The Establishment And Evaluation Of Electronic Information Management System In Hemodialysis Center

BackgroundHemodialysis is one of the main renal replacement therapies. Many patients with End-stage renal disease (ESRD) rely on this technology to survive. The population of patients with end-stage kidney disease has reached more than 200 million globally. In 1970s hemodialysis first appeared in China and dialysis patients grown rapidly all over the country. Scientific and strict management of hemodialysis centers are closely related to the patient’s life and the effectiveness of hospital management. Because of the medical treatment and management are different in separate centers thus a variety of adverse events are often found to occur. These events seriously endangering the patients’ health and makes it the focus of health authorities and hospital administrators. Therefore, the improving of hospital information management must be done to better eliminate medical risks and ensure health care security. Whether the improvement could save manpower and management costs at the same time which is the main focus.At present, domestic and foreign health authorities are mostly rely on the inspections and/or dialysis registration system to assess the operations and medical condition of the hemodialysis centers. Management of hemodialysis depends on a variety of record sheets, ledger, and treatment records. In China the management of hemodialysis-related information (such as medical records, quality control, equipment maintenance, consumables, personnel, financial and etc.) is relatively backward and unable to meet the requirements of quality control assessment. The clinical challenge is how to improve the management efficiency and to keep up with the expansion of dialysis centers.Recently, many hospitals tried some new methods. Dialysis centers abroad and other domestic departments have seek to establish clinical information management databases. A lot of practice shows that the emerging clinical information electronic management system greatly improved the efficiency of information management. It is the future direction of development to improve the clinical efficiency. Therefore, the hemodialysis center introduced the hemodialysis information management system. Purpose of the introduction is to improve the quality information management and to reduce consumption of human resources, improve efficiency with less cost.According to the requirements of system the center reformed hardware and adjusted the software architecture in order to establish the first hemodialysis information electronic management center. This purpose of this study is to evaluate the operation of the hemodialysis information management system and its impact on dialysis efficiency and quality of dialysis through a series of controlled clinical study and survey was satisfaction of both doctors and patients.MethodsFirst, the center established appropriate hardware facilities including the construction of the Central processing unit, connecting cable, hemodialysis machines and auxiliary equipments. Then, the centers introduced a software system and made it meet local quality control requirements. Finally, the center modified the treatment process on hemodialysis and trained all staff and patients treated in this center. The patients have got familiar with electronic information management system and got used to new medical treatment process. On the basis of complete construction a preliminary assessment of information management system have been done. The assessments included the system stability, safety and the effectiveness of information management.Upon completion of the preliminary assessment, prospective controlled clinical study had drawn the comparison between groups of patients receiving conventional management and electronic management. Time consumed in prescription, parameter setting and monitoring blood pressure, heart rate and arterial and venous pressure were analysis in order to evaluate the impact of information management system on work efficiency. At the same time, the incidence of chronic dialysis complications and dialysis adequacy in two groups were compared to observe whether there are obvious differences.In the way of the questionnaire, censuses were done among all dialysis patients and health care workers. The purpose was to evaluate the satisfaction and adaptability of hemodialysis information intelligent management system. The results of these censuses contribute to specify the direction of further improvements.ResultsAfter hardware transformation and software construction, the center has completed the construction of the digital hemodialysis center, and the smooth operation of the hemodialysis intelligent management system. The system successfully achieves this function of hemodialysis real-time monitoring and automatically saved the data send to the server after localization adjusts. Hemodialysis database system was managed to progress patient records, dialysis prescription, the dialysis data, chemical and biological detection.The center improved information electronic management system in various reports generation and output functions and developed of a variety of data analysis functions. The center has also realized mobile ward rounds and remote monitoring capabilities through the establishment of wireless networks. The center developed new work processes and medical treatment process according to the demand of the information electronic management system. Training of the center of all staff and patients were conducted at the same time to ensure them accustomed to the new medical treatment process.System stability assessment results shown that the system were safe and reliable within one year of operation. The data backups were completed on time. Various types of software failures were never occurred. The results of treatment safety assessment shown that the incidence of total number of adverse events, pain in muscle, precordial discomfort, low blood pressure and bleeding were decreased significantly, particularly in the incidence of hypotension. This result suggested that information electronic management system helped improving the safety of hemodialysis treatment. The effectiveness evaluation of information electronic management showed that the integrity and authenticity of records were significantly improved and guaranteed. The 100% implementation of Doctor’s advice helped to reduce medical errors, facilitate traceability and quality control.Analysis of information management system is shown that the times were different in dialysis and vital signs detection. Electronic management group compared with the conventional management group, dialysis prescriptions issued and confirming time was significantly reduced, and vital signs detection time was completely saved. The result shown a significantly improve efficiency and a save of labor costs.Analysis of the dialysis quality shown that patients of electronic management group has its blood pressure controlled much easier and the level of hemoglobin, albumin, normalized protein catabolic rate have no significant difference compared with baseline. Patients of electronic management group have better outcomes on subjective global assessment (SGA) of nutrition and Kt/V index.As the survey show a high proportion of satisfaction of using hemodialysis information management system was reached. The system can be adapted well and the survey among medical staff shown that the majority of health care workers can master the system. And the system is able to complete its daily work and basic maintenance. Compared with paper-based mode of operation, the patient management process was greatly simplified and the speed of report output was significantly improved. In practical work the frequency of using system to make report is gradually increasing.ConclusionsThrough the construction of LAN and upgrade of software system the hemodialysis information electronic management system was successfully established. Some software improvement was been done and treatment process was updated. As the assessment shown the hemodialysis electronic information management system could run stable and treatment security could be ensured, as a result, the efficiency of management was enhanced.The hemodialysis electronic information management system can effectively improve the work efficiency of hemodialysis. Compared with the conventional management group, the electronic management group consumed shorter time on prescript and confirms and can automatically monitor blood pressure, heart rate and record arterial and venous pressure in order to save operating time. After applying Electronic information management system dialysis quality had no significant change. The beneficial effects on blood pressure may be related to blood pressure monitoring and alarm. The elevated nutrition condition may be related to improve Kt/V.Patient and staff satisfaction survey resulted that they could adapted to and application of the information management system well. This study showed that the management system improved both efficiency and the quality of dialysis. The level of hemodialysis center management got some improvement. In the future, more improvement of the system and connection to other hospital management system should be set up. The system should be more suitable to local quality control requirement and the clinical demands.