Implementation of an automated system for monitoring adherence to hemodialysis treatment: A report of seven years of experience

ObjectiveIn this paper we present the clinical deployment and evaluation of a computerized system, EMOSTAT, aimed at improving the quality of hemodialysis sessions. EMOSTAT automatically imports data from the hemodialysis monitoring software tools and analyzes the delivered treatment looking at six clinically relevant parameters. Failures-to-adhere (FtAs) to the planned treatment are detected and reported to the care-givers.MethodsEMOSTAT has been used for more than seven years in the management of a dialysis service located in Mede, Italy. A total of 72 patients were monitored and 21 251 dialyses were collected. Data analysis is performed on the periods 2002–2005 and 2005–2008, corresponding to two different software releases.ResultsThe system had been exploited into everyday clinical practice for the entire considered period. The number of FtAs significantly decreased along the first period: the bulk blood flow FtAs decreased after the introduction of the system. Hemodialysis sessions lasted longer in the second period. Co-occurring FtAs, highlighting the presence of complex FtAs patterns, were also detected.ConclusionsEMOSTAT provides an effective way to re-focus the attention of the dialysis department on the treatment plan and on its implementation. The automatic data collection and the design philosophy of EMOSTAT allowed the routine use of the system.

► Treatment adherence and patients’ management can be improved through the automated auditing of hemodialysis sessions.
► The design of user-friendly automatic tools facilitates their introduction into routine clinical practice.
► A timely clinical target achievement assessment allows decision-makers to ensure continuous quality improvement.
► The full integration of automated auditing tools into the hospital information system can enhance the quality of information management.