Healthcare technology management for dialysis patients by clinical engineers in Japan: A case of Yabuki Hospital. Shiho Esashi

Transcription

1 2014 Educa+onal Sessions; Blood Purifica+on Systems Healthcare technology management for dialysis patients by clinical engineers in Japan: A case of Yabuki Hospital. Shiho Esashi Jun Yoshioka Japan Associa/on for Clinical Engineers (JACE)

2 Background Past presenta/ons at AAMI s conference 2011 Clinical Engineers System in Japan and New Basic Job Guidelines 2010 Kiyoshi Matsusaka, AAMI 2011 Conference & Expo (San Antonio, TX) 2012 Defining the Role of the Medical Equipment Safety Manager" Kiyoshi Matsusaka, AAMI 2012 Conference & Expo (CharloKe, NC) 2013 Healthcare Technology Management by Clinical Engineers" Jun Yoshioka, AAMI 2013 Conference & Expo (Long Beach, CA)

3 Outline 1. Yabuki hospital 2. The current state of dialysis pa/ents in Japan 3. Healthcare technology management by CEs 4. Linking the dialysis management system to electronic medical records

4 Japanese dialysis as of The Japanese Society for Dialysis Therapy (JSDT) ,007 pa/ents, 2,431 pa/ents pmp - Incident 38, 055, Deceased 30,710 - Mean age of incidental pa/ents: 68.5yrs - Longest dialysis vintage: 44yrs. 9mo. 18,296 Clinical Engineers (Dialysis technician) ,541 Doctors, 41,566 Nurses

5 Yabuki Group Yabuki hospital Dialysis machine 81 sets Pa/ent load 244 persons CE 10 persons Yamagata Sea of Japan Pacific Ocean Honchou Yabuki clinic Dialysis machine 45 sets Pa/ent load 135 persons CE 10 persons Tendo Yabuki clinic Dialysis machine 52sets Pa/ent load 130 persons CE 8 persons

6 Single-pa/ent dialysis system and CDDS Single-pa7ent dialysis machines Single-pa7ent dialysis system tap water RO water A B A B A B RO water RO system CDDS Central dialysis fluid delivery system A Powder Central dialysis delivery machine Bedside consoles B Powder 6

7 Water quality in CDDS 2000 Percent achievement of each standard Ultrapure dialysis fluid 57.5% JSDT Standard 94.2% Interna/onal standard 98.1% Number of facili/es JSDT standard < Endotoxin (EU/mL) 0.5 Interna/onal standard < Bacterial count (cfu/ml) The Japanese Society for Dialysis Therapy (JSDT)

8 Comparison of ini/al and running costs Model case in Japan Facility: 40 dialysis beds, 80 chronic dialysis pa/ents Dialysis prescrip/on: 3 /mes/w, 4 hours/session, Dialysate flow rate: 500mL/min. Es/mated cost (Dialysis machines, Control system) CDDS Single Pa7ent system Ini7al 1,228,000 US$ 1,250,000 US$ Running 244,000 US$ 341,000 US$

9 Pro s and Con s in CDDS Pro s Economical Easy daily prepara/on of dialysis fluid Easy control of dialysis fluid quality Easy daily maintenance (disinfec/on of dialysis machines and en/re dialysis fluid loop) Con s Choice of only one dialysis fluid to all pa/ents More /me required in emergent shutdown

10 CDDS in Interna/onal Standard ISO 23500: Guidance for the prepara/on and quality management of fluids for hemodialysis and related therapies Annex B: Equipment B.7 Central dialysis fluid storage and delivery systems B.7.1 General B.7.2 Design and maintenance B.7.3 Dialysis fluid storage B.7.4 Materials compa/bility

11 Na/onal Licensed Clinical Engineers Clinical engineer (CE) Established in 1987 A unique license Educa/on University (4yrs) or academy (3yrs) Master course (2yrs), Doctor course (3yrs) Work place Opera/ng room, Dialysis room, Cardiac catheteriza/on room, Hyperbaric oxygena/on room, ICU, HCU, NICU, Emergency room, and the hospital ward.

12 A dialysis technician - is a medical professional that has been cer/fied to operate dialysis equipment and assist pa/ents while they are receiving dialysis. - has decreased dialysis machines failure which exposes pa/ents to poten/ally harmful risks.

