William Mattern, MD, University of North Carolina; Allen R. Nissenson, MD, Chairman RMS Lifeline Medical Advisory Board; Tom Parker, MD; Sue Scott, VP Information Technology, RMS Lifeline; and Terry Litchfield, VP Quality, RMS Lifeline

Clinical and financial data software IS for pts with end-stage renal disease (ESRD) receiving HD pts have been designed to function at traditional sites of care, such as dialysis units, hospitals, and physician offices. These systems generally capture data limited to the care for which providers at each site have direct responsibility. VA for HD is expensive, difficult to maintain, and a source of substantial morbidity in many pts., particularly the elderly and those with diabetes. Furthermore, information about VA has been difficult to track since placement, complications, and interventions occur at multiple sites of care over protracted periods of time. Two developments are now reshaping the approach to VA care: a broadening of the scope and a more collaborative approach to ESRD care in general, including the use of nurse facilitators in a DM model of care; development of AACs specifically staffed and designed to provide comprehensive and highly efficient VA care. We describe the design of an IS by Baxter Healthcare's recently formed VA DM organization, RMS Lifeline (RMS-LL). The IS is designed to function within AACs and across all other sites of care to capture longitudinal data relating to the processes and outcomes of VA care. Data collection and entry is done at each of the AACs, and uploaded to a central server for aggregation, analysis and reporting. Modules include initial patient referral; scheduling; evaluation of patient care prior to, during and after a procedure at the AAC; patient education; discharge planning; interaction with the referring dialysis units and physicians; basic functions of the AAC including medical records, risk management, inventory control, resource management, billing, accounts receivable and funds management; and tracking over time all VA events, related hospitalizations, and complications. Analysis of the data for each AAC will offer sharing of successful variations of practices, while the aggregated data will establish the best overall practices to be applied across AACs.