When Binh Nguyen, then a graduate student in biomedical engineering at the University of Toronto, was working in the renal engineering department of a local hospital, he was struck by what he felt was a suboptimal setup for dialysis treatment.
"Dialysis is typically done in the hospital. Patients will come in and sit in a chair for four hours each treatment and they do this three or four times a week, not including travel time to and from the hospital," says the 25-year-old Mr. Nguyen, who is based in Sault Ste. Marie, during a brief stop in Toronto.
"It's a very disruptive process to have to introduce into your life. I know a lot of younger people who have to drop out of school or switch to a part-time basis or people who have to leave work because of this."
On top of this, dialysis in the hospital is "very expensive," costing an average of $83,000 per patient per year, according to The Kidney Foundation.
Dialysis works by simulating the kidney function. The most common modality involves the insertion of small tubes into the patient's body in order to pump dialysate from a machine into the bloodstream. Dialysate cleans waste product from the blood and restores electrolyte and mineral equilibrium to the body.
Because dialysis behaves as an artificial organ, the longer patients can spend hooked up to the machine, the better. But hospitals have limited resources and allot a three-to-four hour maximum to make sure as many patients as possible can receive what they need.
Efforts have been made to shift dialysis treatment to the patients' homes. It's certainly more convenient and reduces the annual per-individual cost to as low as $30,000, as it eliminates the extra expenses incurred by nurses and facility use. But there are issues that complicate its efficiency.
For starters, there's an enormous amount of equipment required – individuals can blaze through a dozen sets of tubing in a single week – and people who are already dealing with the stress of their illness may have trouble managing a set-up that requires administrative-level organizational skills.
Dialysis can also be an invasive process fraught with risk. At home, patients are responsible for inserting needles into their own body and there are risks of exit site infection: Most patients are educated in their condition by the hospital, but they're not medical professionals and still need continual support from their health-care team.
Taking these complications into consideration, Mr. Nguyen envisioned an all-encompassing lateral system that would optimize the process of in-home dialysis utilizing technology, but most importantly, improving patient experience.
Along with friend and co-founder Jonathan Tomkun, Mr. Nguyen designed a suite of solutions, installed onto a personalized tablet that would simplify, manage, and assist patients in the management of their in-home care.
He decided to set up shop in Sault Ste. Marie as it's one of the most remote locations in Canada, and some patients have to travel up to four hours to get to the nearest hospital.
"People in healthcare are very particular in terms of comparison, so you make sure you're comparing apples to apples," he says. "We wanted to say we're going to do the valuations in a place like Sault Ste. Marie and Toronto so there's no debate whether this is effective in geographical domains."
The result is eQOL, an acronym for "enhanced quality of life," and Mr. Nguyen's ultimate goal for the technology.
"I worked with some patients doing home dialysis and to see these people not let their chronic condition impede their lives was very inspiring to me. What I wanted to do was build solutions that would allow more patients to follow in their footsteps."
eQOL's system has three components. The first is process management to help patients keep their clinical documentation in order, including record logs for their vital signs. What sets eQOL's data collection apart from traditional models is a focus on qualitative data. Patients can take photos of their exit sites using the tablet's camera feature and text it to their doctor. Doctors can examine the image immediately and offer an assessment, instead of the patient having to drive into the hospital to get it checked out days later.
Patients can track their supply count, punch in the number of tubing, solutions, and saline bags used daily, and make sure they're on top of repeat orders. For patients in the Soo, supply trucks only come through town once a month in some places, which means a missed order can have serious consequences.
The second component involves connectivity. Patients can carry out video conferencing with their medical team, an added dimension that may ease language barriers and miscommunication. For those in parts of Canada that still don't have broadband access, there's also texting and video image sharing capabilities.
Finally, the tablet is programmed with an electronic library of the most up-to-date educational training content and peer-reviewed studies. On the receiving end, the tablet is collecting an enormous store of data-driven insights based on patient behaviours (where they swipe, how long they look at a page), and self-reported telemetric data like blood pressure and heart rates.
If health-care apps are a dime a dozen, the scope of Mr. Nguyen's vision has attracted significant investor interest. Mr. Nguyen has impressed the likes of Denis Turcotte enough to sign on as eQOL's chairman and opened doors to big-time partnerships with U of T, MaRS and the Northern Heritage Fund Corporation.
eQOL's projections, if successful, will add another dimension to the successful shift toward home care. It's broad-thinking minds like Mr. Nguygen's that patients with chronic illness can thank the next time they're receiving treatment in the comfort of their own homes.