This Is A Useful Discussion Of The Prospects Of Digital Health In The Aged Care Sector.

This discussion appeared last week – and is topical in the context of the present Aged Care Royal Commission:

Harnessing the power of informatics to improve aged care

Editor: Dr Ruth Armstrong Author: Johanna Westbrook on: July 17, 2019In: aged care, public health, quality and safety of health care

Introduction by Croakey: The Cairns hearing of the Royal Commission into Aged Care Quality and Safety wraps up today, having heard from a roundtable of chefs, earlier in the week, that the quality of food served to aged care residents varies markedly from facility to facility and is sometimes very poor.

Celebrity chef, Maggie Beer, observed that a modestly increased investment, staff training, and care with menus would lift standards, and that appetising food was surely something residents deserved.

Uneven and often substandard care has been a recurring theme in the hearings so far, and it is disturbing that poor practice has flourished undetected.

The author of the post below, who gave evidence at the Royal Commission’s Darwin hearing last week, says appropriate use and linkage of routinely collected data could shed much needed light on common, systemic problems, such as prescribing errors, medication misuse, and neglected medical issues.

Professor Johanna Westbrook is the director of the Centre for Health Systems and Safety Research at the Australian Institute of Health Innovation.

Below she explains how “harnessing the enormous power of informatics” to create systems that use the data often already at hand, could make a difference in the individual lives of older Australians and their carers.

Johanna Westbrook writes:

Unlike the harrowing personal stories from inside our aged care facilities, my recent appearance at the Royal Commission into Aged Care Quality and Safety was not the stuff of headlines.

However, the opportunity to discuss the causes of systemic failures that lead to sub-standard care, and possible options to address these, was a critical step towards preventing future tragedies and improving the quality of life for many older Australians.

My focus was on the power of ICT (information and communication technologies) to alert us to what is going wrong, where and why. Application of data linkage and analytics, to routine data collected about the treatment and care of older clients held in existing electronic record systems, can provide valuable information to identify quality and safety issues.

Such information is urgently needed to better direct our efforts and to better design our aged care services.

This is not the kind of aspirational statement that requires a blank cheque and lengthy timeframes for implementation. The technologies and capabilities we need are already operating effectively in other sectors and can, with sufficient will, investment and incentives, be applied just as usefully to improve aged care.

Australia’s aged care sector – data rich but knowledge poor

The first step, though, is understanding Australia’s aged care sector as it is. As a healthcare systems researcher, my own work initially focused on how information technologies can impact quality and safety in acute clinical settings. But, realising how little attention has been paid to aged care delivery for our vulnerable elderly, my team of 40 researchers at Macquarie University has since undertaken numerous studies with aged care at their heart.

We’ve found that Australia’s aged care sector is immensely data rich, but knowledge poor. That is, although huge volumes of information are routinely collected and recorded – often describing in detail multiple aspects of every aged care client – most of it is never looked at again.

Much of this potentially useful data remains in silos, often as a mix of paper and electronic files. These records are rarely integrated to reveal sector-wide patterns or challenges, nor used locally to help providers and staff to coordinate, monitor and enhance care.

Challenges and opportunities in medication management

Take, for example, problems and errors associated with medication management, the most common complaint across residential aged care facilities. Our research in hospitals has revealed that electronic medication management systems can reduce prescribing errors by more than 50%, as well as significantly reducing the severity of medication errors that do occur.

No other intervention has ever produced such improvements in medication safety; one of the most intransigent barriers to safer, better quality healthcare.

By contrast, our aged care research, and that of others, has revealed a fragmented medication management process, often with poor coordination between all those involved, from prescribing GPs to dispensing pharmacists and the registered nurses and carers administering medications. Mixed communication methods, like phone, fax and paper – and the lack of centralised, accessible electronic records – means information is constantly at risk of  being delayed, mis-communicated or lost.

Our 2017 study* comparing medication records for residents of aged care facilities with the records of their prescribing GP found an average of 9.97 discrepancies per resident. The most frequent discrepancy was a medication listed on a resident’s chart at the aged care facility but not listed with the same resident’s GP (34.9% of discrepancies), increasing the risk of unintended overprescribing or adverse drug interactions.

There is a great deal more here:

https://croakey.org/harnessing-the-power-of-informatics-to-improve-aged-care/

The full article is well worth a browse. I have to say I was rather amazed there were 40 researchers working in the area at Macquarie Uni! There must be some important work yet to come.

David.