JUDE BARBACK reflects on the difficulties and benefits of incorporating technology into aged care.
Sometimes it seems hard to believe that we’ve reached the point in aged care in which we talk about tablets (as in medication) and tablets (as in iPads) in the same sentence. Yet this is becoming a reality as digital technology becomes an integral part of aged care.
The conversation has moved swiftly. One moment we are marvelling at our ability to gather and store information, the next we are working out the best way to collect this data and what to do with it so that it best serves the interests of the resident at the centre.
Technology and person-centred care
Person-centred care is a phrase that is used all the time, but in reality it is difficult to truly put the person and all their conditions at the heart of care delivery.
Dr Jenny Basran, a keynote speaker at this year’s New Zealand Aged Care Association (NZACA) conference, talked about how technology can assist in delivering person-centred care. Basran, a gerontologist from Canada, believes healthcare with all its disciplines – GPs, nurses, pharmacists, physiotherapists and so on – still struggles to shake off the propensity for creating silos of information around a person’s care.
There is a tendency for health professionals to look at each of a person’s conditions separately, and to naturally place more emphasis on that which falls within their area of expertise. There is no problem with this approach for a person with a single chronic disease; however, the “new normal” as Basran describes it, is that people are now living longer with multiple conditions. To understand and treat one condition in the context of the other conditions, Basran argues we need to shift from this multidisciplinary approach to an interdisciplinary approach, where an assessment carried out by one discipline populates the same single care plan used by another. She says there is currently a tendency for separate disciplines to carry out similar assessments and collect the same data, because they mistrust the assessments and data of other disciplines.
By using a single interdisciplinary assessment tool, a single care plan can be populated by the contributing disciplines, without the need for each discipline to reinvent the wheel. The technology can include ‘what if’ scenarios to see how one area of care might affect another.
While there is little doubt about the efficiency of such an integrated approach, some questions still emerge. How is an assessment error rectified if it is part of the care plan and unchallenged by other disciplines? And how do you implement a tool that replaces or incorporates existing IT systems?
A centralised approach
Technology is ubiquitous and ever-changing, which makes it difficult to bring existing tools and systems together. Ideally there needs to be some collaboration or centralisation of systems to bring some consistency to the fore.
Centralising IT systems is no easy task. The Government’s $3 million patient portal exercise is a good example of this, with take-up proving much slower than expected. Even so, the National Health IT Board remains hopeful of achieving the vision of a patient portal for every New Zealander. As things stand, 75,000 patients are now using a portal, with this number expected to exceed 100,000 by the end of the year.
The National Health IT Plan aims for more eHealth records and collaborative sharing of information between healthcare professionals. Director of the National Health IT Board Graeme Osborne says the strategy envisages patient portals, community and hospital ePrescribing, and data from interRAI and other systems feeding into a single shared care plan for each person. A child born today will have a digital health footprint, says Osborne.
The $6.5 million hospital ePharmacy system is the first shared regional hospital pharmacy software implemented in New Zealand and is a good example of what can be achieved with a centralised approach. The system has been successfully rolled out across all five Midland DHBs – Lakes, Taranaki, Tairawhiti, Bay of Plenty and Waikato.
Health Minister Jonathan Coleman said that prior to the ePharmacy system the five Midland region DHBs each had their own hospital pharmacy management system with different functions and costs. Now the Midland DHBs are using the same terminology for medicines and they know what medications are available.
“The rollout of the ePharmacy system shows what can be achieved with strong regional leadership and close engagement with clinicians and IT vendors,” said Coleman.
The Medi-Map success story
ePrescribing is a hot topic. The national New Zealand ePrescription Service (NZePS) was one of the initial phases of the National Health IT Plan, allowing medical information, including medications and prescription data, to be collected and stored in one complete record, making it easier for health professionals to deal with patients.
The launch of electronic medication platform Medi-Map demonstrates how a system can work with national programmes and strategies.
Four years ago, Invercargill pharmacist Greg Garratt experienced a “serious near miss” at his pharmacy due to the misinterpretation of a prescription, which may have resulted in the death of the patient had it not been rectified in time. The experience prompted Garratt to establish – with the help of software developer Chris Parmenter – Medi-Map, a cloud-based medication platform that aims to join the dots between pharmacists, GPs and aged care providers.
In place of bulky folders filled with illegible faxes, a rest home’s medication round can now utilise a tablet computer. This allows a caregiver or nurse to select a resident, verify that resident with a photo on screen, and administer their medication outlined on screen, with the reassurance that it is the most up-to-date and correct medication list. The electronic system allows any change in a resident’s medicine to be automatically stored in a shared web portal, effectively connecting aged care facilities with pharmacies and general practices.
The system has many benefits: it increases residents’ safety; it is faster and it reduces wastage. However, the understated beauty of Medi-Map is its ability to work with national platforms and other consumer care management systems, like VCare and Momentum.
Medi-Map has built New Zealand ePrescription Service integration into the system, which allows a ‘conversation’ between the prescriber and the pharmacy to take place through the system before the electronic script is given.
Medi-Map received a waiver from the Ministry of Health that removed the need for a doctor’s signature on medicines charts. The tool has already been embraced by many aged care facilities around the country, with more jumping on board. MidCentral DHB made the decision to provide funding towards the set-up for every one of the district’s facilities and their associated pharmacies.
