2014
Educa+onal Sessions; Blood Puriﬁca+on Systems

Healthcare technology management fordialysis patients by clinical engineers inJapan: A case of Yabuki Hospital.

Shiho Esashi
Jun Yoshioka
Japan Associa/on for Clinical Engineers (JACE)

Background
Past presenta/ons at AAMI’s conference
2011“Clinical Engineers System in Japan and New Basic Job
Guidelines 2010”
Kiyoshi Matsusaka, AAMI 2011 Conference & Expo (San Antonio, TX)

2012“Deﬁning the Role of the Medical Equipment Safety
Manager"
Kiyoshi Matsusaka, AAMI 2012 Conference & Expo (CharloKe, NC)

2013“Healthcare Technology Management by ClinicalEngineers"Jun Yoshioka, AAMI 2013 Conference & Expo (Long Beach, CA)Outline
1.
2.
3.
4.

Yabuki hospital
The current state of dialysis pa/ents in Japan
Healthcare technology management by CEs
Linking the dialysis management system toelectronic medical records

Japanese dialysis as of 2012

The Japanese Society for Dialysis Therapy (JSDT)

320000240000• 310,007 pa/ents, 2,431 pa/ents pmp- Incident 38, 055, Deceased 30,710- Mean age of incidental pa/ents: 68.5yrs- Longest dialysis vintage: 44yrs. 9mo.

160000• 18,296 Clinical Engineers
80000(Dialysis technician)- 15,541 Doctors, 41,566 Nurses

01968

1980

1990

2000

2012

Yabuki Group
Yabuki hospital
Dialysis machine：81 sets
Pa/ent load：244 persons
CE：10 persons

Honchou Yabuki clinic

Yamagata

Dialysis machine：45 sets
Pa/ent load ：135 persons
CE：10 persons

Sea of Japan
Paciﬁc Ocean

Tendo Yabuki clinic
Dialysis machine ：52sets
Pa/ent load ：130 persons
CE：8 persons

Single-pa/ent dialysis system and CDDS
Single-pa7ent dialysis machines

Single-pa7ent
dialysis system

RO water
A B

A B

A Btap waterRO waterRO system

CDDS

Central dialysis ﬂuid
delivery system

Bedside consoles
A PowderCentral dialysis
delivery machine
B Powder6Water quality in CDDS
Percent achievement of each standard• Ultrapure dialysis ﬂuid 57.5%• JSDT Standard
94.2%• Interna/onal standard 98.1%

Number of facili/es

2000
1500

JSDT standard

1000

Interna/onal standard

500
0<0.0010.001〜 0.01〜
0.05〜
0.1〜
Endotoxin (EU/mL)

0.25〜

0.5〜

<0.1
0.1〜
1〜
10〜 Bacterial count100〜(cfu/mL)The Japanese Society for Dialysis Therapy (JSDT)Comparison of ini/al and running costs
Model case in Japan• Facility: 40 dialysis beds,
80 chronic dialysis pa/ents• Dialysis prescrip/on: 3 /mes/w, 4 hours/session, Dialysate
ﬂow rate: 500mL/min.
• Es/mated cost (Dialysis machines, Control system)
CDDS
Single Pa7ent system– Ini7al
1,228,000 US$
1,250,000 US$– Running 244,000 US$
341,000 US$

Pro’s and Con’s in CDDS
Pro’sCon’s• Economical• Choice of only one• Easy daily prepara/on ofdialysis ﬂuid to all
dialysis ﬂuid
pa/ents• Easy control of dialysis ﬂuid
quality• More /me required in• Easy daily maintenanceemergent shutdown(disinfec/on of dialysis
machines and en/re dialysis
ﬂuid loop)

CDDS in Interna/onal Standard• ISO 23500: “Guidance for the prepara/on and quality
management of ﬂuids for hemodialysis and relatedtherapies”• Annex B: Equipment– B.7 Central dialysis ﬂuid storage and delivery systems– B.7.1 General– B.7.2 Design and maintenance– B.7.3 Dialysis ﬂuid storage– B.7.4 Materials compa/bility

Na/onal Licensed Clinical Engineers• Clinical engineer (CE)– Established in 1987
– A unique license• Educa/on– University (4yrs) or academy (3yrs)– Master course (2yrs), Doctor course (3yrs)• Work place– Opera/ng room, Dialysis room, Cardiac catheteriza/on room,Hyperbaric oxygena/on room, ICU, HCU, NICU, Emergency
room, and the hospital ward.

A dialysis technician- is a medical professional that has been cer/ﬁed
to operate dialysis equipment and assist pa/ents
while they are receiving dialysis.
- has decreased dialysis machines failure which
exposes pa/ents to poten/ally harmful risks.

