additional talent whenever needed and overseeing resources. Such management structure enabled smooth progress, keeping the project on track. Although the project members were located in different regions, smooth coordination across time zones kept all contributors aligned.

Project results

As a result of our involvement, the following results were achieved (as per January 2024):

  • RenalGenie is used in internal facilities and one customer site to begin with;
  • 100% of deadlines were met.

Customer review

Person

Wai Chuen Chan

Managing Director at RenalWorks

Review verified by clutch and matches the customer’s words

Working with Andersen's professionals made it possible for us to successfully pass our ISO 13485 audit and certification. Their knowledge and assistance also enabled us to meet some other compliance requirements. All the things Andersen held, like sprints and reviews, were purposeful and effective. Overall, their team is communicative and easy to work with.

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