This article appeared last week.
‘Concerning lack’ of digital health systems in residential aged care, survey reveals
A nationwide survey of residential aged care staff has found almost one in ten works in a facility reliant on paper records for care management, while “critical digital systems” are yet to be widely implemented in a sector in “dire need of disruption”.
Conducted by the Aged Care Technology Consortium – a collaboration by Australian technology companies working to modernise the nation's aged care system – the survey found only 8% of residential aged care workers have access to a digital incident management system.
And within the results, 3% said their facility had implemented a visitor management platform, despite the need to monitor contacts and keep residents and staff members safe during the COVID-19 pandemic.
More than half (53%) said their facility uses a digital medication management system and 29% said a pain management platform is in place, while 8.7% reported using a paper-based care management system.
These results are concerning. There is no need for paper care records to be used in aged care when they come with unnecessary risks for residents. Especially as digital systemare available that can provide safer, more efficient and coordinated care," Humanetix CEO Arthur Shih said.
According to the survey, workplace challenges experienced by respondents included documentation completeness (24 per cent), incident management (19 per cent), shift handover and ease of administration (18 per cent), monitoring care quality and managing escalations (16 per cent), and compliance and auditing activities (15 per cent).
Respondents included CEOs (13.04 per cent), Directors of Nursing (19.57 per cent), Facility Managers (36.96 per cent), and Care Managers (6.52 per cent).
The survey, reveals anonymous comments which highlighted frustration at staff shortages, poor shift handovers including for "deteriorating" residents, time consuming compliance reporting, and digital systems that don't integrate.
"No [digital] system talks to each other – even from the same providers! Whether it's clinical care systems, finance systems, incident management systems, HR systems – nothing talks to each other," a survey respondent said.
Another commented: "Paper based systems are not acceptable in this day and age."
The Aged Care Technology Consortium's founding companies – Webstercare, Extensia, Foxo, Visionflex, MEDrefer and Humanetix – announced have joined together to integrate their technologies to help prevent unnecessary transfers to hospital emergency departments - and provide early identification of health needs, improved services in rural and remote areas, more staff time for patient care, better engagement with families, and health record sharing.
More comments here:
There is more coverage on the survey here:
Critical digital systems yet to be implemented across Australia's residential aged care sector: survey
Nearly a tenth of staff polled said they still use a paper-based care management system.
By Adam Ang
July 12, 2022 12:23 AM
The Aged Care Technology Consortium in Australia has noted the dearth of critical digital system implementations across the residential aged care sector in a recent nationwide survey.
FINDINGS
The survey, which was conducted in June, gathered responses mostly from facility managers (37%), followed by nursing directors (20%), CEOs (13%) and care managers (7%).
It was found that most respondents (53%) are working in a facility with a digital medication management system while 29% said they have implemented a pain management platform.
About 9% of respondents reported being reliant on paper records for care management; 8% said their workers have access to a digital incident management system; and only 3% said their facility has implemented a visitor management platform.
The survey also revealed staff's major workplace challenges, including documentation completeness (29%), incident management (19%), shift handover and ease of administration (18%), monitoring care quality and managing escalations (16%), and compliance and auditing activities (15%).
WHY IT MATTERS
"These results are concerning," remarked Arthur Shih, CEO of Humanetix, one of the founding members of the ACTC. He said there is "no need for paper care records to be used in aged care when they come with unnecessary risks for residents [and especially when] digital systems are available that can provide safer, more efficient and coordinated care".
"Aged care providers can find it confusing to choose digital systems, and often their systems don't connect or share information," explained Brian Sullivan, founder and CEO of MEDRefer, also a founding member of the consortium.
More here:
To me the big issue here is to recognize that the aged care sector is one that has a lot of priorities to balance and is also pretty resource constrained and so is going to look very hard as the cost benefit balance of any technology implementation.
Clearly there a many things the sector could do but the question is always going to be does is make economic sense to actually do it?
I believe it is clearly up to the providers of new technology to demonstrate in the real world – i.e. real aged care facilities – that their technology make a real and worthwhile difference for the staff and residents. Technology will get not adopted and used just because it is good!
It is important to remember that the aged care sector is very different from the acute care sector in many ways and thus will require different approaches in many aspects.
I am sure the consortium members are more than aware of these barriers and that they are working hard on them both in a technical and in an overall user value sense. Their long tern survival ultimately rests n being successful with this!
