Case study · Healthcare · Regulated MedTech
Redesigning Fresenius Medical Care’s remote therapy management system for peritoneal dialysis, across two regulated markets and two parallel workstreams.
Fresenius Medical Care needed to unify its therapy management ecosystem across EMEA and North America: evolving legacy platforms, redesigning clinical workflows and introducing entirely new capabilities, all at once.
The starting point was a platform already in clinical use across North America and in pilot clinics across EMEA, with real users, real workflows and real room to grow. Feedback from pilot clinics pointed to clear opportunities: simplifying navigation, surfacing the right data at the right time, and giving nurses the confidence to fully rely on the tool.
The goal was not just a better UI. It was to reshape an entire clinical workflow across regulated markets, while retiring legacy systems and introducing capabilities that did not exist before.
Kinexus is Fresenius Medical Care’s remote therapy management platform for Peritoneal Dialysis (PD). Nurses and nephrologists use it to remotely create prescriptions, monitor treatments and adjust therapy programs from a clinical portal. The platform bridges clinical staff in the hospital with patients performing dialysis at home, through hardware devices (APD cyclers, gateways, patient cards) and patient-facing apps.
Blood is pumped out of the body into a dialysis machine, filtered through a dialyzer and returned. Performed in clinic or at home (HHD), several hours per session, multiple times per week.
The peritoneum acts as the natural filter. Performed at home in two modalities: APD, overnight with a cycler machine, and CAPD, during the day through manual exchanges.
A PD patient’s journey begins long before the platform: diagnosis, choice of modality, catheter placement. Kinexus enters at enrollment and from that point mediates a continuous clinical loop: treat, assess, adjust. Adequacy tests every 3 to 6 months feed prescription updates, which are sent back to the patient at home. Designing for this meant designing for a long-term clinical relationship that plays out over months and years, not for individual screens.
Two parallel design tracks ran simultaneously throughout the project, each with distinct goals, users and technical constraints, both requiring full UX leadership.
Building Kinexus as a fully standalone product for the EMEA market and enhancing it across regions: remote therapy monitoring and programming (APD + CAPD), patient app integration, and the hardware-software bridge with cyclers and gateways.
Enhancing Kinexus with regulated clinical features migrated from legacy products: the Adequacy module (PET, 24h batch and PFT tests) and Modeling & Dosing, a clinical calculator embedded in prescription creation, delivered as micro-frontends.
Every design decision, from a tooltip to a clinical alert, requires compliance with medical device software regulations.
Designing for a clinical web portal and physical devices (cyclers, gateways, patient cards) simultaneously.
Sunsetting legacy products while ensuring every feature was absorbed into Kinexus without disrupting active clinical workflows.
EMEA and NA have fundamentally different product architectures, workflows and regulatory requirements, all needing one cohesive design system.
Led a team of 4 designers, set quality standards, ran critique sessions and mentored junior designers.
Defined experience principles and led journey mapping across user roles: nurses, nephrologists, patients.
Organized and participated in user research with clinical staff across EMEA and NA markets.
Aligned design decisions across PMs, POs, architects, BAs and clinical business unit stakeholders.
Active in sprint planning, requirements collection and continuous delivery across two Scrum teams.
Close handoff and iteration cycles with developers and QAs, bridging design intent and implementation.
The team operated within a Dual Track Agile framework: Discovery ran ahead of delivery, producing validated user stories, wireframes and prototypes, ideally two iterations ahead at all times. Delivery turned validated designs into working software, sprint by sprint.
Research was not a phase: it was a continuous thread running through every sprint and every feature. No design was finalized until it had completed the full cycle.
Interviews and discovery with domain experts to ground every feature in clinical reality before any design work begins.
Flows, processes and screen-level interactions explored through low to mid-fidelity wireframes and prototypes, made tangible quickly.
Designs reviewed in sequence: internal experts first, then country representatives, then clinical users in structured testing sessions.
