The evaluation of digital transformation in renal transplantation in the United Kingdom: A national interview study.

Abstract

Care pathways in renal transplantation involve multi-speciality coordination and administration of clinical data across organisational boundaries. The potential for information technology (IT) to support the service through data management, communication and national registration has been reported. However, no previous national-level evaluation on the current state of digital transformation has been undertaken. We undertook structured phone interviews with transplant coordinators at all 23 transplant centres in the United Kingdom (UK). The interview covered topics including clinical workflows during transplant referral and current data management processes. Based on established frameworks, we elicited IT capabilities, readiness and infrastructure to evaluate the digital maturity at each centre. We analysed interview data thematically and synthesised results across centres to identify common challenges and inform recommendations. Transplant coordinators across centres reported similar care pathways with patients being referred by to transplant centres from regional renal referral centres. Analysis revealed that a key challenge revolved around the inability to access data across organisational boundaries. This resulted in dependence on postal or electronic mail to transfer clinical data, such as blood results or medication lists. Most centres had a hospital-wide electronic medical record, which was unable to meet the specific workflow requirements of transplantation. This was primarily because implemented solutions were unable to provide a single unified view of transplant-related data. As a result, transplant coordinators reported several workarounds to manage clinical data, such as paper folders, Excel© sheets and scanned files on hospital shared drives. Existing front-line IT solutions and wider infrastructure did not support the requirements of care pathways in renal transplantation. Digital transformation should focus on the need to surface patient data across organisational boundaries and provide specific views of data that complement the clinical workflow. This study highlights how regional interoperability remains a major priority to support multi-centre specialist services.