David.
31 comments:
"I am sure the consortium members are more than aware of these barriers"
David, don't be too sure. They call themselves The Aged Care Technology Consortium, so technology is where they are coming from.
I like your comment "Technology will get not adopted and used just because it is good!". It won't get adopted if it is bad either. Even bad technology, like fax gets used because it meets a need.
If technology doesn't meet a need it will get ignored, and there's plenty of evidence that's happening with a lot of Digital Health, good or bad.
There is an opportunity, however it would need to go back to the basics of transformation, to the core component before you ever consider technology, the very thing IT is built on. That of course is secondary to feeding, clothing and having an abusive free environment. Thea dare our elders, they toiled creating this country, the least we can do is left them have the last ten years or so on the house and in comfort.
The tech companies are only going to add huge costs to an already cash strapped industry.
Tim Blake has written an advert in The Medical Republic for his lecture series.
The advert has the grandiose title "What exactly is ‘digital health’?"
https://medicalrepublic.com.au/?p=73089
A brief summary:
"E-health was largely (although not completely) focused on the quality, safety and efficiency of clinical systems."
(i.e. supply side.)
"But at its heart, digital health is fundamentally about harnessing changing societal expectations and dynamics: patients and carers becoming increasingly engaged in their own care; patients acting as active consumers, not just passive recipients of care; the slow but inexorable democratisation of health information, fundamentally changing the power dynamic between engaged patients and clinicians; and the ubiquity of mobile devices across all socio-economic groups and the vast potential that this has for developing engaging, empowering, digitally-enabled models of care. At its core, this is what drives digital health.
On top of this we can then add a toolbox of exciting new technologies and techniques, allowing the appropriate approach to be (co)designed for each patient or consumer cohort, factoring in socioeconomics, demographics, health literacy and the social determinants of health.
These technologies include but are not limited to: mobile devices and apps, consumer health devices and wearables, robotics, virtual and augmented reality, artificial intelligence, blockchains, consumer genomics and microbiomics, telehealth and remote patient monitoring, as well as more traditional technologies such as patient management systems, electronic medical records and data standards such as SNOMED CT and FHIR."
(Blake claims this is demand side)
This is Blake's bio on LinkedIn
https://www.linkedin.com/in/timblake/details/experience/
A technologist who has worked his way up from a programmer at Oracle, though PwC, Tasmanian Health, NEHTA to Strategic Digital Health Advisor at the Australian Department of Health.
At the heart of his message is "the vast potential that this has for developing engaging, empowering, digitally-enabled models of care"
Oh, goodie. It seems the answer to his question "What exactly is ‘digital health’?" is "the vast potential of ..."
He's been working at the heart of State and Federal Governments' push for Digital Health for the past decade and he still thinks it's all about potential.
Healthcare is an elephant of a system. Poking it with a matchstick won't get it to move somewhere it doesn't want to go. It goes wherever it wants, driven by forces well outside the view and/or scope of governments and companies supplying technology.
I wonder if there is a club for all those evangelists who have tried but failed to make the elephant move. You know, the likes of Peter Fleming, Steve Hambleton, Paul Madden, Tim Kelsey, Bettina McMahon and now Tim Blake.
You said "I wonder if there is a club for all those evangelists who have tried but failed to ...... ".
To become a member of the club you must believe in miracles.
This is a series worth following. It highlights what has become sadly normal practice. A practice that influences cultural norms right through departments and Agencies in government. While this continues the public interest remains well down the list of priorities.
https://grattan.edu.au/report/new-politics-public-appointments/
July 19 4:44AM - will it change anything though? The last government has a lot to answer for.
We will see a number of articles and thought pieces for small consultancies all lining up for a slice of the aged care it cash splash. The government will turn to technology as a way of avoiding the hard to face question - why have you allowed the mistreatment of our elderly community?
In other industries technologies have introduced cost savings and efficiencies and improved service – surely the same could be achieved in aged care? It certainly needs it!
"In other industries ....." Hrumph. But not in many areas of health, particularly the MyHealthRecord. The MyHR is a prime example of more fragmentation, time being wasted not saved, and a continuation of unnecessary duplication of tests and investigations.
It's really quite bizzare that 25 million people have been registered as 'having' a MyHR yet most of those people don't 'use' it and for those few who do 'use' it their information is incomplete rendering it almost useless.
