How Fresenius Medical Care goals to save lots of dialysis affected person lives utilizing real-time predictive analytics on AWS


    This publish is co-written by Kanti Singh, Director of Information & Analytics at Fresenius Medical Care.

    Fresenius Medical Care is the world’s main supplier of kidney care services, and operates greater than 2,600 dialysis facilities within the US alone. The corporate offers complete options for folks residing with persistent kidney illness and associated situations, with a mission to enhance the standard of life of each affected person, daily, by remodeling healthcare by way of analysis, innovation, and compassion. Information evaluation that results in well timed interventions is essential to this mission, and important to cut back hospitalizations and forestall antagonistic occasions.

    On this publish, we stroll you thru the answer structure, efficiency concerns, and the way a analysis partnership with AWS round medical complexity led to an automatic resolution that helped ship alerts for potential antagonistic occasions.

    Why Fresenius Medical Care selected AWS

    The Fresenius Medical Care technical crew selected AWS as their most well-liked cloud platform for 2 key causes.

    First, we decided that AWS IoT Core was extra mature than different options and would possible face fewer points with deployment and certificates. As a company, we wished to go together with a cloud platform that had a confirmed observe document and established technical options and companies within the IoT and information analytics house. This included Amazon Athena, which is an easy-to-use serverless service that you should use to run queries on information saved in Amazon Easy Storage Service (Amazon S3) for evaluation.

    One other issue that performed a significant function in our choice was the truth that AWS provided the biggest set of serverless companies for analytics than another cloud supplier. We in the end decided that AWS improvements met the corporate’s present wants in addition to positioned the corporate for the longer term as we labored to increase our predictive capabilities.

    Resolution overview

    We would have liked to develop a near-real-time analytics resolution that might acquire dynamic dialysis machine information each 10 seconds throughout hemodialysis therapy in near-real time and personalize it to foretell each half-hour if a affected person is at a well being danger for intradialytic hypotension (IDH) inside the subsequent 15–75 minutes. This resolution wanted to scale to all our dialysis facilities nationwide, with every location sending 10 MBps of therapy information at peak occasions.

    The complexities that wanted to be managed within the resolution included dealing with excessive throughput information, a low-latency time-sensitive resolution of 10 seconds from information origination to reporting and notification, a extremely accessible resolution, and a cheap resolution with on-demand scaling up or down based mostly on information quantity.

    Fresenius Medical Care partnered with AWS on this mission and developed an structure that met our technical and enterprise necessities. Core elements within the structure included Amazon Kinesis Information Streams, Amazon Kinesis Information Analytics, and Amazon SageMaker. We selected Kinesis Information Streams and Kinesis Information Analytics primarily as a result of they’re serverless and extremely accessible (99.9%), provide very excessive throughput, and are simple to scale. We selected SageMaker on account of its distinctive functionality that permits ease of constructing, coaching, and operating machine studying (ML) fashions at scale.

    The next diagram illustrates the structure.

    The answer consists of the next key elements:

    1. Information assortment
    2. Information ingestion and aggregation
    3. Information lake storage
    4. ML Inference and operational analytics

    Let’s talk about every stage within the workflow in additional element.

    Information assortment

    Dialysis machines situated in Fresenius Medical Care facilities assist sufferers within the therapy of end-stage renal illness by performing hemodialysis. The dialysis machines present rapid entry to all therapy and medical trending information throughout the fleet of hemodialysis machines in all facilities within the US.

    These machines transmit a knowledge payload each 10 seconds to Kafka brokers situated in Fresenius Medical Care’s on-premises information heart to be used by a number of functions.

    Information ingestion and aggregation

    We use a Kinesis-Kafka connector hosted on self-managed Amazon Elastic Compute Cloud (Amazon EC2) situations to ingest information from a Kafka matter in near-real time into Kinesis Information Streams.

    We use AWS Lambda to learn the information factors and filter the datasets accordingly to Kinesis Information Analytics. Upon reaching the batch measurement threshold, Lambda sends the information to Kinesis Information Analytics for instream analytics.

    We selected Kinesis Information Analytics because of the ease-of-use it offers for SQL-based stream analytics. Through the use of SQL with KDA (KDA Studio/Flink SQL), we will create dynamic options based mostly on machine interval information arriving in actual time. This information is joined with the affected person demographic, historic medical, therapy, and laboratory information (enriched with Amazon S3 information) to create the whole set of options required for a downstream ML mannequin.

    Information lake storage

    Amazon Kinesis Information Firehose was the only technique to persistently load streaming information to construct a uncooked information lake in Amazon S3. Kinesis Information Firehose micro-batches information into 128 MB file sizes and delivers streaming information to Amazon S3.

