written by Vincent Jordan
20% of adults aged over 45 years in Ireland have Chronic Kidney Disease (CKD), a condition that significantly increases the risk of cardiovascular disease and premature mortality.
The kidneys filter your blood, removing wastes and extra water to make urine. They also help control blood pressure and make hormones that your body needs to stay healthy. When the kidneys are damaged, wastes and water can build up in the body.
More than 4,000 patients currently have progressed to develop End-Stage Kidney Disease (ESKD) and require lifelong dialysis or transplantation. More than 250,000 haemodialysis treatments are delivered every year, accounting for 20% of all Day Case attendances at HSE hospitals each year. 54% of ESKD patients have a functioning kidney transplant.
Renal services in Ireland are delivered in 14 major hospitals across the state and are there to help citizens who develop kidney disease. This case study describes how the Kidney Disease Clinical Patient Management System (KDCPMS - the electronic patient record for Renal services), was implemented for the patients, nurses and doctors involved with the Renal services in Ireland.
Patients with Kidney Disease require a range of services during their lifetime with the disease. The care team over the lifetime of a patient would often include:
GPs for diagnosis and care in early stages of CKD, supported by laboratory diagnostics;
As disease progressed towards ESKD, the specialist kidney teams are involved.
In ESKD, patients are usually prepared for dialysis treatments including vascular surgery and interventional radiology.
Patients who have regular dialysis treatments sometimes move between different dialysis centres for reasons of study, work, illness or holidays.
Many ESKD patients are assessed for kidney transplant involving further specialist input including with the transplant centre in Beaumont hospital.
The National Renal Office recognised that providing a single electronic patient record for each Renal patient in the country would help to improve continuity of care, clinical audit and quality outcomes for patients living with renal disease.
A multidisciplinary team of renal specialists including doctors, nurses and dieticians was convened with the relevant IT expertise to procure a renal clinical information system, implement it across all renal units and work on enhancing care processes.
The system selected for KDCPMS is eMed Renal from Mediqal Health Informatics. This provides a customised renal EPR that is used by the Renal teams to support care. The Renal teams use the system to document patient conditions, treatments, medicines and transplant workup across all stages of kidney disease.
Before the introduction of KDCPMS, each Renal service kept a medical record for each patient they saw. It meant the full medical details of a renal patient were spread over several different hospitals. Now that KDCPMS is in widespread use, each Renal service has access to the patient’s record of care. This ensures the care team can refer to previous details and update the patient’s record, no matter where the patient attends for service. All of this helps the care teams to provide safe and joined-up care.
KDCPMS is connected to each hospital Laboratory Information System (LIS) and each hospital Patient Administration System. This ensures that the most up to date diagnostic and attendance information is available to the care team each time that a patient presents. Sophisticated patient identity matching processes are in place to ensure safe record keeping.
KDCPMS is also connected directly to the dialysis machines operating in some dialysis units. This allows the dialysis prescription to be automatically programmed into the machine for confirmation by the renal nurse. This eliminates transcription errors from this part of the care process.
As of now 13 of 14 adult hospitals delivering renal services are using KDCPMS. The final adult hospital to join the programme will complete implementation in early 2016. Three contracted dialysis units already use KDCPMS to record dialysis care and during 2016 other dialysis contractors will be invited to use KDCPMS.
Benefits For All
Dr. Liam Plant, Clinical Director – National Renal Office:
“KDCPMS allows our Renal Teams to view an accurate and up to date patient record for individuals living with kidney disease, including laboratory and treatment information. It enables improved monitoring of care delivered and helps teams provide best available treatments to each patient. One of the best features is that doctors and nurses can access records quickly and easily even when a patient transfers from one hospital to another. In addition, real-time data on service activity levels allows each Hospital Group to track these, identify areas of service pressure and target resources to maximum effectiveness. This further informs national strategic planning to develop a world-class service that is equitable and effective in a uniform fashion across the country. It will be foundation of the Irish National Renal Registry”
Improved safety for patients as laboratory tests, clinic letters, and treatment data is all available in one place.
As patients move between care teams, their record moves with them.
Patients when called for transplant, often without notice, are confident the transplant team have a full picture of their condition and treatments.
The renal team can deliver safe, enhanced care for every patient they encounter. Detailed patient information is organised logically and clearly.
Clinical correspondence is easy to produce with extracts of the clinical record automatically included in letters.
Care coordination is improved across care providers.
Clinical audit is swift and straightforward. It allows renal units to measure the effectiveness of their care processes and patient outcomes and informs their improvement initiatives.
National Renal Office & Hospital Groups
> The National Renal Office can use summary data from KDCPMS regarding patient acuity, renal service activity and population trends to better inform service planning and patient-centred care.
> Electronic Health Records – KDCPMS ensures information is captured once and used many times to plan, monitor and improve care for patients.
> Care Delivery Enablement – KDCPMS demonstrates how an EPR improves patient, doctor and nurse experience during care delivery.
> National Support Systems – KDCPMS is used to deliver clinical care details to the Activity Based Funding programme, improving financial forecasting and planning.
> Health Service Insight – KDCPMS delivers reporting and analysis capability which provides real-time information for decision-support, clinical audit, service planning, and renal population health trends.
KDCPMS has been a major investment of time, effort and skills from all the Renal units in Ireland and the OOCIO. It has led to a significantly enhanced capability to provide safe, quality-assured renal care to people in Ireland living with kidney disease.