Fresenius Medical Care
Fresenius Medical Care has defined its commitment to continuous innovation in the Code of Ethics and Business Conduct. The Care Enablement segment, which was implemented on January 1, 2023, oversees the development of products. The Global Medical Office is responsible for the clinical digitalization strategies and the use of digital clinical data for research and operations.
Innovation and digitalization are important strategic elements that contribute to the success of Fresenius Medical Care. It aims to develop innovative, safe, and user-friendly digital products and systems that meet high quality standards. The goal is to further improve the quality and efficiency of treatments. To this end, Fresenius Medical Care is continuously developing digital products and services designed to improve access to and advance healthcare.This has become more critical during the COVID-19 pandemic.
Progress and measures in 2022
- Telemedicine healthcare
In 2022, Fresenius Medical Care continued to develop digital options with the aim of improving access to information for the patients under their care. Digital platforms enable virtual contact, which helped to reduce the risk of infection for patients and staff during the pandemic, for example. Keeping patients and care teams connected and giving them access to recent treatment data is vital for the business segment to be able to continuously monitor and improve medical outcomes, user experience, and the effectiveness of care. Currently, the company provides two patient engagement platforms that are accessible via digital apps. The PatientHub app is used predominantly in the U.S. and the MyCompanion app is available in 23 countries in Europe, Africa, Asia-Pacific, and Latin America. Combined, these apps had more than 25,000 active users in December 2022. In the U.S. alone, Fresenius Medical Care recorded almost 250,000 remote telehealth visits between patients, care teams, and physicians by the end of 2022.
- Digital product innovations
To access the latest innovative technologies, Fresenius Medical Care invests in research and development and collaborate with external partners, including academic institutions. The business segment also invests in startups that develop products, technologies, and therapies in the healthcare sector. In 2021, Fresenius Medical Care initiated a process to further integrate specific environmental criteria in research and development activities. In 2022, the business segment launched a global event aimed at fostering innovation in its product business.
For Fresenius Kabi, the digitalization of processes is a cornerstone in the development of innovations and an important aspect in effective care for critically and chronically ill patients, as well as compliance with regulatory requirements. Fresenius Kabi develops devices and applications in various medical fields to support its customers’ ongoing digitalization. Devices not only have to be optimized in their core functions but increasingly need to be embedded into the IT systems of hospitals, clinics, and plasma centers. Fresenius Kabi wants to benefit from this trend and will focus on the constant development of its portfolio, while acknowledging the increasing role of software in medical technology and its application area.
Responsibility for digitalization is anchored in organizations of the management board areas. The aim is to drive the digital transformation of the business, with the Digital Transformation Board (DTB) focusing on new business models, closed-loop sales and marketing for enhanced customer experience, new digital services, and digital enhancements to products such as digital product labeling and the opportunities they enable. For the concrete implementation of these topics, digital projects have been launched for which DTB has governance and the progress of whichis reported to the Management Board of Fresenius Kabi regularly.
Digital solutions are continuously being developed along the entire value chain to make internal work processes more efficient and simplify them. The steering responsibility for this internal digitization of business processes lies with the Fresenius Kabi IT Executive Board, which is led by the responsible member of the Management Board and the head of the global IT department.
In order to better realize the opportunities of digital transformation and also enable the implementation of new digital business models, Fresenius Kabi has driven forward the realignment of its IT organization as part of the Group-wide IT program. The aim is to further strengthen the implementation of the digital transformation and increase the value contribution of digital applications for the company and for customers. Here, the business segment is increasingly relying on intelligent automation and artificial intelligence (AI) to improve business processes in administrative functions. In production and quality management, Fresenius Kabi is using digital platforms to implement process control systems, monitor equipment efficiency, and manage data and support workflows in laboratories. This also enables the business segment to access data to analyze and automate decision-making processes.
In product development, Fresenius Kabi’s expertise includes all related components, such as the raw material for drugs, the pharmaceutical formulation, the primary packaging, the devices needed for application of drugs and infusions, and the related production technology. In the field of biosimilarsBiosimilarsA ​biosimilar ​is ​a ​drug ​that ​is ​“similar” ​to ​another ​biologic ​drug ​already ​approved., Fresenius Kabi focuses on autoimmune diseases and oncology. More information on R & D can be found in the Group Management Report in the Research and development section.
