Fig. 1. SHARESOURCE medical device connectivity platform.
•Asia Pacific
•Latin America
The SHARESOURCE platform securely communicates with Baxter’s AMIA, HOMECHOICE CLARIA, and KAGUYA automated PD cyclers and allows authorized users to remotely view and manage treatment information sent from a cycler [1–3]. Authorized users can also remotely program the therapy that will be performed by the cycler (Fig. 1).
Need for Sharesource
The SHARESOURCE platform was developed with 3 primary objectives: to improve clinician confidence to send dialysis patients home, to enable patients to extend their time on home dialysis therapy, and to generate operational savings.
The Sharesource features intended to improve clinician confidence include the organization and presentation of the treatment data to the clinician in a timely manner for assessment, allowing the clinician to review the treatment results, assess the therapy, and evaluate patient status and compliance. Sharesource also provides the clinician with the ability to remotely adjust the device settings as needed to maintain the appropriate therapy for their patients. While Sharesource supports the clinician, it is not intended to be a substitute for clinical practice, nor does it create decisions or treatment pathways.
The communications between the patient’s cycler and Sharesource is intended to support the patient by giving them assurance that there is an ongoing connection with their clinician. They know that their clinician is monitoring their status and that potential issues can be identified for proactive therapy management. Sharesource is also designed to reduce the burden on the patient by replacing manual record keeping with the automated data capture and transfer of their therapy information to their clinician. This can be beneficial when working with their clinician to troubleshoot issues or when preparing for their periodic clinic visits.
Sharesource is also designed to deliver operational savings by allowing clinicians to assess therapy success without relying on direct patient communications. The clinicians can review the patient’s treatment data on their schedule from any location where they can access the internet through a browser. Because the treatment data are automatically transferred to Sharesource through a secure interface with the patient’s cycler, manual data entry and the potential associated errors are reduced. Finally, Sharesource may also reduce the amount of paperwork a clinic has to manage by digitizing the patient run sheets.
The SHARESOURCE portal is intended for use by healthcare professionals to remotely communicate new or modified treatment parameters with compatible dialysis instruments and transfer completed treatment data to a central database to aid in the review, analysis, and evaluation of patients’ historical treatment results. This system is not intended to be a substitute for good clinical management practices, nor does its operation create decisions or treatment pathways.
Sharesource Concepts
Treatment Files
The cyclers collect data while the treatment is being performed by the patient, and after the treatment is complete, the collected data are organized, and packaged into a treatment file which is then sent to the SHARESOURCE platform.
Device Settings
All the parameters required to configure a cycler to provide a patient-specific PD treatment. Device Settings are comprised of Device Programs, Patient Settings, and System Settings.
Device Programs are used to enter the therapy parameters for a treatment (e.g., solution type and concentration, therapy volume, dwell time). Clinicians can configure some Device Program parameters to allow or prevent user adjustment [1–3]. For AMIA and KAGUYA, if user adjustment is allowed, clinicians can either allow adjustment of the setting within the device default limits or restrict user adjustment to within a smaller range [1, 3].
Fig. 2. Clinical treatment dashboard example for patients with HOMECHOICE CLARIA cyclers [2].
Patient Settings are used to enter specific information that the patient should enter for a treatment (e.g., weight, blood pressure).
System Settings are used to configure device options (e.g., fluid temperature, language, date format).
Treatment Dashboard provides a 7-day window of up to 28 days of patients’ treatment history at a high level for the clinic (Fig. 2). It is important to note that the overview only displays status for completed treatments. Treatment information is sent after the treatment has been completed, and not in real time. The Treatment Dashboard uses Patient Event icons to notify the clinician of treatment information and events that occurred during a patient’s treatment. Patient Event icons show the following information:
•Treatment was completed without any flag events occurring
•Treatment had at least one flag event occurring
•No treatment data was received for a given day
•No communications have been received from the cycler for a given day.
The Patient Snapshot provides a numeric and graphical overview of the patient’s treatment over a 7- or 30-day period. Specifically, Patient Event icons, night ultrafiltration (UF), and patient survey question results (e.g., weight and blood pressure) are presented.
Treatment Summary provides the details for a specific treatment. Some of the primary information includes:
•Prescribed device program
•Actual treatment time
•Solutions used
•UF details
•Therapy details in a run sheet format
•Cycle profiles (Fig. 3)
Flag rules describe events and conditions that may occur during a patient’s treatment that the clinician can configure Sharesource to notify them of, if they should occur. Flag rules assist with finding patient treatment results that match criteria defined in the flag rule settings (e.g., lost treatment time, lost dwell time).
Event flags will appear on the Treatment Dashboard, Patient Snapshot, and Treatment Summary. The event flags appear and are triggered based on the flag rule criteria that the clinic selects.
Sharesource User Roles
There are 5 Sharesource user roles that align with assignments commonly found in clinics,