Business Opera/ons• Maintenance-Dialysis machinesOther medical devices• Dialysis ﬂuid-Prepara/on, quality control• Construc/on-Dialysis management system-Electronic medical records

Dialysis session work as a daily rou/ne job••••

Puncturing blood vessels
Opera/ng dialysis machines
Checking pa/ents’ vital signs andmonitoring dialysis machines
A team approach to pa/ent care
− Data analysis−
Evalua/on of dialysis eﬃcacy−
Evalua/on of arteriovenousﬁstulaTeam approach for dialysis pa/ents• Nutri/onal support• Dialysis access care
• QOL monitoring• Foot care
• Oral care
• Psycho-nephrology• Social support

Pa/ent friendly
dialysisDialysis management system
Automa7c (Transmission)
Pa/ent's body weight

Automa7c(Capture)
Dialysis management
systemWeightDialyzer
Medicine
Injec/onDialysis ﬂuid

Magne/c card

Dialysis record

Crea/on of dialysis record
Crea/on of therapeu/c cost

Automa7c

Dialysis management
systemVital on a pa/ent
Medicine informa/on

Development of informa/on technology

The Electronic medical record (EMR)• The EMR system electronically records theconsulta/on data of an individual so as to display thesedata as needed.
• The EMR system improves the quality of pa/ent careand decreases medical errors.

Coordina/on
1: Dialysis management system
Environment for safety in treatment

2: Electronic medical records

Sharing of pa/ent informa/on among departments

Those systems are necessary to linking the dialysis
management system to electronic medical records

Linking the dialysis management system toelectronic medical records- MAP
Electronic medical records

Dialysis management system

Remotemaintenance

RemotemaintenanceElectronic medical records
server

The electronic medical
record terminal

Dialysis management system
serverWEB server

The coopera/on of each system
Accoun/ng system

Electronic medical records

Patient registration

Patient attribute
Record ofdialysis direction information
Reference ofdialysis reports

Dialysis management system
Ⅰ. Patient attribute
Ⅱ. Dialysis direction information
Ⅲ. Report preservation
on a dialysis treatment• Vital• Material used
－Dialysis fluid－Dialyzer－Injection

Accounting treatment

Record of dialysis cost

Inspec/on system

Prescription order

Ⅳ. Reference ofprescription order

Blood examination
order

Record ofblood examination

Ⅴ. Blood examination

Examination result

Record ofblood examination result

Ⅵ. Reference ofBlood examination resultNetwork composi/on ﬁgure
Yabuki hospital

Honchou Yabuki clinic
L3SW

Electronic medical records
ServerRadiographic imaging system

Dialysis management system
Server
Dialysis machine

Accoun/ng system ServerRadiographic imaging system
ServerElectronic medical records
L3SW

Tendo Yabuki clinic

Dispensing system
Server

Dialysis machine

Dialysis management system
ServerLAN accessDialysis management system
Dialysis machine
ServerIP sec-VPN

Inspec/on system
Server

L3SW

Electronic medical records

Network security of an electronic medical record
InternetProvider
Next Genera/on Network : NGN

Pa/ent data

Pa/ent data

Pa/ent data

Pa/ent dataClinic

Hospital

ClinicElectronic medical records

Electronic medical records
ServerElectronic medical records• Communica/on Design via NGN• Communica/on between ins/tu/ons using IP sec-VPN (encrypted data)

Flowchart of doctor order― Dialysis prescrip/on change ―Doctor

ProposalAccept by CEs and Nurses
Dialysis management system

Electronic medical records

Order

Prac/ce
Reconﬁrma/on
dialysis machineSurvey of medical accidents in hemodialysis
4.6.1 透析医療事故の実態調査
treatment
A study of medical accidents and the composi/on of a malprac/ce countermeasure manual regarding hemodialysis treatment(1999)

total 21,457cases
Cri/cal cases

quan/ty of responses：1,586/3,073 ins/tutes（collec/on rate : 51.6%）(372)

others(1,298)Mechanical error(4,146)

Hospital Infec/on(560)

Input error
Dialysate(5,442)(184)

Medica/on error
BTF error(1,214)(6)

Injec/on and BTF error(1,792)

Bleeding

about 40％

inclusion of air
Needling error(3,878)
(370)

0.

7.5

(2,195)

15.

22.5

30.
%

The number of human errors
Yabuki group total number of cases

1411

指示漏れ
OrderError

投薬ミス
透析条件設定ミス7Medica/on Error
Inpuqng Error

40Oct

Nov
１0月

Dec
１１月

Jan12月Feb

Install the link EMR and Dialysis Management System

1月

2月

Beneﬁts of the system linkage••••

Secure refrac/on of physicians’ order
Human error preven/onPa/ent informa/on sharing with other staﬀ
Eﬃcient work and labor-saving− A batch of data can be sent(prescrip/on informa/on and treatment record to EMS)
− Paperless environment− No need for medical clerks− Physician can make or change the order from any PC− Preven/on of medical billing error

Problems of the system linkage• Needs some /me to learn opera/on methods− Manual prepara/on, Hold training sessions• Running cost

− High cost of establishing the system linkage− Maintenance cost for the each system− High cost of adding a program and customizing it• Slowdown of the PCs caused by data storage

Is Japan method “GALAPAGOS”?

“GALAPAGOS Cellphone”

light automobile

Pa/ent friendly
dialysis?

28

Conclusion• The Japan-method dialysis system is a pa/ent friendly
team approach.
• The central dialysis ﬂuid delivery system (CDDS) andna/onal licensed clinical engineer (CE) system are the keys
to the success of Japan-method dialysis.
• The linkage of EMR and the dialysis management system iseﬀec/ve in providing the pa/ents with safe and smooth
hemodialysis treatment.
• We hope that our dialysis method improves the QOL ofmany dialysis pa/ents throughout the world.
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おしまい

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