The business segment has standard operating procedures for the development and design of products and for the cybersecurity of its devices; for more information see the Cybersecurity chapter. The responsibility for innovation and development is anchored in the organizations of the management board areas of the Chief Operating Officer (COO) and MedTech. Fresenius Kabi constantly addresses the advancement of scientific findings. Employees work together in cross-organizational and cross-functional teams to develop innovative solutions for medical needs.
Fresenius Kabi develops digital applications for healthcare professionals and patients to support the quality of treatment and improve patient care and quality of life, as well as to open up new business areas and to ensure regulatory compliance. In addition, the business segment uses digital solutions for what are known as track-and-trace systems for the traceability of products. These applications also enable information to be shared with customers and support, for example, the monitoring of inventories in hospitals.
For example, Fresenius Kabi uses radio frequency identification (RFID) technology, known as smart labels, for some of its drugs in the United States. The smart label enables hospitals to automatically identify, locate, and manage their inventories.
With digital technical services, Fresenius Kabi improves the efficiency of processes in hospitals and care facilities. Digital technical service applications accelerate maintenance and can reduce the downtime of medical devices due to maintenance work. In this context, Fresenius Kabi aims to offer its solutions to its customers in as many countries around the world as possible.
Further, for various product segments Fresenius Kabi offers support programs or has launched websites with dedicated information material, practical instructions, and information on handling of its products in many languages. The information is intended for healthcare professionals, patients and their relatives.
In the biosimilars product segment, Fresenius Kabi also offers the support program KabiCare®, which is aimed at healthcare professionals and patients who use or are treated with Fresenius Kabi’s biosimilars products. The digital platform provides users with educational materials on the management or treatment of the disease.
In compliance with data protection regulations, Fresenius Kabi is also working to use the data generated by the apps to improve patient care. For example, the aim is to identify potential risks for patients and improve the decisions made by patients or healthcare professionals.
Automation of processes
An important element of the digital transformation is intelligent automation. Fresenius Kabi is working to increase the efficiency of processes by using innovative methods such as RPA (Robotic Process Automation) and AI. The aim here is to automate repetitive processes that can be standardized using chatbots, intelligent document processing, or recommendation and prediction applications, as well as to drive the harmonization and standardization of business processes. Various solutions have already been implemented and savings potential were identified. Transformative overarching approaches in automating complex processes in global business functions are in the realization phase, e. g. in commercial areas sales and customer service processes.
Progress and measures in 2022
In the fiscal year 2022, the business segment newly introduced the DTB with the aim of driving the digital transformation of the business. It is composed of executives at the first management level below the Management Board of Fresenius Kabi (including the global Head of IT) and reports regularly to the Board.
Product innovation management
We consider it our task to develop products that help to support medical advancements in acute and post-acute care and improve patients’ quality of life. At the same time, our products are intended to enable an increasing number of people worldwide to have access to high-quality, modern therapies.
Fresenius Kabi is continuously working on expanding its product portfolio and has launched numerous products in 2022, for example in the field of biopharmaceuticals, clinical nutrition or MedTech as well as IV generics. Further information on this can be found in the Group Management Report in the Research and development chapter.
In the area of device products, the company works on solutions for interoperability between pump devices, infusion-specific systems, and hospital IT systems in order to improve efficiency and effectiveness in the treatment of patients. Furthermore, devices are being improved with regard to new cybersecurity requirements and insights. Fresenius Kabi, for example, offers an infusion management system for the controlled administration of drugs and fluids. To ensure the safety and correct functioning of the devices, they are equipped with an automatic test.
In the area of transfusion medicine and cell therapies, Fresenius Kabi is advancing its systems for collecting blood components and using new technologies to increase efficiency and efficacy. Systems are being optimized to support the processing of technical information. The applications for data management of the networked devices will also be expanded to support customers in their digital transformation initiatives.
In the reporting year, Fresenius Kabi introduced a plan in the United States to add two-dimensional (2D) barcodes to its pharmaceutical portfolio of vials, syringes, IV solutions and parenteral nutritionParenteral nutritionApplication ​of ​nutrients ​directly ​into ​the ​bloodstream ​of ​the ​patient ​(intravenously). ​This ​is ​necessary ​if ​the ​condition ​of ​a ​patient ​does ​not ​allow ​them ​to ​absorb ​and ​metabolize ​essential ​nutrients ​orally ​or ​as ​sip ​and ​tube ​feed ​in ​a ​sufficient ​quantity. products. The initiative will help streamline workflows at healthcare facilities by reducing the potential for error-prone manual data entry in medication management systems. Fresenius Kabi in the United States plans to gradually offer 2D barcodes on all drug product labels. The business segment offers an application for field staff in the United States to digitize and modernize the maintenance of equipment for transfusion medicine and cell therapy. This app is already in use in Italy and Poland and will also be available in Spain and Portugal from spring 2023 onwards.
