#920 A knowledge management system enabling telemedicine for hemodialysis: an ongoing project
Authors: Zito Anna , Prete Daniele , Napoli Marcello , Elia Gianluca , De Pascalis Antonio 
Published: May 2024

Abstract

Background and Aims
Knowledge management (KM) systems, when applied to telemedicine, leads to multiple benefits regarding the organizational model and the dissemination of knowledge among the stakeholders. There are some studies on the application of telemedicine in Chronic Kidney Disease (CKD) and TeleDialysis (TD).
TD allows the provision of personalized care through technology (dialysis services at home, in hospitals, in satellite centers).
ASL Lecce represents the Regional Health System of the Puglia Region managing the health needs of the population of the province of Lecce. Currently, 800 patients are treated in dialysis facilities within the hospital, in satellite centres or at home (home haemodialysis, HHD). A hub&spoke model of dialysis care provided through a distributed network has been created.
In this complex scenario, KM is particularly relevant since it allows the creation, modelling, sharing and systematic translation of health knowledge. We did not find any research on the application of Knowledge Management systems in TD.
The aim of our study is to fill the gap regarding the application of a KM system to TD in the context of ASL Lecce.

Method
In September 2023, a TD platform applied to 24 patients already receiving Home Hemodialysis (HHD) was implemented in the Department of Nephrology at the V. Fazzi Hospital, ASL Lecce, to combine the patients’ home, satellite units and the central institution into a single common workplace. The integrated TD platform is intended as a set of infrastructural components, software and hardware functional to the continuous monitoring of dialysis treatments (Fig. 1).

Results
A KM system was created acquiring information from the dialytic network (schedules, clinical data, diagnoses, medical indications, observations of health personnel, accuracy of the performance, degree of satisfaction of the patient and health professionals). All the collected material was organized in a systemic way so that it could be used for the decision-making processes of the specialists and medical staff of the Nephrology Department, also valid for junior doctors and trainees. Fig. 2 shows how the KM system, applied in the near future also to the TD process, may facilitate the processes of capturing, storing and transforming knowledge into wisdom (Fig. 2).
Objectives of the research:
The implementation of the KM system in the TD service is focused on sharing knowledge as data-driven and people-centric:
1. Data-Driven:
In the next months, the existing datasheets and clinical records will be integrated with a huge amount of data on the patient side, collected remotely via the TD platform. The ability of KM to influence performance is studied in Fig. 3.
2. People-Centered:
Collaboration and communication are essential for discovering, exploring, and disseminating knowledge. Especially as part of TD, the hub&spoke organization helps to build a team that share common concerns, increase knowledge, and improve quality of care.

Conclusion
As for dialytic services, the TD platform integrates into the organizational model of hub&spoke. The KM system has a pivotal role in effectively update the process of care, both in the care practices and for the support of the decision-making processes.
Going forward with the TD program, we aim to show that KM improves healthcare services and case management in terms of performance and value creation.