Design discussed with developers to explore feasible approaches. Technical constraints inform the final direction before handover.
Discovery started from three complementary sources: consolidated feedback from pilot countries, structured walkthroughs of the as-is platform with current and future users, and a consolidated as-is service blueprint mapping processes, touchpoints and pain points. An expert heuristic review completed the baseline.
Nurses managing PD patients have little time and even less tolerance for friction. Their daily tasks span monitoring multiple patients, responding to alarms, adjusting therapies and coordinating with nephrologists, all within a tool they are expected to trust completely. Four needs emerged consistently from research:
“I want to quickly understand situations that need a prompt intervention.” Hierarchical information, immediate visibility of critical situations, effective system feedback.
“I aim to be involved with minimal cognitive effort.” Natural interactions, clear navigation, minimal information overload, familiar terminology.
“I need to be in control.” Comprehensive in-product guidance, customization, clear system behavior that avoids misunderstandings.
“I want to quickly evaluate the status of a patient.” Trends, prescribed vs performed, accurate medical data, consistent data language across products.
“I need to identify issues as soon as possible: see trends to understand where there are recurring problems and take action quickly.”
PD nurse“We just need information to make prescriptions and receive the treatment results. I think less is more in these kinds of software.”
PD nurse“I don’t want to see everything in the dashboard overview, but I want to be able to reach everything from it.”
PD nursePrescription management is the clinical core of Kinexus: creating therapy prescriptions, configuring them in detail and delivering them through multiple channels. An end-to-end Human Factors validation of the as-is platform produced an unambiguous picture of use errors, failed tasks and safety-critical gaps.
No clear information hierarchy to guide clinical decisions.
No summary, no way to scan a prescription without entering edit mode.
Transferring a prescription to the patient card or gateway was confusing.
Nurses had no visual feedback of the prescription while building it.
The flow went through three major iterations, each shaped by a new layer of feedback: from exposing all information at once, to a list-first approach with inline detail on demand, to clear Published / Saved / History states with a contextual action menu.
The redesigned flow guides nurses step by step with clear structure and immediate feedback: a live cycle graph updates as parameters are set, “Save and close” replaces an ambiguous Save, scheduling is scannable, and publishing to the patient card or gateway is a deliberate, guided choice. Prescriptions can be created independently or with the embedded Modeling & Dosing support, and delivered anywhere: saved as drafts, or published to patient card, gateway or the patient app.
Embedded within the prescription flow is the Modeling & Dosing micro-frontend: a clinical calculator that suggests prescription parameters based on the patient’s data. Feeding into that calculation are the Adequacy assessment tests, whose results clinicians select directly within the flow. Two medical device features, designed in parallel, with a data handoff that had to be clinically accurate and interaction-safe.
Targets weekly optimisation instead of one prescription at a time. Uses transport status from PET, adequacy data from 24h batch, and clinical targets like weekly Kt/V and creatinine clearance to suggest volume, cycles, dwell time and solution concentration. The clinician sees a live estimated outcome and can accept, adjust or override everything. The design challenge was seamlessness: a regulated medical device that feels like a natural extension of the prescription form.
Brings formal adequacy testing into Kinexus, previously in PatientOnLine. Three test types: PET every 6 months (with double mini PET variant) classifying membrane transport status, 24h batch every 3 months measuring weekly Kt/V and creatinine clearance, and PFT for CAPD patients. Results produce a structured report with transport classification, D/P ratio curves and quantitative values, exportable as PDF and reusable as Modeling input.
Kinexus sits within a large, interconnected ecosystem of products, teams and markets, where a design decision in one place has consequences somewhere else entirely.
Joining a company mid-transformation meant process itself was something to actively shape, not just follow.
In a historically tech-driven organization the value of design has to be demonstrated, earned and reinforced continuously.
The hardest challenge was positional, not visual: moving design from executing decisions to shaping direction, one increment at a time.