What is even more bizarre is that in the face of a trillion dollar deficit the government continues throwing over $300 million at the MyHR every year in the misguided belief it is, in some strange way, making the health system more efficient and saving the government money!
"In other industries technologies have introduced cost savings and efficiencies and improved service..."
You obviously do not understand the difference between "other industries" and healthcare.
All other industries get benefits from a large number of a very few standard transactions/activities. This lends itself to process automation.
Healthcare consists of many different transactions/activities. Every patient is unique in their health and sickness. Every experience with healthcare is unique. Even if standardised processes are applied, the experience cannot be automated.
The naivety of the "other industries" is the reason why so little progress has been made applying technology to healthcare, as opposed to medicine, where it is doing just fine.
Other industries - the catch phrase of those who have never worked in those industries or have left and are just entering health IT. A patient journey is not the same as an ATM transaction nor is it similar to a supply chain. The share only one similarity, all are poorly presented in PowerPoint.
I think this thread is unreasonable
Firstly, there's no question that health is not like the other industries; the work flows are more complex and variable, and error conditions matter very much more. I don't know anyone claiming otherwise. But it's a false binary to claim that because it's not that simple, there's no prospect for digital to make any difference, but that's where this thread has pretty much ended up.
There are really significant success stories from digital health in this country and overseas, and the careful provision of digital services associated with really thoughtful transformation of healthcare services has led to better health outcomes.
It follows that any particular digital health initiative may or may not be useful; they each have to be evaluated on the merits, based on a. realistic knowledge of how they're going to be used, and how the adaptive healthcare system that's driven by many perverse incentives will respond to them (that's particularly difficult, since it often can't be predicted, and so you have to suck the risk up and give it a go)
Tim's original quote: "the vast potential that this has for developing engaging, empowering, digitally-enabled models of care"... that comes from what is effectively a marketing tool, so I wouldn't set too much store on it. Tim has produced some actual working solutions, so I think the commenters should not judge too harshly
What you say Grahame sounds quite reasonable, however it does lead one to ask why is the government continuing to pour so much money money into the ADHA and the MyHR?
IMHO, this thread is quite reasonable.
The government should be making good and rational decisions about spending its (our) money.
Assuming there is a choice is it better to spend money on digital health or digital medicine (as defined by Tim)?
I suggest that the $3+billion that has been sucked into NEHTA/ADHA/PCEHR/MyHR with little payback would have been better spent in medical research.
The over-hyped Digital Health sector has attracted too much attention with its "vast potential ...". The vast opportunity cost is invisible to taxpayers but that doesn't mean it isn't significant.
Some of the comments on this blog may be a bit over the top, but sometimes you have to shout to be heard over the hollow claims of vested interests.
"why is the government continuing to pour so much money money into the ADHA and the MyHR?"
As far as I can tell, the answer is that the Australian government has no way to handle bureaucratic failure. My view is that the original project succeeded moderately well for a Mark 1 project, but at the point where we should've said "OK, what do we do now, to make this useful to the healthcare system", the choice was instead to say "how do we browbeat the healthcare system into making what we have useful" and now there's no way to get the government to say, "we should decide to do something different, or stop trying". But note that this was a political decision (read the Senate inquiry outcome, in particular, their response to my submission). So the answer is: politics.
> The government should be making good and rational decisions about spending its (our) money.
of course it should. But what part of Australian politics suggests to anyone that this is what will happen? Australia is a basket case, fatally but not seriously flawed. The bill will become due later, when we can't kick the can down the road anymore. In the meantime, we're all richer because of coal tax revenues (not)
"the original project succeeded moderately well"
In what sense did it do that?
It was supposed to solve the interoperability problem and join existing repositories of health information. In this it failed miserably.
What was implemented was a dumb data dump that requires significant curation effort by overworked GPs and contains a minuscule amount of health data.
To compound the failure, the government continues to lie about the MyHR "reducing data fragmentation". It did this to the ANAO who repeated the lie in its final review.
IMHO, you can't even claim it is like the curate's egg - good in parts. It is woeful in all its parts.
@3:13 PM sums up the whole sorry saga perfectly.
