Jeff Burbank is the chief strategy and transformation officer for Fresenius Medical Care North America.


Disclosures: Burbank is an employee of Fresenius Medical Care.
October 12, 2021
3 min read

To move home dialysis forward, universal access to connected health technologies is needed


Jeff Burbank is the chief strategy and transformation officer for Fresenius Medical Care North America.


Disclosures: Burbank is an employee of Fresenius Medical Care.
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For the hundreds of thousands of people living with kidney disease who rely on dialysis as a life-sustaining treatment, providing easier access to home therapy is essential.

While we continue to strive to deliver better and easier-to-use technologies that help drive adoption of home treatment, a key mandate of the government’s Advancing American Kidney Health initiative, our success is increasingly dependent on all patients having access to the internet.

True innovation cannot be just about evolving treatment systems, it must ensure everyone is connected across the care continuum.

Technology divide

We should think of internet access as equally important for a patient’s success on home dialysis as prescribing iron supplements or a phosphate binder. We must not allow financial barriers to get in the way of connected health technologies to improve patient quality of care. While studies have clearly demonstrated that use of connected health is improving lives, limitations on access to technology, tech literacy and financial stability must be eradicated.

The technology divide is greater for certain populations in the United States. A recent study from the Pew Research Center shows that while 80% of white adults report having a broadband connection at home, that number drops to 71% for Black adults and 65% for Hispanic adults. Among Americans 65 years of age and older, only 61% own a smartphone or have broadband internet access.

In a survey sponsored by Fresenius Medical Care North America (FMCNA) last year around barriers for aging in place, the company found some aspect of technical literacy impacted two out of three people, and 25% said they struggle with learning new technology. Furthermore, other studies have shown that new telehealth users were more likely to have higher annual incomes.

Bridging these gaps is crucial to eliminating the technology divide. When we invest in patient education, integrate social work access and align ourselves with community-based initiatives that increase access to food and housing services, connected health technologies can thrive.

Power of connected health

As a leader for more than 2 decades at NxStage Medical, I knew that connected health technology would be critically important to patient outcomes and success on home hemodialysis. The Nx2me connected health platform allows care teams access to information from the home hemodialysis (HHD) cycler remotely, including weight, blood pressure and temperature in addition to reviewing medications taken and answers to health assessment questions. The technology works – when someone has internet access. Nx2me has been shown to improve patient retention with a 29% lower therapy discontinuation rate (excluding death and transplant) and a 39% higher likelihood of completing their home training program.1

Close the gap

It has always struck me that a physician can provide thousands of different services and prescriptions but cannot prescribe internet access. Yet, we now know those with access to the internet and training on simple technologies that will become even more automated are keys to success for so many patients at home. This is why we must advocate for technology to be tied to clinical outcomes and remove any technological and economic barriers.

When assessing new patient readiness for home dialysis, we have always looked at access to water and electricity, sanitation and a location to store supplies. We have found creative ways to remove any barriers, including bagged dialysate for HHD when local water conditions are not adequate.

But access to internet in remote locations where our patients are simply off the grid has been hard to overcome given national infrastructure and technology limitations.

That is, until now. As new low-level satellite technology is emerging that allows anyone, anywhere, to have fast, reliable internet service, internet accessibility will become more widespread. The industry, working with government and private payers, should strive to make connectivity a basic part of the home treatment itself.

The evolution of connected health and home dialysis has just begun. It is time for the industry – and government – to come together, help more patients remove these technological barriers and open up internet access to any patient, anywhere in the world. Technology is medicine. The internet is medicine. And we must treat it that way.


  • Weinhandl E, et al. Hemodial Int. 2018;doi:10.1111/hdi.12621.