KDCPMS Overview Now and into the Future 28 November 2014 Beaumont 3rd Annual Transplant & Nephrology Conference Deirdre Keown, RGN, MSc Health Informatics

Presentation Overview KDCPMS “Kidney Disease Clinical Patient Management System”  Past Background CAWT Renal Project  Present Where we are now  Future Challenges Reality Benefits

CAWT Renal Project  August 2008 the cross border collaborative health services project won a prestigious ‘European Health Forum Award.’  It was developed with funding secured by CAWT from the European Union INTERREG IIIA programme.  The project enabled six hospitals in the border region to install common specialised information systems so that they could share data to assist them in the treatment and care of patients with kidney disease. Beaumont 3rd Annual Transplant & Nephrology Conference 28 November 2014

Background to KDCPMS  National Renal Strategy Review (NRSR) 1. Identified the development of a Renal Health Intelligence system as a key requirement. 2. Proposed establishment of a National Renal Registry. 3. Formation of a National Renal Office (NRO).  “A dedicated Kidney Disease patient management system that will facilitate the clinical management of all patients with kidney disease, from first presentation to a renal centre right through to renal replacement therapy.” AIM

KDCPMS Project Objectives The chosen ICT System must be : COMPREHENSIVE : Electronic medical record of patient medical history and events MULTIRELATIONAL : Interface in real-time with existing hospital PAS & LAB systems and HD Machines SHARED CARE PLANS : Improved access to the care plans for renal teams: Nephrologist, Renal Nurse, Dietician, Transplant Co-ordinator SEAMLESS : Easy transfer of patients between Units EFFICIENT: Enhance efficiency of current resources by avoidance of unnecessary tests and reduce dependency on paper based records REGISTRY ORIENTATED: Establish a core information framework to support the development of a National Renal Registry.

The Journey of KDCPMS Begins..  August 2010 : Contract awarded to Mediqal Health Informatics Limited (M.H.I) for the supply, installation and maintenance of a Kidney Disease Clinical Patient Management System (KDCPMS) at 16 Renal Units in Ireland.  The application is referred to as “eMEDRenal”  November 2010 : Mediqal appointed Ms Yvonne O’Reilly as RoI National Project Manager to oversee this contract.  Contract includes : - A Single Database & Multiple Instances - Delivery of PAS & LAB Interfaces on each site - Irish Standard Build (90% Std, 10% Local) - Full Audit Traceability - Delivery of HD Machine Interfaces where MHI have developed the technology to communicate with Suppliers machine software. (FMC)  2015 : Contract with MHI will be extended to include  Dublin Contracted Satellite Units (initially)  St James Hospital

HSE Board/CEO NHO DirectorICT Director Project Board Dr. Liam Plant (Executive Chair) ICT Steering NHO Steering Project Team Dr. Austin Stack (Clinical Director) Vincent Jordan (ICT Programme Manager) Anne McCahill (Project Manager) Deirdre Keown (Business Implementation) Change Control Board Implementation Process 16 sites KDCPMS Project Governance User Groups

16 Public Renal Units Phase 1 Cavan General Hospital Sligo General Hospital Letterkenny General Hospital Merlin Park Hospital, Galway Mayo General Hospital, Castlebar Cork University Hospital Kerry General Hospital, Tralee Waterford Regional Hospital Midland Regional Hospital, Tullamore University Hospital Limerick St Vincent’s University Hospital Beaumont Hospital (Pending) AMNCH, Tallaght Mater Hospital, Dublin Children University Hospital, Temple St Our Lady’s Children Hospital Crumlin Phase II Contracted Satellite Units St James Hospital Geographic Scope

KDCPMS Current position: Actively used in patient care in 11 Chronic Renal Units. Beaumont going live early All HD and Home Therapy patients recorded. Most run Transplant Follow-up clinics. Moving to all units recording all end-stage patients. Some units documenting CKD patients. Most have laboratory information directly integrated into patient record.

Ongoing lifetime of the Solution:  eMEDRenal Go-Live is the Starting Point  Ongoing Leadership is Key :  Drive enhancements at a local level  Interfaces (HD, PAS, LAB)  Ensure there is participation in  User Groups (UAT of new Releases)  Change Control Board &  Sustain a focus on data-driven improvement in patient care  National clinical audit initiatives Resulting in Enhanced Care Delivery at a Local Level

Renal System Administrator.. Pivotal Role  System Manager duties  Account Management  Configuration Management  Staff Training  Application review of eMEDRenal  Kt/v Management  New Version Testing  Data Gathering  Report Management  Updating of Patient Admin Beaumont 3rd Annual Transplant & Nephrology Conference 28 November 2014

27th September 2013MH1 Annual User Group Meeting12

Beaumont 3rd Annual Transplant & Nephrology Conference 28 November 2014

Complexities/Challenges Technical Challenges Cultural Challenges Organisational Challenges Regulatory Challenges Beaumont 3rd Annual Transplant & Nephrology Conference 28 November 2014

Challenges of using eMEDRenal effectively  Data completion is challenging.  Crucial to get patient classification correct: Clinical Supervision, Treatment Location, Modality  The eMEDRenal Reporter will provide a framework for performance monitoring.  Standard Operating Procedures & Guidelines are required for effective use  Why do it?  Allows for immediate reporting of important markers of performance Beaumont 3rd Annual Transplant & Nephrology Conference 28 November 2014

Census Reporting Proposal for All units review and validate their records. Start with lead Nephrologist and Renal System Admin (RSA) checking classification and lists 2.NRO issues a “% completion” report on 1 st December for all units (missing data) 3.Lead Nephrologist and RSA complete the minimum dataset for all patients before Christmas break 4.NRO extracts 23hrs 31 st Dec 2014

The Future … A National Renal Registry Beaumont 3rd Annual Transplant & Nephrology Conference 28 November 2014

23 The KDCPMS Journey What we have to build What we’d like to build