13 Business Opera/ons Maintenance -Dialysis machines Other medical devices Dialysis fluid -Prepara/on, quality control Construc/on -Dialysis management system -Electronic medical records

14 Dialysis session work as a daily rou/ne job Puncturing blood vessels Opera/ng dialysis machines Checking pa/ents vital signs and monitoring dialysis machines A team approach to pa/ent care Data analysis Evalua/on of dialysis efficacy Evalua/on of arteriovenous fistula

15 Team approach for dialysis pa/ents Nutri/onal support Dialysis access care QOL monitoring Foot care Oral care Psycho-nephrology Social support Pa/ent friendly dialysis

16 Dialysis management system Automa7c (Transmission) Magne/c card Pa/ent's body weight Automa7c (Capture) Dialysis management system Weight Dialyzer Medicine Injec/on Dialysis fluid Dialysis record Automa7c Crea/on of dialysis record Crea/on of therapeu/c cost Dialysis management system Vital on a pa/ent Medicine informa/on

17 Development of informa/on technology The Electronic medical record (EMR) The EMR system electronically records the consulta/on data of an individual so as to display these data as needed. The EMR system improves the quality of pa/ent care and decreases medical errors.

18 Coordina/on 1: Dialysis management system Environment for safety in treatment 2: Electronic medical records Sharing of pa/ent informa/on among departments Those systems are necessary to linking the dialysis management system to electronic medical records

19 Linking the dialysis management system to electronic medical records- MAP Electronic medical records Dialysis management system Remote maintenance Electronic medical records server WEB server Dialysis management system server Remote maintenance The electronic medical record terminal

20 The coopera/on of each system Accoun/ng system Electronic medical records Dialysis management system Patient registration Patient attribute Ⅰ. Patient attribute Accounting treatment Record of dialysis direction information Reference of dialysis reports Record of dialysis cost Ⅱ. Dialysis direction information Ⅲ. Report preservation on a dialysis treatment Vital Material used -Dialysis fluid -Dialyzer -Injection Inspec/on system Blood examination order Examination result Prescription order Record of blood examination Record of blood examination result Ⅳ. Reference of prescription order Ⅴ. Blood examination Ⅵ. Reference of Blood examination result

21 Network composi/on figure Yabuki hospital Honchou Yabuki clinic L3SW Electronic medical records Server Radiographic imaging system Accoun/ng system Server Dialysis management system Server Dialysis machine Radiographic imaging system Server Dispensing system Server L3SW Electronic medical records Tendo Yabuki clinic Dialysis machine Dialysis management system Server LAN access Dialysis management system Server Dialysis machine IP sec-vpn Inspec/on system Server L3SW Electronic medical records

22 Network security of an electronic medical record Internet Provider Next Genera/on Network : NGN Pa/ent data Pa/ent data Pa/ent data Pa/ent data Clinic Electronic medical records Hospital Electronic medical records Server Clinic Electronic medical records Communica/on Design via NGN Communica/on between ins/tu/ons using IP sec-vpn (encrypted data)

23 Flowchart of doctor order Doctor Dialysis prescrip/on change Proposal Accept by CEs and Nurses Dialysis management system Electronic medical records Order Prac/ce Reconfirma/on dialysis machine

24 Survey of medical accidents in hemodialysis treatment A study of medical accidents and the composi/on of a malprac/ce countermeasure manual regarding hemodialysis treatment (1999) total 21,457cases Cri/cal cases others Mechanical error Hospital Infec/on Input error Dialysate Medica/on error BTF error Injec/on and BTF error (372) (184) (6) (560) (1,298) (1,214) (1,792) quan/ty of responses 1,586/3,073 ins/tutes collec/on rate : 51.6% (4,146) (5,442) about 40 Bleeding inclusion of air Needling error (370) (3,878) (2,195) %

25 The number of human errors Yabuki group total number of cases Order Error Medica/on Error 4 Inpuqng Error 0 Oct 0 Nov Dec Jan 12 Feb 1 2 Install the link EMR and Dialysis Management System

26 Benefits of the system linkage Secure refrac/on of physicians order Human error preven/on Pa/ent informa/on sharing with other staff Efficient work and labor-saving A batch of data can be sent (prescrip/on informa/on and treatment record to EMS) Paperless environment No need for medical clerks Physician can make or change the order from any PC Preven/on of medical billing error

27 Problems of the system linkage Needs some /me to learn opera/on methods Manual prepara/on, Hold training sessions Running cost High cost of establishing the system linkage Maintenance cost for the each system High cost of adding a program and customizing it Slowdown of the PCs caused by data storage

28 Is Japan method GALAPAGOS? GALAPAGOS Cellphone Pa/ent friendly dialysis? light automobile 28

29 Conclusion The Japan-method dialysis system is a pa/ent friendly team approach. The central dialysis fluid delivery system (CDDS) and na/onal licensed clinical engineer (CE) system are the keys to the success of Japan-method dialysis. The linkage of EMR and the dialysis management system is effec/ve in providing the pa/ents with safe and smooth hemodialysis treatment. We hope that our dialysis method improves the QOL of many dialysis pa/ents throughout the world. 29

30 Thank you for your aken+on and thank you for your +me