Implementation of a renal clinical software system - results of a 12 month pilot study

Aim: To determine whether implementation of a commercial clinical software system across the renal service would deliver outcome improvements in renal information management and clinical care at the Royal Hobart Hospital.

Background: An absence of a central repository for renal specific clinical information posed clinical risks for health professionals required to access multiple electronic sources to maintain continuity of care.

Methods: In 2013, a pilot study was initiated with a budgeted cost of $80,000. With a dedicated project position, the system was integrated into renal outpatient clinics and dialysis settings with support of pharmacy, pathology, cardiology and medical imaging. Extensive staff education was undertaken as a staged process for sustainable change.

Results: The clinical cohort was defined (n = 1278). Improved communication to primary care providers was found: outgoing clinic letters increased from 22% pre-trial to 96%; 31% increase in correspondence containing co-morbidity history and medications, time for letters to be included in hospital file reduced from 4 weeks to 1 week. Safety outcomes have been difficult to quantify. Immediate access is now available to all medications prescribed and investigations requested. Internal and external pathology results directly downloaded into the patient file. The ability to audit outcomes has been more difficult than predicted but has been refined in collaboration with the software provider. Cost savings of $120,000/annum have been made. There has been a high uptake by healthcare disciplines of 97–100% on audit.

Conclusions: Implementation has resulted in better integration of information across the renal service and with primary care providers. The cost of implementation is covered by first year savings and a dedicated project position supporting implementation, training and auditing is essential.