Telemedicine to Promote Patient Safety: Use of Phone-Based Interactive Voice-Response System to Reduce Adverse Safety Events in Pre-dialysis CKD

Abstract

Chronic kidney disease (CKD) patients have several features conferring upon them a high risk of adverse safety events, which are defined as incidents with unintended harm related to processes of care or medications. These characteristics include impaired renal function, polypharmacy, and frequent health system encounters. The consequences of such events in CKD can include new or prolonged hospitalization, accelerated renal function loss, acute kidney injury, end-stage renal disease and death. Health information technology administered via telemedicine presents opportunities for CKD patients to remotely communicate safety-related findings to providers for the purpose of improving their care. However, many CKD patients have limitations which hinder their use of telemedicine and access to the broad capabilities of health information technology. In this review we summarize previous assessments of the pre-dialysis CKD populations’ proficiency in using telemedicine modalities and describe the use of interactive voice-response system (IVRS) to gauge the safety phenotype of the CKD patient. We discuss the potential for expanded IVRS use in CKD to address the safety threats inherent to this population.

Driving Health Technologies Towards Performance: A Contextualization Within the Hospital Sector

“…Similarly, clinical procedures may exert an impact on staff's ways of performing clinical activities with effects on both staff's and patients' satisfaction and safety (Marley et al, 2004). Telemedicine can affect nancial performance, for example by assisting patients in less expensive settings (Thaker et al, 2013), patients' safety and overall satisfaction, for example by reducing waiting lists and avoiding unnecessary visits to the hospital (Weiner and Fink, 2017). Arti cial intelligence is key in driving activities towards safety (Yeung et al, 2018) and in providing learning and growth opportunities to organizations (Neill, 2013).…”

Role of telehealth in renal replacement therapy education

“…There are notable challenges associated with the use of telehealth for education, however, including those associated with data privacy/security, governance, and mistrust of clinical content delivered via telehealth applications. Additionally, matching patients with appropriate technologies for education is critical . A “digital divide” among persons with different ages, education levels, literacy, numeracy, and incomes has been described, which may be of particular relevance for RRT education .…”

“…Additionally, matching patients with appropriate technologies for education is critical. 50 A "digital divide" among persons with different ages, education levels, literacy, numeracy, and incomes has been described, which may be of particular relevance for RRT education. 51 For example, ESRD prevalence is the highest among individuals 65-74 years old; 1 many of these patients may not feel comfortable with technology and may prefer in-person education/discussions about their options.…”

Improving safety and efficiency in care: multi-stakeholders’ perceptions associated with a peritoneal dialysis virtual care solution

“…There are promising signs that PD, estimated to be provided to 190,000 patients worldwide,10 and remote home management are providing a virtual care opportunity (telenephrology)11,12 for managing CKD 1. Telenephrology enables exchange of information and ongoing monitoring and surveillance of CKD patients’ health statuses 12,13. Positive clinical and experiential outcomes (increased satisfaction,14,15 quality of life,16,17 survival,18–20 and decreased costs21) have been associated with PD.…”