title: Implementation of an automated system for monitoring adherence to hemodialysis treatment: a report of seven years of experience.
abstract: OBJECTIVE
  In this paper we present the clinical deployment and evaluation of a computerized system, EMOSTAT, aimed at improving the quality of hemodialysis sessions. EMOSTAT automatically imports data from the hemodialysis monitoring software tools and analyzes the delivered treatment looking at six clinically relevant parameters. Failures-to-adhere (FtAs) to the planned treatment are detected and reported to the care-givers.
  
  
  METHODS
  EMOSTAT has been used for more than seven years in the management of a dialysis service located in Mede, Italy. A total of 72 patients were monitored and 21251 dialyses were collected. Data analysis is performed on the periods 2002-2005 and 2005-2008, corresponding to two different software releases.
  
  
  RESULTS
  The system had been exploited into everyday clinical practice for the entire considered period. The number of FtAs significantly decreased along the first period: the bulk blood flow FtAs decreased after the introduction of the system. Hemodialysis sessions lasted longer in the second period. Co-occurring FtAs, highlighting the presence of complex FtAs patterns, were also detected.
  
  
  CONCLUSIONS
  EMOSTAT provides an effective way to re-focus the attention of the dialysis department on the treatment plan and on its implementation. The automatic data collection and the design philosophy of EMOSTAT allowed the routine use of the system.
authors.affiliation: Dipartimento di Informatica e Sistemistica, Università di Pavia, Via Ferrata 1, 27100 Pavia, Italy. riccardo.bellazzi@unipv.it
authors.forename: Riccardo
authors.initials: R
authors.lastname: Bellazzi
authors.forename: Lucia
authors.initials: L
authors.lastname: Sacchi
authors.forename: Ezio
authors.initials: E
authors.lastname: Caffi
authors.forename: Amedeo
authors.initials: A
authors.lastname: de Vincenzi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Nai
authors.forename: Francesco
authors.initials: F
authors.lastname: Manicone
authors.forename: Cristiana
authors.initials: C
authors.lastname: Larizza
authors.forename: Roberto
authors.initials: R
authors.lastname: Bellazzi
mesh_terms: D001331:Automation / Q000592:standards*; D003625:Data Collection / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008991:Monitoring, Physiologic / Q000295:instrumentation*; D010349:Patient Compliance; D006435:Renal Dialysis / Q000295:instrumentation / Q000592:standards*; D012984:Software