    Medical datasets are required to counterpoint stream information sourced from on-premises information warehouses by way of AWS Glue Spark jobs on a nightly foundation. The AWS Glue jobs extract affected person demographic, historic medical, therapy, and laboratory information from the information warehouse to Amazon S3 and remodel machine information from JSON to Parquet format for higher storage and retrieval prices in Amazon S3. AWS Glue additionally helps construct the static options for the intradialytic hypotension (IDH) ML mannequin, that are required for downstream ML inference.

    ML Inference and Operational analytics

    Lambda batches the stream information from Kinesis Information Analytics that has all of the options required for IDH ML mannequin inference.

    SageMaker, a totally managed service, trains and deploys the IDH predictive mannequin. The deployed ML mannequin offers a SageMaker endpoint that’s utilized by Lambda for ML inference.

    Amazon OpenSearch Service helps retailer the IDH inference outcomes it acquired from Lambda. The outcomes are then used for visualization by way of Kibana, which shows a personalised well being prediction dashboard visible for every affected person present process therapy and is accessible in near-real time for the care crew to offer intervention proactively.

    Observability and traceability for failures

    As a result of this resolution provides the potential for life-saving interventions, it’s thought-about enterprise essential. The next key measures are taken to proactively monitor the AWS jobs in Fresenius Medical Care’s VPC account:

    • For AWS Glue jobs which have failures and errors in Lambda features, a direct e mail and Amazon CloudWatch alert is shipped to the Information Ops crew for decision.
    • CloudWatch alarms are additionally generated for Amazon OpenSearch Service at any time when there are blocks on writes or the cluster is overloaded with shard capability, CPU utilization, or different points, as really useful by AWS.
    • Kinesis Information Analytics and Kinesis Information Streams generate information high quality alerts on information rejections or empty outcomes.
    • Information high quality alerts are additionally generated at any time when information high quality guidelines on information factors are mismatched. To test mismatched information, we use high quality rule comparability and sanity checks between message payloads within the stream with information loaded within the information lake.

    These systematic and automatic monitoring and alerting mechanisms assist our crew keep one step forward to make sure that methods are operating easily and efficiently, and any unexpected issues could be resolved as rapidly as doable earlier than it causes any antagonistic impression on customers of the system.

    AWS partnership

    After Fresenius Medical Care took benefit of the AWS Information Lab to create a working prototype inside one week, professional Options Architects from AWS turned trusted advisors, serving to our crew with prescriptive steering from ideation to manufacturing. The AWS crew helped with each solution-based and service-specific greatest practices, helped resolve key blockers in each part from growth by way of manufacturing, and carried out structure opinions to make sure the answer was sturdy and resilient to enterprise wants.

    Resolution outcomes

    This resolution permits Fresenius Medical Care to raised personalize care to sufferers present process dialysis therapy with a proactive intervention by clinicians on the level of care that has the potential to save lots of affected person lives. The next are among the key advantages on account of this resolution:

    • Cloud computing sources allow the event, evaluation, and integration of real-time predictive IDH that may be simply and seamlessly scaled as wanted to achieve extra clinics.
    • Using our software could also be notably helpful in establishments dealing with workers shortages and, probably, throughout house dialysis. Moreover, it might present insights on methods to stop and handle IDH.
    • The answer permits trendy and progressive options that enhance affected person care by offering world-class analysis and data-driven insights.

    This resolution has been confirmed to scale to an appropriate efficiency stage of 6,000 messages per second, translating to 19 MB/sec with 60,000/sec concurrent Lambda invocations. The power to adapt by scaling up and down each part within the structure with ease stored prices very low, which wouldn’t have been doable elsewhere.


    Profitable implementation of this resolution led to a assume large method in modernizing a number of legacy information property and has set Fresenius Medical Care on the trail of constructing an enterprise unified information analytics platform on AWS utilizing Amazon S3, AWS Glue, Amazon EMR, and AWS Lake Formation. The unified information analytics platform provides sturdy information safety and information sharing for multi-tenants in numerous geographies throughout the US. Much like Fresenius, you’ll be able to speed up time to market by utilizing the best software for the job, utilizing the broad and deep number of AWS analytic native companies.

    Concerning the authors

    Kanti Singh is a Director of Information & Analytics at Fresenius Medical Care, main the large information platform, structure, and the engineering crew. She likes to discover new applied sciences and how one can leverage them to unravel complicated enterprise issues. In her free time, she loves touring, dancing, and spending time with household.

    Harsha Tadiparthi is a Specialist Principal Options Architect specialised in analytics at Amazon Internet Providers. He enjoys fixing complicated buyer issues in databases and analytics, and delivering profitable outcomes. Exterior of labor, he likes to spend time along with his household, watch films, and journey at any time when doable.


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