The Evaluation of Digital Transformation in Renal Transplantation in the UK: A National Interview Study

Abstract

Background: Care pathways in renal transplantation involve multi-speci ality coordination and administration of clinical data across organisa tional boundaries. The potential for information technology (IT) to su pport the service through data management, communication and national registration has been reported. However, no previous national-level ev aluation on the current state of digital transformation has been under taken.Methods: We undertook structured phone interviews with transplan t coordinators at all 23 transplant centres in the United Kingdom (UK) . The interview covered topics including clinical workflows during tra nsplant referral and current data management processes. Based on estab lished frameworks, we elicited IT capabilities, readiness and infrastr ucture to evaluate the digital maturity at each centre. We analysed in terview data thematically and synthesised results across centres to id entify common challenges and inform recommendations.Results: Transplan t coordinators across centres reported similar care pathways with pati ents being referred by nephrologists at renal units to transplant surg eons at specialist centres. Analysis revealed that challenges included an inability to access data across organisational boundaries. This re sulted in dependence on postal or electronic mail to transfer clinical data, such as blood results or medication lists. Most centres had a h ospital-wide electronic medical record, which was unable to meet the s pecific workflow requirements of transplantation. This was primarily b ecause implemented systems were unable to provide a single unified vie w of transplant-related data. As a result, transplant coordinators rep orted several workarounds to manage clinical data, such as paper folde rs, Excel© sheets and scanned files on hospital shared drives.Conclus ions: Existing front-line IT systems and wider infrastructure did not support the requirements of care pathways in renal transplantation. Di gital transformation should focus on the need to surface patient data across organisational boundaries and provide specific views of data th at complement the clinical workflow. This study highlights how regiona l interoperability remains a major priority to support multi-centre sp ecialist services.