Enhancing Renal Care Efficiency through IT Integration

1. “Do Once and Share” Feedback from the Renal Team B Stribling, K Harris, A Keogh, J Medcalf

2. Aims • Identify the potential for using the National Programme for IT to improve the efficiency of care processes • Reduce unknowing duplication • Promote national consistency • Reduce the waste of professional & patient time • Ensure a common input to the Technical Office (central IT)

3. Why do it?   

4. Scope - I • Provide baseline information on the current standard clinical practice, and likely changes to clinical pathways • Identify training implications • Produce Guidelines for primary care on the implementation of the project • Outputs for SNOMED required

5. Scope - II • Describe existing renal IT systems, and the expectations of the wider renal community for future systems • Describe any finished, or pilot projects in progress • Develop communication plan between National renal community and NPfIT • Report to stakeholders on progress to date • Produce timely reports as required

6. Out of scope • Comprehensive engagement with social care • Comprehensive evaluation of needs of private care providers • Comprehensive evaluation of the requirement for the care of children with renal disease • Comprehensive training manual to include recommendations for delivery

7. CKD initial assessment Patient unknown to have renal disease • Identified by • Coincidental Investigation • GP system identifies “at risk” (CVD, DM, ↑BP) • Other clinic • Pharmacy screening program • Formal screening program (if became technically simple • Symptoms of CKD (least likely) • Previous acute renal failure Patient info throughout Tailored to CKD stage and individual patient Language Paper as well as IT Assessment and stage of CKD • Repeat Creatinine • Creatinine:age:sex:race = MDRD or other GFR estimate • BP • Urinalysis for blood and protein, protein:creatinine ratio • Screen for other disease eg DM • Drug / PMH / Lifestyle history Advice and support Pharmacy/ Others NELH Clinical Advice System Map of Medicine • Stable CKD * • Return GP CDMP with • Tailored management plan based on standard templates • All test results • Re-referral advice Local Referral Guideline Choose and book Templates Stable CKD * Chronic Disease Management Program (CDMP) Renal or other X-ray Nephrology Advice “Virtual Nephrologist” or Other method of communication Pathology Doctor • Progressive CKD • Shared primary / secondary care Specialist Nurse “One Stop” Nephrology Outpatients Assessment Access to all previous data PMH, FH, DH, BP,GFR, Urinalysis, Imaging etc † Dietician Guideline Pharmacist review Medicines management Pharmacist & electronic Prescribing support • Other Renal Disease requiring specialist advice • Shared primary / secondary care NELH Guidelines / policies etc Primary care Referral to other speciality e.g. Urology † consider possibility that patient might prevent this

8. Patient unknown to have renal disease CKD initial assessment • Identified by • Coincidental Investigation • GP system identifies “at risk” (CVD, DM, ↑BP) • Other clinic • Pharmacy screening program • Formal screening program (if became technically simple • Symptoms of CKD (least likely) • Previous acute renal failure Patient info throughout Tailored to CKD stage and individual patient Language Paper as well as IT Assessment and stage of CKD • Repeat Creatinine • Creatinine:age:sex:race = MDRD or other GFR estimate • BP • Urinalysis for blood and protein, protein:creatinine ratio • Screen for other disease eg DM • Drug / PMH / Lifestyle history Advice and support Pharmacy/ Others NELH Clinical Advice System Map of Medicine • Stable CKD * • Return GP CDMP with • Tailored management plan based on standard templates • All test results • Re-referral advice Local Referral Guideline Choose and book Templates Stable CKD * Chronic Disease Management Program (CDMP) Renal or other X-ray Nephrology Advice “Virtual Nephrologist” or Other method of communication Pathology Doctor • Progressive CKD • Shared primary / secondary care Specialist Nurse “One Stop” Nephrology Outpatients Assessment Access to all previous data PMH, FH, DH, BP,GFR, Urinalysis, Imaging etc † Dietician Guideline Pharmacist review Medicines management Pharmacist & electronic Prescribing support • Other Renal Disease requiring specialist advice • Shared primary / secondary care NELH Guidelines / policies etc Primary care Referral to other speciality e.g. Urology † consider possibility that patient might prevent this

9. Assessment of CKD

10. Assessment of CKD

11. Local Referral guidelines

12. Renal PatientView • Commissioned by Renal Information Exchange Group (RIXG) • Provides web-based information to Renal patients about diagnosis, treatment, test results, clinical correspondence, Transplant suitability

13. Existing Functionality • Majority of Renal units already have a well developed clinical computer system • Functional, locally managed and flexible • Contains many of the key elements of an Electronic patient record • Able to share information, but until now not been a high priority

14. Existing Functionality • 31 of 52 English & Welsh units (as defined by Renal Registry 2004 report as having IT systems) responded. • 6 of 7 Scottish units with IT systems responded. (+ One with no IT system) • 2 Northern Ireland units responded • 3 Paediatric units responded 42 units total

15. Risks/Issues • NELH • not complete within this project timescale • Implications of SNOMED • Map of Medicine • not complete within this project timescale • Renal Dataset ready 2007

16. Conclusion • Described a reproducible framework on which to hang IT to support CKD • Described existing functionality (what we have to protect) • Promoted Renal as an IT literate “can-do” speciality • Identified “easy” opportunities for further innovation and road-testing existing ideas