Kidney Donor Case Study
Kidney Donor Case Study
1. Innovative NZ
technology facilitates speedy and consistent donor-recipient
2. Clearly-defined and published criteria bring clarity and transparency to a sensitive issue
3. Unique system to be marketed worldwide
Helping health professionals with the toughest of decisions
AUCKLAND, 24th March 2004 - Health professionals have to make tough decisions every day of their lives, and few are more difficult than those faced by the National Kidney Allocation System (NKAS). Sadly it is usually in tragic circumstances that donor kidneys become available, but ensuring a positive outcome for one of the 350-400 New Zealanders who at any given time are waiting for a suitable kidney is the key role of the NKAS.
As you would expect, there are strict criteria for deciding which of the people on the list should receive a new kidney. These are based on clinical factors such as blood type and tissue matching and the length of time the recipient has been on the waiting list. Donors must have previously been fit and healthy and with excellent kidney function, and cross matching is undertaken to minimise rejection risks.
The aim is to maximise the chances of a successful transplant, but the decision has to be made quickly to leave as much time as possible to trace the potential recipient and prepare him or her for the transplant.
NKAS previously used an Australian system developed and implemented in 1998. Local staff worked with the Australian developer to implement the algorithms and matching rules used in New Zealand. It has worked well and represented a great improvement on the previous manual systems, but still had some significant shortcomings.
It was very hard to make changes to the system. The only person who could change the rules and algorithms was based in Australia, and maintenance of the database of recipients was unwieldy. Changes had to be sent to the system developer every month for him to update the database. The system was not able to interface directly to the new Blood Services system (HistoTrac) which meant that results of tests carried out on donors had to be input manually into the matching system, which took time and introduced the possibility of errors.
NKAS needed a system that would implement selection criteria based upon the policies set by the Ministry of Health. The system had to provide facilities for rules to be easily input and maintained, and had to be easily interfaced to the databases holding information on potential recipients and to the HistoTrac system.
NKAS enlisted the help of Healix, a software development company specialising in the capture and replication of best practice in heath sector processes. Healix believed that IDIOM, a locally-developed business rules technology, could quickly and efficiently handle the complex sets of rules and policies underlying the matching process and undertook a proof of concept exercise to ensure their thinking was sound. This demonstrated that IDIOM could capture the rules and ensure they were applied in a consistent manner. IDIOM offered an extremely powerful user interface that allowed rules to be programmed very quickly, and also permitted changes to rules to be made simply and easily if policies changed. Healix’s use of IDIOM combined with Microsoft’s .Net framework also made development of the Donor-Recipient Matching System simpler and cheaper.
The new system produces a list of the best potential recipients in order of ranking. It also automatically eliminates positive cross matches (ie those with a high probability of rejection), an important feature not provided by the old system. A ranked list of the top forty names is sent to Dr Ian Dittmer, Medical Director of NKAS, for review and he then forwards it to the donor coordinators who contact the transplant units managing the treatment of the top two potential recipients. The transplant units have four hours to make contact with these two individuals, and if they cannot contact one of them (or if one is unwell and therefore unable to undergo surgery) then the next person on the list is contacted. The NKAS works to a strict deadline: any transplant must be completed within 24 hours of the donor kidney becoming available, and this means that schedules for contacting potential recipients and getting them to the transplant centre ready for surgery must be met.
Incorporating all the factors involved led to a complex set of rules which had to be applied consistently. As well as speeding up the matching process, automating the system has the benefit of making the selection process utterly transparent – an important consideration when the decisions to be made have such serious consequences.
“The allocation rules are published and with the new system we will be able to give anyone on the waiting list a full explanation as to how and why each recipient has been selected. The way in which these extremely important decisions are made is completely fair and objective, and being able to demonstrate this gives everyone confidence in the process. A transparent and fair allocation system can also encourage people to become donors,” says Dr Dittmer.
He describes some of the other advantages of the new system as follows.
“Whilst the old system was workable it had become inflexible and cumbersome. Now we can maintain our databases and manage the implementation of our rules and policies ourselves when they change. For example, we recently decided to give children under 15 years of age greater priority in allocation decisions. The new system makes it easy to quickly change the rules to reflect this change in policy.”
He continues: “Because we worked closely with Healix, they were able to develop and implement a system, based on New Zealand know-how and IDIOM technology, that now leads the world in the area of donor-recipient matching. We will be encouraging other organisations world wide to look at the solution we have adopted as it meets a clear need in a unique way.”
Matt Hector Taylor, Director of Healix, said “We believe the new system will speed up the matching process and ensure consistent, good quality decision making. Top quality systems can have a major positive impact in the health sector and have the potential to improve clinical decision-making and patients’ quality of life. The excellent input provided by NKAS has resulted in a superb solution that we believe will improve allocation matching systems worldwide and become a significant New Zealand health sector success story”.
Healix provides innovative information solutions aligned to healthcare process and real “business” problems for a global healthcare market. Healix's targeted health sector applications are built from an integrated HealthSolutionSet focused on model-based architecture and execution.
1. Best practice
is represented in base models
2. Instances of the models can be tailored for specific users’ requirements
Healix supports its applications with strategy, Enterprise Architecture, process redesign and technical services to ensure implementation and operational success.
Healix is a joint venture between RHE and Associates Ltd and HealthMAP Ltd. HealthMAP is a specialist in: health IT strategy, business and clinical process redesign, business and clinical decision and rules deployment, solutions specification and project management/ implementation. As a result of this work HealthMAP has developed a comprehensive set of health sector models (strategy, process, decision etc.). RHE is a supplier of innovative bespoke solutions based on object, component and service oriented technologies. They have focused on how to build systems based on models.
About Idiom Limited
The IDIOM Decision Suite was designed for a world market, and is XML-based to provide technology independence and flexibility. It provides a simple, GUI environment for the direct capture of business decisions and their underlying rules from expert end users. IDIOM produces English language documentation of decisions and rules for its human audience, and source code for the computers. It is easy to understand and verify whilst being extremely efficient in execution.
Idiom’s customers include Allianz, IAG, and Power Solutions DTD. While business rules software has near universal applicability, early adopters have been in the insurance, health, and financial services industries. These are ideal markets for IDIOM because they are highly competitive and must respond to ongoing regulatory and market pressures. Most of the changes that they need to make to their systems are business rule changes driven by changes in strategy or market conditions. With IDIOM, the business decisions and rules are decoupled from the underlying applications and infrastructure. That means rule changes can be quickly and inexpensively implemented, without changes to the underlying applications.
IDIOM is also a powerful tool
for software developers, systems integrators and OEMs, who
can embed IDIOM in their architecture or applications to
produce flexible, highly configurable solutions for their
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