Transforming Home Dialysis Management of Patients with Advanced Kidney Disease Using an Intelligent Automated Application in Practice

To describe the design, development, and deployment of an electronic health record (EHR)-based application to manage the Mayo Clinic home dialysis program, improve staff efficiency, and ensure delivery of high-quality clinical care. At Mayo Clinic, the Cohort Knowledge Intelligence Solutions (CKIS) team develops innovative patient cohort management solutions using the Epic Healthy Planet module. The CKIS team uses a collaborative and agile approach that incorporates feedback from clinical stakeholders and informatics to create these solutions that improve and automate processes for clinical staff, all managed within the EHR. Over several months (September 1, 2019, to December 30, 2020), the clinical nephrology and CKIS teams met regularly to develop in an iterative fashion 2 home dialysis applications. Time spent on various EHR-related home dialysis tasks was compared before and after the implementation of the applications based on the Nursing Efficiency Assessment Tool (NEAT). Two EHR applications were developed for managing home dialysis referrals and enrollments or monitoring, respectively. The applications consolidate all needed information and provide real-time data to manage patients at the individual or population level. Time saved for the 2 dialysis nurses who worked before and after the implementation was 25 and 20.4 minutes per 8-hour shift, respectively. We developed and implemented 2 EHR applications that proved useful and increased efficiency in managing a home dialysis program. These digital tools can facilitate quality metrics reporting, scale the home dialysis program, and improve care delivery.