Nx2ME

[Simon Dog]

Just had Nx2Me training at the Fresenius clinic on Friday - even got issued a ipad for recording data.     The system looks good (though you cannot control the machine or reset the alarm from the ipad).    I was not really impressed by their approach to double nat a second router on my router and use a wireless adapter on the NxStage machine - much easier to just plug the NxState into my domestic area network and configure the Ipad to connect to the same network (works just fine this way)

[Rerun]

Good Job!  Keep us posted.

           

[PrimeTimer]

Does the Nx2ME replace a handwritten treatment log and does it allow a patient to email the info to their home computer and be printed out? Is it mainly for patients who are remote? 

[Simon Dog]

Nx2me replaces the hand written logs, and automagically uploads the data to the clinic - although I have been asked to maintain a manual log as well for the first few treatments until the home treatment RN confirms she can get all my data via the clinician portal.

By definition, home treatment is "remote".  Nx2ME is not real time remote monitoring - the treatment data is uploaded at the end of the treatment.

There is no need to enter data into your computer and print it out - everything is transmitted via the internet (or cell adapter if you do not have internet) from the Ipad.

What is nice is that all the data from the machine (blood flow rate, dialysate flow rate, arterial pressure, venous pressure, etc) is obtained automatically - the only data that needs to be manually entered is vitals, weight, temp, and the lot number of the various supplies.   I am doing a treatment now and have a display up that gives concurrent display of AP/VP/EP (no waiting to cycle through) and a graph of the trend over the past few minutes.   When there is an alarm, it pops up on my ipad along with an explanation of the particular error code.

The system connects to your internet or, if you don't have internet, NxStage can provide a cell interface if you are in the dark ages.

The Nx2Me app corrects a big deficiency of the NxStage control panel - the inability to see all your settings and current values at a single glance.

NxStage appears to have done a pretty nice job on this app.   Too bad they don't have an Android version.

[cattlekid]

Is there an option to load the software onto your existing iPad?  I always had an iPad when I was doing my treatments and I wouldn't have wanted to juggle two.

[Simon Dog]

Is there an option to load the software onto your existing iPad?  I always had an iPad when I was doing my treatments and I wouldn't have wanted to juggle two.

Look in the apple store for Nx2Me.

[PrimeTimer]

Is there a monthly service fee (internet or cell) to have the Nx2ME? Can your vitals be manually entered into Nx2ME or are they still handwritten on a log sheet and turned in to the clinic?

[Hootie]

Would like it but our Davita location does not use this technology...

[Simon Dog]

Is there a monthly service fee (internet or cell) to have the Nx2ME? Can your vitals be manually entered into Nx2ME or are they still handwritten on a log sheet and turned in to the clinic?

I believe the list price for Nx2Me is $95 per patient, per month.   The actual negotiated price a big chain pays is *way* less.  I heard a number, but I am not sure it was something that should have been mentioned to me, so I remain silent.

The info from the machine is transmitted via standard internet wifi from the NxStage system 1 to the iPad.  The vitals are entered into the iPad manually.  When the treatment is done, you hit a synchronize button and the info is uploaded to the clinic.  If the RN changes to EDW or other parameters, you get a message the next time you enter the application on the iPad.  The system is paperless, and you don't have to turn in anything to the clinic - they get it automatically.   When I have a number that is a bit "off" I hear from the home care RN.

The Nx2me uses your home internet connection, though I think they also offer a cell modem for the disconnected.   I am not being charged any fee.   

A future version will use a bluetooth scale and BP meter so the only vital you have to enter manually is temperature.

The Nx2me enhances patient safety, since you can much more easily monitor your pressures - I can see mine at a glance while typing this since it is literally next to me.    It also shows the actual blood flow rate, not what the machine is set for (so you can see it ramping up, or changing as the system does its occasional self test (caution 2).    When the system stops (caution 9) while it recovers from a high venous pressure, you can watch the pressure work down rather than wonder if the system is doing anything while you nervously wait for the blood pump to start.

Another safety benefit is there is much faster turn around time from the clinic RN with the instantly transmitted treatment logs and therefore more timely adjustments to EDW, treatment protocol, etc.

Nx2Me makes treatments easier and safer and both FMC and DaVita would be well served to make it standard.   Once competing home units like the Tablo are deployed, direct internet logging will become a necessity to remain competitive.

One thing missing is control of the machine - you can't do anything to effect the System 1 with the Nx2Me.  It would be really nice if you could clear an alarm from the iPad, however, that would probably cause the software to require FDA approval.

[PrimeTimer]

Thanks, Simon Dog. Sounds like it does a lot of what I do as the carepartner. Would love it if it also took BP (perhaps in the future). I know I'm dreaming but would be great to be able to carry some sort of hand held monitor around to check on hubby's numbers if I should leave the treatment area....all at the push of a button and see "oh, hubby's arterial still looking good, whew!" Or "Uh oh, better get in there and adjust a needle before it alarms!"

[PrimeTimer]

Got to thinking that it might be nice if we had something that captured and hilighted "trends". For instance, a trend that shows an increase in AVF pressures might warrant an appt for a fistulagram. But I suppose someone (nurse) would still have to take the time to be able to immediately show it to the Neph, opposed to waiting and glancing at treatment sheets on a monthly basis. That probably will never happen. We check my husband's fistula every day and for now, I am the noisemaker. 

[Vt Big Rig]

As usual I have a story for this also ..

We recently moved to a new clinic. They use Nx2Me for home patients. When we got home it worked great for three days, then it would not connect. Call NxStage, try this, try that try this try that for three days, nothing works. One guy tells you the machine has to be running, one guys tells you he can't fix it until you are not running. Finally I am told only a certain guy can fix it. And of course he is out today, Ok next day he gets on the line to diagnose. Seems to find the problem. Will send a new conex box with new software. Great.