The KetoApp supports patients with chronic kidney disease with information on nutrition and the nutritional values of foods, in order to enable a varied diet despite the restrictions caused by the disease. After a successful pilot phase in Mexico in 2021, roll-out of the application has been started in other countries, such as Chile, Colombia, Ecuador and Peru.
Automation of processes
The business segment initiated a global digitization project in 2021 to further standardize and harmonize the processes for planning and managing the supply chain network in transfusion and cell therapy production, by leveraging the latest ERP (Enterprise-Resource-Planning) technology and a modern cloud infrastructure. The three-year program aims to deliver an enhanced value case for the transfusion and cell therapy production network through improved data transparency and optimized oversight, stronger and better connectivity between the production network and sales organizations, connectivity to business partners’ systems, and faster decision-making processes. In 2022, the first three manufacturing plants were integrated into the cloud infrastructure. Implementation at further plants is planned for the coming years.
The expansion of digitalization is key for Fresenius Helios to ensure the sustainability of its hospitals and outpatient facilities, and to continuously improve the quality of healthcare and the service provided to patients.
Since 2020, Helios Germany has used a newly developed process for managing digitalization projects in Germany via the Helios Digitalization Board (Helios DIGI Board) to manage and centrally evaluate proposals for digitalization projects. Proposals are collected in the clinics and outpatient facilities of Helios Germany and in the Fresenius Group and then rated. The Board decides on the approval of project proposals. All digitalization projects, including rejected project ideas, are published in the Helios.Digital project database via the myHelios intranet.
Since 2019, Helios Spain has followed a defined Digital Transformation plan with six main initiatives: boost the patient portal and improve online appointments; review and improve clinical pathways (digitalized); improve data management and patient knowledge; simplify and automatize administrative processes; speed up the deployment of the unified platform for Electronic Patient Files (EPF) and Health Information System (HIS); develop new digital services (e-commerce platform and digital hospital).
Among other things, this IT and process strategy aims to further improve digital patient interaction such as video conferencing and chats, where patients can present their medical history, protocols, and automated tests for specific diagnoses. To ensure that the IT strategy is gradually implemented, the division has introduced a competence model called Digital Stars at Spanish hospitals. This model is based on three pillars: Digital Customer (patients), Digital Professional (employees), and Digital Organization (administration). Each of the three pillars has key figures to indicate progress in digitalization and its acceptance, and collects data, for example on the number of patients making use of digital medical consultations, the number of electronic prescriptions issued by employees, and the number of invoices automatically generated. The data is evaluated on a monthly basis and enables comparison of the state of evolution of digitalization in the various hospitals in Spain.
The Helios patient portal
Fresenius Helios started introducing a patient portal at its clinics in 2019. Patients can now access treatment documents such as diagnoses, book appointments online, or attend video consultations at 61 German clinics, around the clock and from home. The portal can be accessed via the websites of the respective clinics. In 2022, the patient portal recorded 205,000 registered users (2021: 130,000), 700,000 documents (2021: 300,000) exchanged via the portal and nearly 435,000 online appointments (2021: 85,000).
Many users already access Helios Spain’s patient portal, via the web version or the app MyQuironsalud. Nearly all Spanish hospitals are connected and some Latin American hospitals have also implemented the patient portal in 2022.The hospitals benefit from a central data repository and improved data transmission and coordination between healthcare professionals. Via the digital portal, patients of Helios Spain can track the progress of their own clinical treatments and view recommended therapeutic measures. They have direct access to three-dimensional (3D) radiological images and can contact their responsible specialists and interact via web formats. In addition, it is possible to digitally request an appointment for most of the examinations available and to read up on the risks associated with an examination. Prior to a procedure, patients can also sign a consent form electronically via the portal. In 2022, the patient portal recorded one million new registered users, reaching a global amount of five million registered users. It also recorded around 90 million yearly accesses and managed more than 4 million online appointments.
Electronic patient file (EPF)
An EPF with doctor’s letters, findings, and complete clinical imaging is available at the majority of workstations in the clinics; this creates added value for both treatment providers and patients. In the reporting year, other medical data such as nursing documentation and medication were made available in the EPF at Fresenius Helios. In about half of the Helios clinics, integrated software solutions already issue warnings of possible interactions with other drugs, which increases patient safety.
