Investigators have developed a cloud-based, HIPAA–compliant software solution to ensure timely ureteral stent removal and validated its performance in a pilot study.
Investigators at the University of Michigan have developed a cloud-based, Health Insurance Portability and Accountability Act–compliant software solution to ensure timely ureteral stent removal and validated its performance in a pilot study.
The system’s development and pilot testing are described in an article accepted for publication in the Journal of Endourology.1
John M. Hollingsworth, MD, MS, a professor of urology and health management and policy at the University of Michigan, is a senior author of the paper. He told Urology Times®, “Retained ureteral stents are common, occurring in over 12% of the patients in whom they are placed. A retained stent is bad because it can lead to substantial morbidity and increased costs of care for the patient. Moreover, a retained stent can be a source of liability for the urologist who placed it.”
He continued, “The problem faced by urologists is a lack of reliable tools to facilitate the tracking of ureteral stents to ensure their timely removal. The solution that we created to address this problem leverages data captured in the electronic health record [EHR] to automatically log and follow patients across the care continuum. Notably, the solution facilitates patient tracking without disrupting existing provider workflows.”
Hollingsworth added that the software also overcomes limitations of existing ureteral stent–tracking software.
“One stent manufacturer has a mobile application that generates reminders about device removal, but the app is manufacturer specific and necessitates activities outside the normal workflow to maintain the stent log. There are also automated systems created by other provider organizations to capture information from the EHR, but these systems are EHR specific,” he said. “Our solution is agnostic to the device manufacturer, and we believe it can be seamlessly integrated into any EHR because it was built on Health Level Seven standards, which are common across all EHR platforms.”
For the pilot study, medical records of patients who underwent ureteral stent placement for any indication at University Hospital or 1 of its ambulatory surgery centers during a 1-month period were identified through medical record review. Information was extracted manually from the patient’s record to determine the accuracy of the software in identifying the placement procedure, scheduling follow-ups, and issuing alerts for patients without a return appointment.
The study included data from 46 patients who had a total of 51 stents placed during 49 procedures. The software captured all the procedures, correctly identified the 31 procedures in which a patient had a follow-up visit scheduled before the primary surgery, and alerted providers to the 18 procedures for which a return visit was not scheduled.
The review of the software’s performance for tracking patients who returned for stent removal showed that it registered all patients who attended their follow-up visit. Most important, it identified the ones who failed to show for their appointment.
Since submitting their manuscript, Hollingsworth and colleagues have been working to address the limitations of the initial software version tested. He explained that the initial version generated provider alerts when patients did not have a follow-up scheduled or had failed to arrive for or canceled an appointment, so an office staffer needed to contact those patients to reschedule an appointment. In addition, although the software could read the EHR, it could not write data for it. Therefore, the provider or a designee had to log in to the application outside the EHR to confirm ureteral stent removal.
“In the latest version of our software, patients receive secure text messages regarding appointment information, and we are developing the capacity for the software to be fully automated to remove the need for manual record closure, eliminating this step,” Hollingsworth said.
Further validation of the software is also ongoing. The software has been deployed at another academic medical center, which uses a different EHR from the 1 used at the University of Michigan, and at the University of Michigan’s interventional radiology clinic.
“Because our software uses electronic messages that are generated during the extraction of administration and clinical tasks, which are standardized across EHRs, it is potentially compatible with all major platforms. These recent deployments of our software will demonstrate its agnosticism to the EHR vendor and show its extensibility to other temporary implantable medical devices,” Hollingsworth said.
1. Tam C, Newman M, Dauw CA, et al. Developing and implementing a cloud-based software solution for tracking ureteral stents: a pilot study. J Endourol. Published online October 1, 2020. doi:10.1089/end.2020.0168