I.e. we’re terrible at at-home dialysis, will digital health be different? Short answer: I certainly hope so.
Agree on so many of your points. As a previous nurse who helped advocate for care in older adults homes rather than driving them to offices and dialysis, I learned a lot. A big thing I think digital health can do is help better triage a certain type of patient - the health literate, "healthy" chronically conditioned, over 18, technologically savvy, and those with all mental capacities" to the realm of telehealth and digital specific platforms leaving office visits for those who are not those things or need in-person evaluation due to progression or acute issue with chronic condition. All we hear from nurses and doctors is there is not enough of them yet more people living with chronic conditions and more aging adults. I believe if our health system wants to stay afloat it will need to harness tech to help make up for the people and brain power we won't have to take care of the masses. The story of dialysis is so disheartening and I lived it. I will say home dialysis or any home care solutions for that matter - I fear the work and stress the health system and corporations will place on family caregivers - free labor makes for a great business model.
For what it's worth - I worked as a home hemodialysis nurse for Fresenius for a while through early 2020, and they were really trying hard to move people from traditional clinics into the home. Part of it seems to be because of reimbursement incentives changing to encourage home dialysis (specifically from CMS, but private insurers as well) and part of it is because I think there was a realization that the solution up to that point (continue to build more brick-and-mortar centers as the dialysis patient population grows) wasn't going to work anymore because of staffing issues. Home dialysis is waaay more efficient staffing-wise, at least from my experience.
If you ever do end up writing something about dialysis and would like someone from the field to assist, I'd love to help!