Reconciling Quality and Efficiency: Fixing Information Silos In Care

A single, quality assured plan of care, key information and a detailed schedule of care activities for each resident, shared by all involved in care delivery?  Sounds obvious doesn’t it?

Yet, what we have in aged care is a fragmented, often inaccurate and sometimes contradictory set of information sources, preventing care workers from acting as a team.  Care protocols are poorly documented, and rely heavily on individual staff remembering what needs to be done and how to do it. What’s more, staff find it hard to show that care has actually been delivered as required.

The result is a vicious cycle in which staff are scrambling to keep on top of residents’ needs. This creates stress and the stress causes errors, resulting in more stress, and in turn, causing more errors. Resident health and quality of life are compromised by preventable health incidents, which adds to costs for the aged care provider, and in the downstream health sector.

Technology could help. It’s not a panacea, but can support a business-wide transformation that delivers quality assurance and put aged care providers on a sustainable financial footing. By automating record-keeping and providing decision support at the point-of-care, it gives staff back the time to care.  Stress subsides and errors fall. The destructive feedback loop is inverted, and the residents and the business prosper.

It’s not surprising that aged care has trouble with managing information. It is an incredibly complex environment. At aged care home we worked with, we identified over 60 assessment paper forms, 360 clinical activities, and over 1,000 facts that needed to be recorded about individual residents. Additionally, we identified 18 different types of users. For each user, we created a system giving them access real-time data, tailored to their needs, and from a ‘single source of truth’ at the point-of-care.

The management of such a complex information environment requires a new generation of IT that can support the ‘wellness’ of residents and staff alike.  Our research shows that the technology must:

• Simplify the information environment and co-ordinate staff so that they work as a team. 
• Provide accurate data, care plans and decision support at the point-of-care in a single ‘source of truth’ for all who deliver care;
• Create time and identity stamped records in real-time at the point of care; and
• Reduce the administration load so that staff can concentrate on caring.

To do this, the technology must be:

• Agile, safe and secure.
• Highly intuitive – and usable by low skilled staff with limited English language skills.
• Able to support many different types of user, including carers, administrators and health professionals.
• Able to run on any device – PCs, tablets, and smartphones.
• Equipped with management tools to analyse care practices for impact on resident welfare, and predictive tools for managing activity loads.
• Cloud-based to allow scalability and minimise infrastructure costs.
• Developed in accordance with relevant accredited quality systems and methods eg ISO 9001).

The technology must also be ready for future technology and business changes.  These include:

• Configurability – able to adapt quickly, at low cost to changing business needs and clinical practices.
• Support revenue streams – Aged Care Providers have the potential to become hubs for sub-acute and community-based care (home care, disability care, mental health, social work etc) opening new business lines.
• Telemedicine – real-time data for all clinicians, wherever they are located. 
• Accountability – in a litigious world, highly accurate records of care removes uncertainty in disputes.  More importantly, it avoids issues arising in the first place.
• Direct connection with medical devices, including wearable monitors – new Software as a Medical Device regulations are coming for software that connect to medical devices and/or provides data used in clinical decision-making.
• Artificial Intelligence – high integrity, detailed data allows AI applications, which are increasing in all areas of healthcare.

Technology does not solve problems on its own. Not understanding this, invariably leads to wasting money and resource time. That said, when technology is correctly used as part of a business process re-engineering and cultural change initiative, transformative results are possible.

The challenges facing the delivery of quality aged care services on a sustainable basis will not be met without such a transformation.  Aged care, like all health care, is a complex mix of clinical, wellbeing, care, and aspirational components. It is delivered by a multi-disciplinary workforce requiring a blend of expert skills, intuition, and emotional intelligence.  The workforce needs accurate, comprehensive and consistent information about the resident to do their job effectively, and enjoy the satisfaction of helping residents to maintain a quality experience and dignity in their twilight years.

Matt Darling is Chief Systems Architect at Humanetix.