Informatic nephrology: 17 years of one-center experience

MUSSO, CARLOS G.; PLAZZOTTA, FERNANDO; OTERO, CARLOS; AGUILERA, JERONIMO; CAMPOS, FERNANDO; DIEZ, GUILLERMO ROSA; LUNA, DANIEL; DE QUIRÓS, FERNAN GONZALEZ BERNALDO

INTERNATIONAL UROLOGY AND NEFROLOGY

Kluwer Academic Publishers

Año: 2015 vol. 47 p. 1587 - 1588

0301-1623

Editor,In this letter, we reported our experience regarding informatics nephrology during the last 17 years (1998?2014) in our Nephrology Division of Hospital Italiano de Buenos Aires (HIBA), Argentina, focused this inform in six domains: electronic medical record (EHR), data warehouse (DW), multimedia electronic record (MER), personal health record (PHR), clinical decision support systems (CDSS), and tele-monitoring (TM) [1, 2, 3].Since its first implementation in 1998, the HIBA-EHR progressively became a fundamental tool for accessing, storing, and sharing patient information in a legible, private, confidential, and secure way [4]. Our Nephrology Division has five sections: clinical nephrology, clinical renal physiology, kidney transplant, hemodialysis, and peritoneal dialysis. Both dialysis sections constitute the HIBA Dialysis Unit which is administrated by Fresenius Medical Care (FMC). Since all renal patient assistance had to be recorded in HIBA-EHR, all dialysis patient assistance had to be recorded in FMC-EHR, and medical software was both not interoperable, thus interoperability among them had to be performed by implementing clinical document standards (CDS) defined by HL7, and it currently allows that dialysis medical records performed in FMC-EHR automatically migrate to HIBA-EHC avoiding duplicated files and writing work [5]. Our EHR also has specific predetermined structured forms for recording hemodialysis and peritoneal sessions [5].DW is a data repository in which the information contained in EMR is available without identification (de-identified data) and thus is adequately protected (privacy) for being used in our nephrology management and scientific research [6].Regarding MER, this function allows nephrologists not only to have direct access to the written inform of medical tests but also to test images. The integration of this information is made possible by applying international standards and easy communication protocols such as CDA or DICOM [7].In our institution, patients have a PHR that allows them to access to their health information stored at hospital EHR by Internet in a safe and confidential environment. They are able to observe test informs, to print them, and even to take medical appointments. Besides, patients can obtain information from the hospital Internet page, which consist of guidelines set there by physicians regarding different sorts of health recommendations [8]. This information is offered to the patient according to their problem list, and this is possible through the terminology services that map all the problems into the patient?s problem list with an international standard (SNOMED CT) and some international classification systems (ICD 9, ICD 10, etc.) and then match this problem list with different institutional education resources [8, 9]. Additionally, patients can enter personal data asked by their physicians (blood pressure, etc.) or reports of tests performed in another health centers. Even more, a PHR application, called patient-doctor mail system, offers the patient the possibility of sending a message (e-mail) to the doctor?s hospital electronic address [10].CDSS are programs additional to the EHR which contribute to achieve a better medical assistance by reducing the risk of mistakes. In our EHR, we currently have ?reminders?, which consist of specific labels, usually composed by an acronym of the problem they are reminding, located on the top of the EHR screen. And we also have alerts that interrupt the documentation or prescription process if the patient has allergies, the drugs have some interactions, or the doses are high than the recommendation for this patient [9, 10, 11].Microorganism reminders are very important for reminding to keep the isolation and hygiene measures necessary for caring these patients. In our dialysis unit, out of 340 assisted patients during the last 2 years, among those who had reminders, the distribution of them was as follows: Klebsiella pneumoniae multiresistant (n:19), Staphylococcus aureus resistant to methicillin (n:85), N1H1 influenza (n:13), do not accept blood transfusion (n:8), latex allergy (n:12). Another CDSS that our EHR have consist in validated recommendations (clinical practice guidelines, etc.) which help doctors in their decision-making process [11].Regarding TM, in a pilot experience, we monitored using a special device a group of clinical variables (weight, blood pressure, etc.) in four ambulatory peritoneal dialysis patients during 6 months. This device obtained these data and sent them automatically to the patient?s EHR, where they were followed by us.Conclusion In our experience, informatics tools have become our nephrological assistance, management, and research activities more qualified and effective.