In general, this makes many processes more efficient, which improves medical quality. The expansion of the Germany-wide telematics infrastructureTelematics infrastructureThe ​telematics ​infrastructure ​is ​intended ​to ​network ​all ​those ​involved ​in ​the ​German ​healthcare ​system ​and ​enable ​a ​secure ​exchange ​of ​information ​across ​sectors ​and ​systems., ordered by the government, into which the EPF will be integrated in the future, focuses on improving the quality of care and the efficiency of care and administrative processes. This project aims to modernize the technical infrastructure in the German healthcare system up until 2025. E-medication is one planned aspect of the telematics infrastructure. It will enable electronic prescriptions to be transmitted digitally to parties outside the hospital – e. g., medical practices and pharmacies – and to be uniquely assigned and tracked. Patients can make their own decisions on the distribution of information.
In Spain, the EPF contains all the information needed for patients' care, including discharge papers, along with medication information and prescriptions. Thanks to this paperless process, patients can go directly to the pharmacy with their smartphone. Prior to an appointment at the hospital, they fill out a form online and then receive notifications and directions. At the clinic they are navigated directly to the treatment room via the app.
Digitalization of hospital routines
Many patients in Spain come to hospitals from primary care – e. g., family doctors’ practices. 65% of them are assigned to one of around 350 protocols depending on their health status. These protocols are used to define the laboratory tests that are immediately necessary prior to a treatment consultation, to arrange appointments, and to ensure that the responsible physician receives all diagnoses and information prior to the consultation. This saves time, because patients can start treatment immediately after the consultation or go home if no further action is needed. The availability of real-time test results or existing patient data ensures that 30% of patients can be discharged directly after an initial consultation. Due to digitalization, meetings in the oncology outpatient clinicOutpatient clinicInterdisciplinary ​facility ​for ​outpatient ​care, ​managed ​by ​physicians. ​The ​responsible ​body ​of ​a ​medical ​care ​center ​includes ​all ​service ​providers ​(such ​as ​physicians, ​pharmacists, ​healthcare ​facilities) ​that ​are ​authorized ​to ​treat ​patients ​with ​statutory ​health ​insurance. have decreased by 60%. Patients are also staying for less time – no longer eight hours on average, but only around two.
In the area of reproductive medicine, the average time to start a new fertility treatment has also been reduced by 60%, thanks to the digitalization of processes.
Digital support in nursing care
In many Helios hospitals in Germany, nurses use digital devices for support – for example, with mobile monitors at the patient’s bedside in which vital signs can be inserted digitally. These spot-check monitors transfer the data to the electronic patient files; transmission errors are thereby reduced.
Helios Spain has developed an algorithm based on AI that is used in the emergency room, among other places: it is used to determine the likelihood of bilateral pneumonia based on laboratory test variables and other patient parameters – before the X-ray shows it. The algorithm is used to rank the condition of COVID-19 patients. Another algorithm can diagnose pneumonia based on real-time X-ray images.
Digital support for treatments
Fresenius Helios healthcare facilities conduct video consultations. A significant boost in the use of such video consultations resulted from contact restrictions during the COVID-19 pandemic. In 2022, Helios Spain conducted about 24,800 video and 960,600 telephone consultations and answered 48,200 chat inquiries. The division also offers a Teledermatology Service. In this process, a dermatological lesion to be examined is photographed by a medical technician. The photo is inserted into a digital platform and evaluated by a specialist within 48 hours. The patient thus receives the diagnosis as well as referrals or prescriptions for subsequent treatment in a comparatively short time. Clinical sessions are held online within the network of all Helios Spain hospitals, including in Colombia and Peru.
Helios Germany has also started online consultations in the pre-stationary sector. The division also plans to introduce digital measures to shorten waiting times. In addition, Helios Germany is expanding its offer of digital follow-up care via its own outpatient centers – for example, for wound management following surgery. Thus, specialists from Fresenius Helios digitally accompany patients throughout their treatment path – regardless of whether they are at the hospital or being treated at an outpatient center.
Experts at Helios Germany have been using online conferences, referred to as tumor boards, to review and discuss oncological diagnoses collectively across locations and disciplines, determine the best possible treatment, and thus improve medical quality during cancer treatment.