Next day ...no conex box. Oh my, "shipping did not send it, it will be there tomorrow". Next day a new wifi adapter  shows up, no conex box. "We will send it  for over night delivery but it is too late for today, it can't go till tomorrow". Next day we leave for the weekend about 5 PM. Come home and conex is on doorstep. Install same. Still not working. Call "certain guy" ..... who tells operator he will call me back. I guess he forgot to mention it would be the next day!!!!

Finally he calls (after I had done a treatment) and the only way it works it direct connection (hard wire) from conex box to router. I sync in and he tells me it does not  have the new software. Wants to know if it  is OK to leave it with wire strung across the floor. NO!!! So now I have two wifi adapters, two conex boxes and it still doesn't work. Supposedly today I am getting a flash drive with the new software on it. And an IP over power adapter so I do not have to rearrange all the stuff to get router close to conex box. (it is within six feet now).

So in the month since we moved I have assembled a new pureflow, replace the chassis on said pureflow because heater would not work and now spent a week fussing with Nx2Me.

Getting a little tired of fixing their equipment. For what we get charged there should be someone on staffs at  clinic that can fix this stuff. I am sure an elderly person (who am I kidding I am elderly) who have issued wrestling and changing out a chassis by themselves).

I will stop ranting now.

[Simon Dog]

I was fortunate that the internet outlet in my treatment room is very near the NxStage, so I was able to hard wire the NxStage to their router.   It is unfortunate their instructions don't recommend this.

I've been doing NxStage for a couple of years, and have replaced the Systgem 1 once (the courier did the replacement) and self-replaced the PureFlow control unit 4 times.  Even with the cost of overnight shipping, I expect self-replace saves NxStage a fortune over having a national service network.

It's too bad they don't give you the admin password for the router.  If they did, your could login to it and see if the connex box grabbed a DHCP lease.

But I suppose someone (nurse) would still have to take the time to be able to immediately show it to the Neph, opposed to waiting and glancing at treatment sheets on a monthly basis.

If there is anything funny about my numbers (such as a typo when entering my weight) I generally get an email from the home care RN the next day.

[Xplantdad]

Our Fresenius location just asked if we had an Ipad...I asked them if they were going to start using the NX2Me app? They asked how I even knew about the app....LOL

Thanks Simon Dog! We'll see how long it takes them to roll it out. I also told them about the new snap and tap setting 3 weeks ago.  They just got notification this past Monday from corporate

[Simon Dog]

It is curious Fresenius asked you if you had an iPad.  I was told "Only on OUR iPad, and we will provide it to you".

[Xplantdad]

Hmmm...That's be the next thing I ask then. The person who asked me is new there...so it wouldn't surprise me if they were mistaken. 

[Simon Dog]

Would love it if it also took BP (perhaps in the future).

NxStage paid me $25 to sit with one of their product managers and give a test run of the new version of Nx2Me that interfaces with a bluteooth blood pressure machine and scale.   Instead of entering values on the Nx2Me, I just had to hit "accept" once the values were picked up by bluetooth and displayed.

I do not have this version of the software on my Nx2Me, nor do I have the bluetooth enabled gadgets, and I have no idea when they will be made available.

[Xplantdad]

Hopefully we will get the NX2Me soon.

In the meantime We just bought a blood pressure cuff that has a USB connection. It will download to your computer or laptop and graph/export, etc. Cool stuff!

[Hootie]

Do you have a link for  the bluetooth BP cuff? Would like to check it out....

Davita told us last week that our clinic for HHD will start using Nx2me by the end of the year...I offered to be the first in the area...Would love the technology rather than faxing in sheets that sometimes go through and sometimes not due to me using an internet/IP fax.

[Simon Dog]

I hated paper log sheets.   Since I was stuck in-center for a while (I preferred not to do the cath at home), I spent the time writing a web based application for entry of the data.  The RN would printout my logs from the web and have me sign them at my monthly appointment.

[Xplantdad]

Do you have a link for  the bluetooth BP cuff? Would like to check it out....

Davita told us last week that our clinic for HHD will start using Nx2me by the end of the year...I offered to be the first in the area...Would love the technology rather than faxing in sheets that sometimes go through and sometimes not due to me using an internet/IP fax.

Sure...here you go...we have the one in the middle!

http://www.costco.com/blood-pressure-monitors.html

[Simon Dog]

I've been informed the Fresenius "pilot program" for the Nx2Me is over, but I can keep and continue using the iPad.   I've also been told that patients who don't have an iPad left over from the pilot program have the option of using Nx2Me on their own iPad, but they will not be issued one by the clinic.

I notice new old stock iPad Minis going for less than $200 on fleabay.   If I did not have one from the clinic, I would not hesitate to buy one just to use Nx2Me.  It is more convenient, and the real time display of pressures enhances patient safety.

[KatieV]

I've been informed the Fresenius "pilot program" for the Nx2Me is over, but I can keep and continue using the iPad.   I've also been told that patients who don't have an iPad left over from the pilot program have the option of using Nx2Me on their own iPad, but they will not be issued one by the clinic.

I notice new old stock iPad Minis going for less than $200 on fleabay.   If I did not have one from the clinic, I would not hesitate to buy one just to use Nx2Me.  It is more convenient, and the real time display of pressures enhances patient safety.

I was in the pilot program at my clinic a few years ago.  I loved using Nx2Me and, when I went back on NxStage this summer, I was thrilled to see they were using Nx2Me.  Being able to see all three pressure readings at once instead of waiting until they scroll around again is great!