Independent Dialysis Foundation (IDF) elected to beta test Clinical Vision, dialysis software solution…
The following is an interview with John Sadler, MD. Dr. Sadler is Chief Executive Officer of IDF and Clinical Associate Professor of Medicine in the Nephrology Division at the University of Maryland. He is Chairman of Nephrology News and Issues Editorial Advisory Board and former Co-Chair of AAMI’s Renal Disease and Detoxification Committee.
Clinical Computing: "Tell us about your experience with software vendors in the renal market…"
“IDF's efforts to automate our clinical data have been laborious and various. We began as participants in a University of Maryland project to automate several clinical and teaching functions on the medical campus in Baltimore. Because of the recurring nature of treatment, the IS people thought this would be something they could accomplish in the two year span of the grant for this pilot. They failed, but enabled us to visualize much of what we needed to have in an effective electronic clinical database.
A local programmer then worked with us for two years in an effort to create a system. He knew computers, but was trying to do this along with other work, lost his focus, and, badgered by multiple staff of IDF for their favorite elements, produced an unworkable collection of software. He tried to start with off-the-shelf software and add code specific to dialysis needs, and the fit was poor. Ultimately, he gave up. Hard feelings all around, despite the best of intentions.
After screening several vendors, we then decided we couldn't afford most of them, and settled for an incomplete, DOS-based program as all we could afford. It produced dialysis run sheets, collected lab data, and allowed tabulation of actions, but was not capable of data analysis. It did have a flexible report writer, which made it usable for a few years.
Along with this clinical system, we used HyperChart billing software, provided through Althin Medical as an adjunct to their computerized dialysis machines. HyperChart was limited, too, but workable. Then it stopped being maintained, and Althin, trying to provide a replacement, offered us another. We undertook that attempt, moved from a server in each facility to a central server with connections spanning most of Maryland, and worked to help make the software effective. After a long struggle, that effort was abandoned. We installed QMS Focus to do our billing but did not have a clinical database system to go with it. Getting service reports from the clinic into it remained a manual function.
So, at the end of many years, we had successfully implemented a billing package with one vendor and had multiple failed attempts at automating the clinical side of our operation.”
Clinical Computing: "Tell us about your experience with Clinical Computing…"
“After another search we met the CCI people, who were developing a new, Windows-type, system called Clinical Vision, and seeking an American beta site. After much review and debate, we decided to do it. It's not finished yet (is any software?) but it is comprehensive and functional. Requests for help are met with prompt response, little of the defensiveness we had become accustomed to is evident, and real efforts are made to find workable solutions to teething problems common to new programs. Having a prior background in dialysis clinical systems (PROTON, di-PROTON and RENLStar) helps CCI understand the processes and problems, so corrections are directed at the problem, not at programming niceties.
At every stage, decisions about development, deployment, interfaces, and problem solving have been made quickly and effectively. This is due largely in part to both parties designating who has decision-making authority. Cooperation between organizations has been good.”
Clinical Computing: "Beta projects are often difficult for both the customer and the vendor. Talk about your initial experience with Clinical Vision…"
“Much can be drawn from what has gone before. The product was beta release and therefore not as complete as wished, but CCI gave us status reports that were generally accurate, and timelines for development that were conservative and often exceeded. There has been a general understanding of our questions, staff to respond effectively and promptly, and an attitude of helpfulness.
Clinical Vision is good. We don't yet know how good, since we are still learning. It's not perfect. Some actions are still a bit awkward. Users can't independently do as much as I would like, but it is steadily improving.”
Clinical Computing: "Having lived through this process as many times as you have, what lessons would you pass on to your counterparts in the industry that are contemplating clinical systems…"
“It is always risky to embark on an expensive, important endeavor that is peripheral to your primary knowledge base. Your own understanding is incomplete, and has to depend, at least in part, on what the vendor tells you. The vendor has to make money and you have to get full value for all you spend. The best safeguard is to establish benchmarks for the vendor and if they fail to meet them or justify the failure, bail out! Be realistic about your own capabilities and weaknesses, get the best help you can, check references carefully, and make your decision.
Define roles and contacts; set a reasonable timetable; assure that everyone understands the benchmarks and responsibilities; allow for contingencies; be aware that this is stressful to clinicians, IT people, programmers, and leadership – expect that new processes are always somewhat unwelcome. Change is not easy, even if it enhances the work. Hold your own people and the vendor's people accountable at every step: not for punishment, but to define goals and learn about failures. Give your confidence after it is earned – neither too soon nor withheld.
Recognize that the product is never final, and dealing with change goes on forever.
Accept that automation doesn't really save money: it costs; but it's supposed to help make us better clinicians.”
