POS-301 IMPROVING THE IDENTIFICATION AND MANAGEMENT OF KIDNEY DISEASE THROUGH AN INTEGRATED CLINICAL INFORMATION PLATFORM AND DECISION SUPPORT TOOL

Abstract

Kidney disease in Australia disproportionally affects remote living Indigenous Australians, who experience end-stage kidney disease (ESKD) at rates up to 30 times higher than non-Indigenous Australians. In the Northern Territory the rates of kidney disease are particularly high, as are the concomitant diseases of diabetes and cardiovascular disease. Prevention and care coordination are severely challenged by a highly mobile population and rapid staff turnover in remote community health services. Patients with a high risk of developing kidney disease, and rapid progression to ESKD, are slipping through “the cracks” in our health system. To address this we designed and developed an integrated clinical information system for the early identification and risk stratification of people with chronic kidney disease using a rules-based engine. Territory Kidney Care (TKC) utilises a service orientated architecture that connects to existing primary and hospital based electronic health records, automatically and securely transferring relevant clinical information of select patients based on agreed criteria. The key functionality of the system is the ability to identify disease phenotype patterns from consolidated data, based on clinician defined algorithms. This facilitates timely recognition, prioritisation, and the ability to monitor progress and predict disease outcomes. We utilise an agile approach for algorithm development involving domain experts and evidence-based medicine. Algorithms used in the derived clinical decision support were tested and validated for efficiency and accuracy. TKC seamlessly consolidates primary and tertiary care information in real-time and derives clinically relevant summaries based on dynamic algorithm-based phenotyping. This allows automatic identification, prioritisation, and summation of relevant clinical information, augmenting clinical decision making. Significant time efficiencies have been demonstrated with a substantial reduction in administrative time in the collation and synthesis of complex information from multiple sources, reduction in requirement for remote community travel and earlier and targeted advice to the primary care provider in the management of complex conditions. Integrated systems of care which focus on prevention and care coordination, can slow the progression of kidney disease and reduce complications of inter-related illnesses such as diabetes and cardiovascular disease. TKC enhances primary health care with minimal resource impact, primarily because the system does not alter the primary health service user interface, require the adoption of additional technologies or completion of paper-based records.