Modern operating theaters with hybrid systems and robotics
Helios Spain has 12 operating theatres with robotic equipment, making it one of the pioneers of this technology in Spain. In 2022, Helios Spain incorporated for the first time a trauma robot, for hip and knee replacements, at its Olympia Medical Centre in Madrid. Also, in the reporting year, three additional Da Vinci robotic-assisted surgery systems were implemented. This allows to a continuous growth of robotic surgery in Helios Spain’s hospitals, both in spine surgery and in other surgical specialties. By the end of 2022, more than 1,300 robotic-assisted surgeries had been performed.
Concerning hybrid operating systems two new systems have been added in 2022: one hybrid operating room (total number: nine) and one Kinevo 900 surgical microscope (total number: five). This last equipment offers a hybrid function of endoscope and exoscope, capturing detailed images of internal and external microstructures of the body. This allows operations to be projected directly onto a high-resolution screen and displayed in 3D.
Progress and measures in 2022
In 2022, Helios Spain developed a new digitalization path for its hospitals consisting of four phases: new tools adoption, digital transformation, healthcare model transformation, and liquid healthcare – meaning a concept of giving the best healthcare to the patients in every situation. In each phase the division measures several Key Performance Indicators (KPIs) to define when a hospital is ready to pass to the next phase. In committees, Helios Spain discusses and reviews the status of digital KPIs as well as transformation projects and innovation cases.
Fresenius Vamed has established digitalization as a strategic business area with various objectives: the business segment aims to implement digitalization initiatives and projects, coordinate digitalization activities within the Vamed Group, drive digital innovations, and generate new digital solutions such as services. To this end, additional personnel have been recruited in the competence areas of innovation, products and project management. Among other things, Fresenius Vamed is developing various rehabilitation services, as well as patient services for digital assistance systems that support ambient assisted living (AAL) and rehabilitation services. In the project business, Fresenius Vamed has long used complex virtual models (building information modeling – BIM) in the planning and operation of healthcare facilities. They makte it possible to simulate and optimize the entire life cycle – from planning and design to construction, operation, and maintenance – of a healthcare facility. Additionally, Fresenius Vamed is also undertaking internal digitalization projects in the areas of project business, high-end services, and general operations management. The management of the digitalization strategic business unit regularly reports to the Management Board on its progress.
Digital and technological support for treatments
One focus of Fresenius Vamed is to make rehabilitation and aftercare services for patients largely accessible with digital solutions. Digital rehabilitation services are offered to complement the existing range of services. With the digital rehab lighthouse project, Fresenius Vamed is helping to improve healthcare, especially in structurally weak regions. The business segment has developed digital treatment paths, evaluated technical solutions, and implemented projects in the field of digital rehabilitation. New digital business models such as virtual reality rehabilitation are being developed.
Fresenius Vamed is working to expand its therapy offering with state-of-the-art technology. Robot-assisted therapy represents an intervention measure in neurorehabilitation that is gaining in importance. The Zihlschlacht post-acute care clinic has been offering this form of therapy since 2005 and now operates one of the largest centers in this field. To improve the data basis for the use of robot-assisted therapies in clinical practice, the post-acute care clinic participates in an international network of leading institutions in the application of modern rehabilitation technologies. It is pursuing the goal of establishing a corresponding database. In addition, the Zihlschlacht post-acute care clinic has expanded its technology-supported therapies and procured five so-called myosuits. The soft exosuits support patients during walking, i. e. they are a movement aid for people with weak legs. Fresenius Vamed aims to push ahead with the development of the Myosuits for home use, thus helping those affected to maintain and increase their exercise progress even after their inpatient stay.
Digital health network management
DIGEM, the digital health network management developed by Fresenius Vamed, supports nursing professionals in their daily work. Via mobile devices such as tablets, it provides quick access to relevant patient and nursing information as well as healthcare services. DIGEM thus relieves the burden of paper-based administrative tasks. This is because the demand for care services is increasing due to demographic change and a widening urban-rural divide. The healthcare system and the application process for benefits are complex and time-consuming. DIGEM is an integrated digital tool that enables mobile care services to provide comprehensive healthcare services to those in need of care. Thanks to faster processing time as well as simple and structured documentation, more time is left for patient care in the end.
The abbreviation SMAPP stands for Smart Health Posts and App. Through SMAPP, Fresenius Vamed brings healthcare to regions where it has been available only to a limited extent. More about the intelligent hybrid combination of Smart Health directly on site and a global telemedical offering via app is explained in the section Access to healthcare and medicine.
Progress and measures in 2022
In 2022, the management approach and the governance structure of the digitalization strategic business unit of Fresenius Vamed remained as reported in 2021. Progress focused on various digitalization projects and initiatives in the areas of high-end services, overall operations management, and project management.