Computing in Dialysis Units: How to Engage and Train All Medical Staff when Introducing Computing in Patient Care?

Enormous amounts of clinical data accumulate over months and years in patients with chronic renal failure. The medical supervision often includes over 50 different time-varying clinical and laboratory parameters. It is virtually impossible to keep track of all these data with conventional records even if these are well-organized and used with discipline (Gordon et al 1983). As a result nephrologists have been among the first physicians to use computers in patient care (Stead 1984). There are by now several reports on successful applications of computer technology for the handling of clinical data in dialysis and transplantation units (Pollak et al 1977, Gordon et al 1983, Knapp 1983, Morgan and Will 1983, Pollak et al 1983, Stead et al 1983, Stead 1983, Taylor and Sells 1983, Trimbel et al 1983, Wing et al 1983, Stead 1984). However, it is also known but less well-docunented that many medical computing projects have failed when transferred from a research base to clinical practice (Stead 1983). One reason for such failures may have been a frustrating and unsuccessful dependence on computer experts with whom clinical staff have had difficulty communicating; such problems have been particularly severe in large, “mainframe” projects, which use a central computer (Gordon et al 1983). In recent years many of the difficulties inherent in early computer technology have been eliminated. Software has become more and more user friendly. Furthermore, improved computerized medical records systems (Pollak et al 1983, Stead et al 1983) and clinical database systems for handling of numerical data in dialysis and transplantation units (Gordon et al 1983) have been developed. Although this has solved many of the problems concerning computing per se the introduction of computer technology in the clinic may lead to other problems including difficulties to integrate the new technology within the existing organizational framework. Furthermore, problems may arise if nurses and other users are not well-informed about the purposes and functions of the computer system.