JMIR Publications

ABSTRACT

Background:

Continuous renal replacement therapy (CRRT) is a life-sustaining critical care intervention widely used for hemodynamically unstable individuals with acute kidney injury. Recent efforts, including standardized procedures, structured documentation, and quality monitory, have shown small improvements in CRRT delivery and safety. However, fragmented workflows and paper-based documentation limit the sustainable implementation of these improvements in routine practice.

Objective:

This study aimed to design and evaluate a CRRT information system to support standardized procedures, structured documentation, and quality monitory.

Methods:

A user-centered design approach, informed by Design Science Research (DSR) methodology, guided a multi-step process of identifying problems, defining objectives, and designing and evaluating the information system. The approach to design involved close collaboration within a nurse-led, 10-member multidisciplinary team comprising nephrologists, nurses, information technology specialists, and information engineers. Evaluation included six months of real-world clinical use with ongoing feedback collected through a dedicated WeChat workgroup and a System Usability Scale (SUS) survey of 27 CRRT care team members.

Results:

A role-based CRRT information system was developed, comprising 14 clinical modules and 6 core functions. The system embedded a continuous data-processing pipeline that enabled automated capture of treatment-related data directly from CRRT machines, creation of structured nursing documentation, and generation of quality indicators from structured data. During demonstration, workflow refinements—including dual-nurse verification and enhanced device data transmission—were incorporated following pilot testing. Over six months of clinical use, 42 user-reported issues were identified across three domains: data retrieval and calculation, fidelity of automatically generated clinical documentation, and interface appearance. Quantitative usability survey (n=27) demonstrated excellent usability (mean SUS score 95.19, SD 5.09).

Conclusions:

A CRRT information system integrating standardized clinical procedures, structured documentation, and ongoing quality monitoring supported complex clinical practice and management beyond simple digitization. Workflow-aligned, data-flow–enabled design may help future critical care information systems better support clinicians working in information-intensive environments.