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Renal Unit Activity

Specific Opportunities for Information Support

YORKSHIRE CENTRE FOR HEALTH INFORMATICS UNIVERSITY OF LEEDS

Tom Crocker

medtcro@leeds.ac.uk

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Case study of St James’s renal unit and the information system

• Models and diagrams

• Identifying processes and opportunities for information support

• Plans for the future

Overview

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Renal pathway - purpose

Understand theactivity of a renal unit

Renal pathway diagram

{Want a simple and clear walk throughwith extra information on theimplications for the patient available}

{Want a depth of information they can rapidly assimilate}

{Want a model that is accurateand unambiguous to identifyopportunities for support}

Explain the activityof a renal unit

GP / other clinical staff

Renal expert IT specialist

Patient / family member

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• I have modelled areas of St James’s renal unit using the Unified Modelling Language

• UML syntax helps to make diagrams clear and unambiguous

• 13 types of diagram1. Use-case diagrams – show purpose

2. Activity diagrams – like flow-charts

Models and diagrams

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Patient care - purpose

Have health statusreviewed

Have care planreviewed

Enable informeddecisions about care

Receive treatment

Be educated aboutrenal and associated health

Get clinicalcorrespondence

Refer patient tounit

Be cared for

Renal unit

Patient

GP

Consultation - purpose

Have health statusreviewed

Have care planreviewed

Enable informeddecisions about care

Be educated aboutrenal and associated health

Attend consultation

Patient

Renal unit – consultation

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Clinic visits for each patient

SecretaryPathology LabClinic TeamInformatics Team

Prepare patient list and synoptic sheets

for clinic

Clinic visits for each patient

Enter changes to Proton

Correct errors in returned results

Check abnormal results and take

appropriate action

Test samples and return results

Type out consultation letter

and distribute

Organising Consultations

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Consultation

Patient PhlebotomistConsultantNursingReception

Book in patient

Attend clinic

Take blood pressure and weight

Consultation

Take samples and send for testing

Agree next appointment time and

book patient out

[Yes] [No]

Patient tohave tests?

A clinic visit

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ConsultantPatient

Selective review of patient history

Examine, interview and inform patient. Infer and

deduce needs

Agree future investigations / treatment / consultations

Record consultation outcome

Call patient in

Enter consultation

Leave consultation

A Consultation

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Renal IS - purpose

Information System

Review patienthistory

Consultant

View graphical displayof test result trends

View tabulardisplay of results

Discover estimate oftime to renal replacement

therapyReceive guidance

from a protocol

<<include>>

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Informatics-based procedural loop

Clinical Staff Informatics group Consultant

Input information andprepare summary

Reviewinformation

Makedecisions

Returndecisions

Returnresults

Followprotocols

Reviewactivities

[see consultant][see clinician]

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PROTOCOL JUDGEMENTcomputer

results decisions

Computer-based procedural loop

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PROTOCOL JUDGEMENTcomputer

results decisions

Medical staff Transplant Co-ordinator

Computer-based procedural loop for transplantation

SpecificationCalibration

Characterisation

Specialty Panel

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• Models can aid understanding by:– Simplifying reality– Making our ideas explicit

• UML is a particularly useful tool

• Drill-down example from patients’ needs to staff needs of an information system

• Generic patterns and variety can be identified

Summary

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• To improve the understanding of processes within renal units

• Examine process variety (e.g. for anaemia management) across different units

• Compare with outcomes data• Identify generic patterns • Research solutions from other disciplines• Intended PhD – consultation with units and

Renal Registry

Future work

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Questions

Renal Unit Activity

Specific Opportunities for Information Support

YORKSHIRE CENTRE FOR HEALTH INFORMATICS UNIVERSITY OF LEEDS

Tom Crocker

medtcro@leeds.ac.uk

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Shifting the balance to the left

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Lemniscate of Booth

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