Development of a fully integrated, dialysis electronic patient record across a large, diverse

haemodialysis programme.
Background: Our Trust is one of very few UK hospitals to have developed an electronic
patient record (EPR), PICS, used ubiquitously across the institution. This includes clinical
documentation, electronic observation and prescribing, supported by complex clinical decision
support. The Trust cares for an in-centre haemodialysis (HD) population of 970 patients spread
across 10 units. Only the base unit is an NHS unit with the satellite units supplying dialysis via
private provider partnerships (4 Diaverum, 4 Fresenius, 1 Assure Dialysis). During 2014 and
2015 a major reorganisation of the HD programme prompted development of a dialysis EPR
within PICS to integrate across all providers and ensure that dialysis care details were easily
available across sites and configured to allow both ease of clinical use and financial billing,
assessment of external and internal KPI and UKRR returns.
Project outcomes: Across the differing units, a variety of dialysis machines are being used;
Fresenius 5008 at Trust and Fresenius units, Baxter Gambro Artis Physio and latterly B Braun
Dialog + at Diaverum and Baxter Gambro Artis Physio at Assure Dialysis. At each of the units
the provider set up a direct link from machine and scales to their own internal dialysis
management system which then fed via an HL7 output into PICS. These systems allow
bidirectional information flow so that data can pass from the dialysis machine to the provider’s
dialysis management system detailing dialysis sessions, and also from the management system
to the machine facilitating easy and reliable change in dialysis prescription. Specifications were
agreed with all providers to deliver automated, real time, session by session data for each patient
into a clinical flowsheet within PICS. This data flow also allows rapid and timely submission of
data for financial purposes and easy assessment of unit KPIs e.g. average blood flow rates or
dialysis times.
In addition, all pathology data was integrated into the clinical systems with transfer of both tests
processed at Trust labs (6 units) and that analysed at Fresenius labs into the patient flowsheets.
A separate bespoke ‘dialysis QA (Quality Assurance)’ flow sheet was developed including only
outpatient bloods with all appropriate renal tests displayed for the monthly MDT meeting.
Averaged BP, blood pump speeds, ultrafiltration volumes, time on dialysis and arterial and
venous pressures are also displayed along with space for comment to allow easy continuity
between monthly QA clinics.
Conclusions: Modern dialysis machines combined with bespoke management systems allow
bidirectional data flow minimising the need for manual data input. We believe that integration
of several dialysis providers, both private and NHS into a shared hospital EPR allowing viewing
of dialysis parameters, observations, patient medications and average monthly parameters for
QA clinics is unique. We feel that this model improves patient care and is likely to be useful in
other renal units.