Updating Renal Connect

Updating Renal Connect

RenalConnect is an open-source, web-based, and freely-available (via GitHub) clinical management tool we developed in the Fraser Health renal program in order to assist with management of PD peritonitis, as well as tracking and managing patients being followed by our “transition nurses”, ie those who are new starts to hemodialysis or at high risk of needing to start dialysis imminently.

We have phased-out usage of RenalConnect for PD peritonitis as the features have been rolled into PROMIS.  While we used RenalConnect for managing peritonitis as part of our quality improvement strategy, we noted a significant impact on our program and presented these findings at the American Society of Nephrology meeting in 2012.

Our transition nurses have been using RenalConnect to track and manage their caseloads.

We are strong believers that when we track data as part of our clinical care (rather than simply have clerks or analysts enter data retrospectively or prospectively), the data records and reports generated are more accurate and useful.  Simple put, our fantastic clinicians will likely enter data really accurately as it impacts the person they are caring for.

As a result of being “power users” of the software, our transition nurses were able to provide insightful feedback.  We took this feedback and brought it back to our software developer, Dr. Dimas Yusuf, now a senior resident in Internal Medicine.

We were able to add some nice upgrades (and bug fixes) to the web application.

Some highlights:

  • Often, reporting out mean results can be significantly impacted by just a couple outliers.  We added median results in our reports to give a more complete picture of our outcomes.
    • In the example in the image below, while mean interval from starting HD to meeting a transition nurse if 17.2 days (red arrow), the median is actually 7 days (blue arrow).  This is due to a handful of outliers which skew the mean.2015-06-19_08-56-17
  • When we report out mean and median results, sometimes the results just don’t look like they make sense.  This can happen if there has been an error in data entry.  We’ve added the ability to “Inspect data”.  This feature allows one to drill down on all the data points (by clicking “Inspect data”, blue arrow) that make up any given metric and see if any of the values may be erroneous.  Inaccurate data points can then be quickly fixed (by clicking “manage start”, red arrow).
    2015-06-19_09-04-35

2015-06-19_09-06-46

  • We added 2 new reports to assist with quality improvement in PD:  Time from PD referral to PD catheter insertion and Time from PD referral to PD start.2015-06-19_09-10-39

In general, patients on hemodialysis who are waiting to start PD are on dialysis using a central line.   We know that observational data suggests the any benefit of PD over HD in the short term is likely driven by central venous catheter usage1.  In addition, hemodialysis is much more costly that peritoneal dialysis2. Of course, people wanting to switch to PD from HD likely want it to happen sooner rather than later.  So it serves the triple aim of healthcare to move people onto peritoneal dialysis as quickly as possible.  This new reporting metric will allow our program to understand how we’re performing and try to tighten up our processes of care.

  • We added support for French and Spanish so it is more useful to other members of the global nephrology community.  Over time, we’d love to see contributors add support for more languages.
  • We added support for patients who may not yet have started dialysis (but were still being followed by our transition nurses), and for those who recovered after starting dialysis.
  • We fixed a ton of bugs, many of which were quite annoying.

Of note, all members of the Fraser Health renal team who need access, can login here http://renalconnect.com.

Login to RenalConnect

 

Any members of the FHA Renal team who need access, can do so by requesting it directly from the medical director.

 

We’ve made sure that RenalConnect remains a freely accessible tool that can be downloaded, installed, and implemented by anyone who wishes to use it around the world.  Our hope is that an open-source community will develop around this software and we’ll see it improve over time. Of note, the software developer has kindly agreed to offer a hosted and supported solution that allows medical teams to use the software without having to worry about setting up and maintaining their own installation.

 

 

References

 
Perl J1, Wald R, McFarlane P, Bargman JM, Vonesh E, Na Y, Jassal SV, Moist L. Hemodialysis vascular access modifies the association between dialysis modality and survival. J Am Soc Nephrol. 2011 Jun;22(6):1113-21. PMID: 21511830.
 
Chui BK1, Manns B, Pannu N, Dong J, Wiebe N, Jindal K, Klarenbach SW. Health care costs of peritoneal dialysis technique failure and dialysis modality switching. Am J Kidney Dis. 2013 Jan;61(1):104-11. PMID: 22901772.
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