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A Bucket Full of Numbers?. An Insight to Hemodialysis Data Management Systems. Kevin Lyons Fresenius Medical Care, Bad Homburg / Germany. Evolution of Hemodialysis Data Management Systems Potential Pitfalls A case for automatic data acquisition The Current ‘State of the Art’

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a bucket full of numbers

A Bucket Full of Numbers?

An Insight to Hemodialysis Data Management Systems

Kevin Lyons

Fresenius Medical Care, Bad Homburg / Germany

topics
Evolution of Hemodialysis Data Management Systems

Potential Pitfalls

A case for automatic data acquisition

The Current ‘State of the Art’

What should a modern IT system provide?

What about the future?

Topics
evolution
The early days….

Paper record.

Only option available.

Manual.

Difficult to evaluate trends.

Prone to tpyographical error.

Very short term use.

Limited contribution to patient care.

Evolution…
evolution over 25 years
Evolution over 25 years

Adapted from Ronco C 2000

a case for a database
A dialysis unit may collect several GB of data per year

Device & machine data

Pressure, conductivities, flows, temperatures, physiological data

Other treatment information

Symptoms,access documentation, hospitalizations …

Laboratory results

Diagnosis

Demographic information

Drug prescription & intake

Reference data (medications, diagnosis catalogues, …)

It is hard to store/maintain this information without databases

A case for a Database?
driving forces towards data management

Downward pressure on healthcare costs

Sheer Volume of data to manage

Optimisation of Resources

Desire to become paperless

Steady increase in patient numbers

Compliance to Standards E.g. DOQI

Keeping abreast of technology

Sharing & Exchange of information

Driving Forces towards Data Management

COMPUTERISE!

industry responds
Industry Responds…..

Sample for illustrative purposes only

evaluation of clinical computing systems as used by dopps participants
Nurse Medical Manager Director

Pleased with current system 41% 34%

Need to add additional functions 75% 73%

Need a new system 45% 55%

Current system is very good at

Patient care…. 37% 33%

Current system is very good at

Monitoring quality and outcomes 44% 38%

Evaluation of Clinical Computing Systems as Used by DOPPS Participants

Sargent J 1999

factors limiting the effectiveness of computer systems
Purchasing system before needs are defined

System does not meet the requirements

Data collection and entry

Management of collected data is complex

Lack of a friendly interface

Reporting not targeted to improving patient care levels

Not upgradeable

Lack of an ongoing training program / poor training

Factors Limiting the Effectiveness of Computer Systems

Adapted from Ronco C 2000

slide11

… modern dialysis machines are able to provide much more treatment information...

T [°C]

T [°C]

Online plus™ System

Online plus™ System

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other medical devices can provide information too
Other Medical Devices Can Provide Information too…

…in principle, any device with an RS 232 or similar interface can pass on its measured parameters

the missing link
The Missing Link…

Workstations

File Servers

Workstations

slide14

Manual -v- Automated Measurements (1)

Table 1: Time needed to produce dialysis prescription using automated data acquisition compared to manual data entry

Source: Rourke E et al. “Man or Machine”

slide15
Blood Pressure Pre-Finesse

150/90

140/92

150/110

150/80

140/90

150/90

202/100

150/90

150/90

150/85

Blood Pressure Post-Finesse

191/110

212/89

196/99

210/104

188/89

214/105

191/89

169/84

175/84

190/110

Manual -v- Automated Measurements (2)

Table 2: Comparison of 10 Blood Pressure readings taken by a patient immediatelybefore the installation of Finesse and 10 automated readings produced immediatelyafter the installation of the system

Source: Rourke E et al. “Man or Machine”

slide16

Manual -v- Automated Measurements (3)

Figure 4 : Comparison of reported symptoms 3 months prior to, and

3 months after installation of Finesse

Source: Rourke E et al. “Man or Machine”

benefits of a data acquisition system
Real time treatment information

Accuracy of recorded data

Patient reported

Typographical

Therapy given based upon patient status

Burden of data collection greatly reduced

Facilitates Audit and Analysis

Benefits of a Data Acquisition System
acquisition alone is not enough it can only be successful when implemented with the right database
Acquisition alone is not enough… It can only be successful when implemented with the ‘right’ database.
what characterises an outstanding data management system
Functionality

Data presentation & analysis

Integration of dialysis machines & medical devices

Advanced features (decision support, bio-feedback)

Integration with other systems

What Characterises an OutstandingData Management System?
what characterises an outstanding data management system20
Acceptance: The user likes to work with it, …

Simplicity, usability and workflow

Don’t have to drastically change their way of working

Training

Please

Confirm

F60

Where do I have

to enter what??