Garratt and his team are working closely with the National Health IT Board to ensure Medi-Map is part of the longer term National Health IT strategy.
Meeting the clinical and business need
The take-up of Medi-Map and other new tools, systems and platforms now available to the health sector tends to flourish as organisations became convinced of the technology’s ability to assist their practice without damaging their bottom line. The thing about adding technology into the health equation is that it has to contribute to achieving both clinical and business objectives. Organisations generally want to know that the systems they will invest in will serve the interests of their clients and their business.
The reluctance of GPs to take on patient portals, for example, has not been so much to do with how the portals will impact on the clinical solution, but more to do with how they might affect general practice costs and revenues. To this end, not-for-profit health IT organisation Patients First commissioned consulting firm Sapere Research Group to conduct financial modelling on behalf of the National Health IT Board to look at how patient portals might affect general practice time and the bottom line. In this example, the research found that patient portals have the potential to provide a net gain to general practice.
InterRAI, on the other hand, needs to convince practitioners of its worth as a clinical tool. There is a degree of weariness on the subject of interRAI, even though it is early days for the assessment tool in New Zealand. Many clinical staff feel they’ve invested a lot of time and effort into the tool without seeing any benefit or outcome yet.
According to interRAI’s Vij Kooyela, there is light at the end of the data tunnel. A new Data Analysis and Reporting Centre established by Technical Advisory Services (TAS) is currently in its establishment phase, which will run from July 2015 until June 2016. The collection and analysis of data from clients in home-based and community care, long-term care facilities and hospitals will provide information to serve NASC agencies, the Ministry of Health, DHBs, and aged care facilities, as well as contributing to a global picture of interRAI trends. Kooyela says the information will assist planning and decision-making at the client, facility and DHB level.
InterRAI is one part of the jigsaw – albeit a major part. But it needs to be integrated with other platforms and consumer care management systems. It is no use having systems and tools that work in isolation – health technology needs to be collaborative.
Health IT organisation SimplHealth – which drove the aforementioned national ePrescription service – released a white paper earlier this year that suggests that by harnessing information through collaborative technology, it might be possible to bring greater consistency and efficiency to the way aged care is managed in New Zealand.
The paper, titled ‘Will you still need me, will you still feed me, when I’m 65?’, points to an overhaul in the way the disability support services sector was run as an example of what can be achieved by taking this sort of approach. Previously disability support services were managed inconsistently, with the various Needs Assessment and Service Coordination (NASC) agencies storing assorted information in different systems. The inconsistencies – aside from creating inefficiencies and room for error – meant it was difficult for the Disability Services Directorate to forecast future demand.
To address this, the Ministry of Health funded a major programme of work, led by Hague Consulting, which culminated in the development of a web-based National NASC Information System, named ‘Socrates’. The system collects information from the NASCs and stores it securely in a central database. It interfaces with a Geo-coding application, the National Health Index database, and Government funding and payment systems.Jodi Mitchell, chief executive of SimplHealth, the IT vendor behind Socrates, says the system enables a better understanding of New Zealand’s disability service requirements.
After implementing the Socrates system, Mitchell said it was discovered that $3 million in payments had been made to deceased clients. It also disproved the assumption that adults with disabilities needed more money than children with disabilities.
Mitchell believes it is possible to replicate the way technology and business systems were used to build efficiency and consistency into the disability sector in other areas of our healthcare system, namely aged care.
The white paper identifies three things needed to better manage the health of the growing older population: access to more information so that an overall view of demand can be developed; more consistent and better quality data; and a business process to hinge it all together.
Mitchell points to the disability exercise as an example of what can be achieved with this sort of approach.
“These types of systems already exist and could be adapted for aged care,” she says. “More sharing of information and collaboration through a business process would save time, support better decisions, and improve healthcare outcomes.”
Not a substitute
Indeed, data is important. We have become adept at collecting data. But is it the right data? And how should we put it to good use?
Dr Basran says we need to establish what we’re trying to achieve rather than collecting data for data’s sake. She says we’re good at gathering data on health and safety, but we could be better at monitoring other aspects of care, such as a resident’s quality of life.
Technology is there to assist care, not to replace it. The incorporation of technology into aged care should ideally make life easier for residents and aged care staff, not harder. By simplifying and automating the administrative aspects of aged care, technology can help free up time for delivering quality care to residents. It should also help reduce the possibility of errors.
As with anything new, there is always likely to be resistance to the introduction of new technologies, especially from staff who have had only minimal exposure to technology in the past. However, the implementation of new technologies and the associated training can be seen as a way of engaging with staff, empowering them with new skills, and building a sense of teamwork.
Ultimately, it should be presented to staff as a means of enhancing care delivery. There is a risk that we become so caught up in the technology at our disposal that we lose sight of the true origins and meaning of care.
Professor Dan Levitt, a keynote speaker at the NZACA conference, sang the praises of sensor technology for older people in the home, but was quick to point out that they were not a substitute for social interaction.
While technology will continue to play an increasing role in aged care, let’s hope it doesn’t completely replace the kind smile and the warm hand of the person helping to ensure a resident’s wellbeing and quality of life.