Effective Computerized Patient Record Improves Patient Well-Being and Financial Performance

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Effective application of information technology has transformed many facets of modern life, such as manufacturing and finance, but has had little measurable effect on medicine in general, or on nephrology and dialysis in particular. The failure of information technology in medicine can, in our opinion, be traced to poor design and implementation of medical software. Even today, nurses and physicians still spend 50% and 33%, respectively, of their time on paperwork. Our approach to computerization of the patient record, begun 24 years ago, treats the patient as the central core of the computerized record system, and makes use of a comprehensive, clinically relevant, time-oriented, digitally coded database. An embedded query tool allows quick and easy organization of the database at the point of care to make knowledge available about individuals and groups of patients, and without delay. In those scenarios where effective computerization has been combined with effective clinical and administrative management, the results have been striking. Demonstrated and published results include: 1) Improved patient welfare, with a decrease in both mortality (20-25% less than the U.S. average) and in morbidity (increased serum albumin and muscle mass, and decreased blood pressure and hospitalization). 2) More efficient and effective use of personnel caring for the patient (5.9 fewer full-time staff per 100 hemodialysis patients than the national average), with consequent increase in patient satisfaction and saving of staff time. 3) Reduction and containment of costs of medical supplies. 4) Effective management of the processes involved in billing, collection, and accounts receivable. 5) Online, continuous quality improvement and effective clinical and administrative management of the dialysis unit based on timely, complete knowledge of relevant information (especially when unexpected events occur). 6) Significantly improved return on investment; net savings of at least $13.69 to $17.40 per hemodialysis treatment have been achieved.

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