Without workflow:

The worker looks

for the work

With workflow:

The work looks

for the worker

What Characterises an OutstandingData Management System?
slide21

Acceptance: Training is an ESSENTIAL element

  • NEVER underestimate the importance of training
  • Create local experts via the TTT concept
  • Ensure ALL relevant disciplines are involved
  • Bilateral responsibilities
what characterises an outstanding data management system22
Cost effectiveness

Benefit from changing technologies and competition

Scalability

What Characterises an OutstandingData Management System?
cost effectiveness
Profit from competition, be independent of

Platform (AS400, PC, SUN, …)

Database (DB2, Oracle, MS-SQL, …)

Operating System (OS400, NT, Win9x, Solaris, …)

Profit from changing Telecoms market, choose

LAN, Frame-Relay, Internet, Dial-up, …

Profit from global developer community and use open and (license) free standards

Java, HTML, XML, Servlet, Internet (www, ftp, …)

Cost Effectiveness
xml extended mark up language
THE data exchange format

Non proprietary, widely supported (Microsoft, SUN, IBM, oracle, …)

Standard also in the medical field (HL7)

XML: Extended Mark-up Language

XML

<machine_data id="Fresenius_4008">

<patient id=Q1299817212 />

<row>

<data name="time">15.02.2000 19:47:21</data>

<data name="ven. pressure">1926</data>

<data name="art. pressure ">9548</data>

<data name="Temperature">7784</data>

<data name="UF-Volume">4153</data>

<data name="UF-Rate">1093</data>

</row>

<row>

<data name="time">15.02.2000 19:47:26</data>

<data name="Temperature">3529</data>

<data name=“Dialysate-flow">681</data>

<data name="UF-Volume">8225</data>

<data name="UF-Rate">1808</data>

</row>

...

</machine_data>

Standard-Interface

150220001947211926954877840000415300324331093de34ar153

150220001947260000000035290581822500deas01808de34ar154

...

Vendor specific

Human readable

cost effectiveness scalability
Cost Effectiveness: Scalability

1000+ PCs

Technical

Scope

Disease state

management

100 PCs

Entire medical

documentation

10 PCs

Warehouse

Functional

Scope

Workflow

1 PC

Machine integration

Dialysis

unit

Dialysis

clinic

Hospital

Chain

Single

doctor

National

Healthcare

internet w hat s so special
For the very first time in history we have:

Option to share information and to communicate without any restrictions by borders and locations

Send: text (letters), pictures (x-ray), movies (echo), sounds

Discuss: chat-rooms, news-groups

Retrieve information: on-line databases & journals

Standardised technology

Chance to share common data: consistent, non-redundant, without lavish interfaces, shared by larger community, e.g. Several clinics

Affordable by nearly everybody

Internet….. What’s so Special?
  • For the very first time in history we have:
    • Option to share information and to communicate without any restrictions by borders and locations
      • Send: text (letters), pictures (x-ray), movies (echo), sounds
      • Discuss: via chat-rooms, news-groups
      • Retrieve information: on-line databases & journals
    • Standardised technology
    • Chance to share common data: consistent, non-redundant, without lavish interfaces, shared by larger community, e.g. Several clinics
    • Affordable by nearly everybody

State-of-the-art clinical IT systems have to utilize these opportunities!

slide27

Thank you

for your

attention

Kevin Lyons

Service & Training Manager

Fresenius Medical Care

Regional Office Middle East

PO Box 3264

Dubai UAE

Tel +9714 332 9317

Fax +971 332 9316

Mob +971506250443

E-mail: kevin_lyons@hotmail.com