Nephrocare Health Services – Best Quality Data Model FINALIST – 2018

India’s largest network of dialysis centres with 135 sites in 85 cities and 18 states, it operates under the brand NephroPlus.

In the majority of dialysis centres in India, patient data is recorded on paper and manually managed. To change this, NephroPlus has created a platform to monitor and maintain patient data digitally. In select centres, it has deployed real-time data which allows the clinical staff to monitor patient data remotely.

This data has captured information on the Indian population which can be applied to further clinical research and awareness of nephrology. Its platform has allowed NephroPlus to generate automated recommendations and understand micro and macro trends which can influence its quality and decision making going forward.

Nephrocare Health Services Pvt Ltd (NephroPlus) was founded in 2009 by a dialysis patient Mr Kamal Shah and former McKinsey & Company consultant Mr Vikram Vuppala. In a short span of just 8 years, NephroPlus has grown to become the largest network of dialysis centres with 135 operations centres (as on Jan 31, 2018) spread across 85 cities in 18 states. With our motto of “Guest Care Comes First”, our topmost priority is to enable people on dialysis across the world lead long, happy and productive lives. We strive to provide the highest quality dialysis in an affordable setting. All our teammates undergo hours of rigorous training and certification before they are inducted to handle patients, who are referred to as “Guests” in our ecosystem. We have also introduced for the first time in India, innovative concepts like “Holiday Dialysis” which help our patients lead enriching lives without any boundaries. As of 31st Jan 2018, NephroPlus has ~103 centres with Private Hospitals, ~29 centres with Government Hospitals and 3 Standalone centres with combined 1,450+ beds under operation. Some of India’s top hospitals including Max Group of Hospitals, Jehangir Hospital, Medica Hospitals, IVY Hospitals and Sahyadri Hospitals have partnered with us to provide quality dialysis service to their patients. NephroPlus is also the preferred dialysis partner for various Indian government agencies and state governments. In FY17, NephroPlus achieved its target of ~USD 15 MM in revenues and is enroute to cross USD 21 MM in FY18. NephroPlus currently has a staff strength of about 2,000 employees. In addition, more than 75 of leading Indian Nephrologists are our partners who help us develop the best quality protocols.

We are providing quality dialysis at a cost currently unmatched by any other dialysis players in India. The typical consumer is a person with Stage V CKD (Chronic Kidney Disease) and has been recommended maintenance / regular Dialysis by a nephrologist.
Till date we have served over 1,46,000 patient with nearly 11,000 active patients currently dialyzing with us. Each patient typically has 10-12 dialysis sessions in a month. NephroPlus is currently doing 3,300+ dialysis sessions per day.
Dialysis services are provided by NephroPlus, through the dialysis units outsourced by Hospitals to NephroPlus.

How has it changed the way it collects and manages data?
Majority of the dialysis centres in India still use archaic methods for collection of patient data. Patient data is completely paper based and managed manually.
NephroPlus since its inception has put huge emphasis on efficient digital data collection. NephroPlus developed its in-house software “BO” where all the patient prescriptions and investigations are entered on continuous basis. When a patient joins NephroPlus, their complete baseline health data is entered into BO portal.
In selected centres, NephroPlus has also deployed latest real time data monitoring systems which allow our clinical team to monitor patient data remotely on real time basis.
These innovations have not only has led to better data collection, it has also allowed to manage and monitor the data of our large network resulting in targeted interventions and improved treatment quality.

Monthly Clinical Summaries:
Based on patient investigation and prescription data, an automatic monthly summary is generated for all patients in the system. Summary contains all of prescriptions and investigations of the patient. This enables us and our Nephrologists to make targeted treatment decisions for all 10,800 patients in the system

Outcome trends
As all patient data is available on BO portal, it allows us to monitor all the important dialysis outcomes such as Dialysis adequacy (Kt/v), Hemoglobin (Hb), Albumin (Alb) for every centre in the network.
Outcome trends for every centre in the network is monitored and analysed by NephroPlus clinical team to monitor treatment quality.
In addition, Network level and center level outcomes are monitored and discussed at every monthly board call

Data for Clinical Research

Our robust data collection system has put us in for front of dialysis clinical research in India. Large volume of clinical data collected by us allows us to monitor different trends among dialysis patients based on various demographic, geographic factors such as age, gender, location.
For example, we discovered that only about 30% of dialysis patients in India are female compared to worldwide average of 42% indicating that in India, women are not given equitable access to healthcare. This was published by many leading newspapers in India raising awareness of the issue.

In addition, NephroPlus is the only firm in India which has published large clinical dataset of dialysis patients. Never before NephroPlus, was data of such high quality and volume of Indian dialysis patients published in international nephrology conferences.

Last but not the least, all the clinical data is available to our Nephrologist partners on request if they would like to do any study of dialysis patients in India.

Proactive Interventions
We have developed intelligent algorithms which generates auto recommendations based on patient’s monthly summary. NephroPlus clinical team reviews these recommendations and makes necessary adjustments.
This allows us to make timely proactive interventions necessary for well-being of the patients.
These recommendations are shown to the Nephrologists for approval and amendments. Nephrologists in India are often overburdened and these auto generated summaries not only reduce their workload, they also enable them to make better data driven decisions.

Monitor macro and micro trends
Outcome trends are analysed by the NephroPlus clinical team at both centre level and network level allowing us to monitor both micro and macro trends.
Centres where outcomes are below the desired levels, interventions are made to improve the results.
Staff of the centres with high patient clinical parameters are incentivised. In addition, clinical staff appraisals and incentives are based on quality of care provided by them.
This has created a culture where quality is valued above everything else.

In summary, our innovations in data collection and management have made it possible for us to adhere to our motto of “Guest Care Comes First”

• Month : March
• Year : 2016

Clinical Indicators
Patient outcome is the highest priority area at NephroPlus. We have consistently seen quality metrics (lab compliance, investigation outputs in range etc.) increase after we transition operations from hospitals to NephroPlus.
Below is the table showing improvement of quality in patient outcome as tested in NephroPlus network

%Kt/v –

%Kt/v in range demonstrates the effectiveness of Dialysis process. Our focus on quality of dialysis has helped us increase this factor significantly.
Metrics Jan’15 July’15 Jan’16 July’16 Jan’17 July’17 Jan’18
% Kt/v in satisfactory range 72% 72% 79% 80% 80% 84% 86%

Number of cross infections
Another key metric of quality is cross-infection (sero-conversion) rate, which is close to 0 for NephroPlus, with the market at around 30% sero-conversion over 3 years.