> In what sense did it succeed moderately well
Something went live. That something was a working system where every Australian had a common health identifier. if you don't understand what an achievement that was, you don't remember beforehand. We had a single linked up system across the all the states, and everyone at least paid lip service to it's importance. We had managed to get some conformance process up and some software passed it. We had an architecture that could theoretically have served for join existing repositories. We put up several significant pieces of national infrastructure. Sure, they didn't work as well as they could, but they worked. We got the national clinical terminology service out it (later, true)
All that was good. Far from finished or useful, and that's my point. But from where we were when it was first suggested, all those things were achievements. Had we had the fortitude to do a redesign, and actually try and build a useful system, we could have done so, building on those achievements. But we didn't. I recall begging Tim to at least try, but no. Politics, as I said.
Unfortunately Grahame, if it didn't get completely developed, embedded and accepted widely, then it failed.
You basically agree when you say there was a need to do a redesign to try and build a useful system.
Please stop trying to guild the lilly by skirting around the basic fact that we failed.
"I recall begging Tim to at least try, but no. Politics".
With respect Grahame it had nothing to do with politics.
It had to do with incompetent leadership; a $600,000 / annum egotist; marketing rhetoric with little to no substance or truth behind it; and no understanding of the complexity of the problems to be solved.
The only 'politics' were that it's too embarrassing to tell the politicians the project has failed, doing so would put 'my' lovely $600,000 job and salary at risk, and it would be far too difficult for 'me' to change the story and admit 'I' was wrong. With the utmost respect I suggest that is not 'politics' it reflects the characteristics of a dishonest incompetent failed 'leader'.
it's always fun here debating anonymous. I'm not claiming the project didn't fail. All I'm saying is there is value in Digital Health, when it's done properly. Nor is it right to blame the failure of a government over more than a decade on a single player, not matter how disappointed we are by their individual decisions or outcomes.
"there is value in Digital Health, when it's done properly"
reminds me of the old surgeon's joke(?)
The operation was a success; the patient died.
You won’t get the collective mindsets that sit in various corners of the debate to shift while rocks are the means of communicating. Not sure how to change the conversation (not famed for my compromising manner) other than focus on the things that have been a success - such as health identifiers- that have been a success left wanting. The MyHR, to some extent, normalised the potential for health IT, but like many things, its technology, usefulness, and relevance can be short-lived.
Interoperability is another lofty goal that just needs breaking down - it holds different values to different cohorts. Discover those values and appreciate what that commune sees as a priority.
Take the half successes and build a case around them. Perhaps a national entity could focus on the collective wins across Australia rather than boasting about its own questionable value.
I agree with the statement about not holding governments or individuals responsible - we all believe we are right.
I am rather surprised by the suggestion by some that digital health can't work because healthcare is more complex than other industries.
If I can book a flight from Nur-Sultan to San Paulo then I think it is entirely reasonable that I should expect my GP to communicate with a specialist via more sophisticated means than paper referrals and fax.
We can all agree that My Health Record has failed and hopefully the new government will quickly see that. But just because the government failed, doesn't mean digital health can't work. Digital health isn't just My Health Record. There are private innovators in Australia that are managing to solve some of healthcare's problems. Look at Webstercare. How many lives has that company saved? It started off with the Webster Pak and now has numerous medication management software products.
@11:32 AM "We can all agree that My Health Record has failed".
Having had a considerable amount of unsatisfactory personal clinical experience with the My Health Record I find it mystifying in the extreme why so many very important people, like Dr Steve Hambleton, Dr Mukesh Haikerwal, Dr Brendan Murphy, the RACGP, and many others, continue to promote it and continue to support directing huge amounts of taxpayers' funds into keeping it alive!
@2:05PM They tell each other the same 'story'. They pass it from one to another spouting the same snake oil. It's called repetitive parroting.
AnonymousJuly 22, 2022, 10:37 AM - it is more that people dumb down what is a very complicated information challenge, usually to mask a lack of understanding or to sound more worldly (usually both). Your example is an excellent example of this - The airline booking industry has a margin for error that is probably not safe in healthcare. Booking flights from a to b does not require context or other inputs, just a credit card.
The digital health agency is falling into this trap again - best not read their post too much
Dr Margaret Faux uses banking as an example:
https://medicalrepublic.com.au/were-still-in-the-travellers-cheque-phase/73331?utm_source=TMR%20List&utm_campaign=f3b7329b45-Newsletter_July_24_07_22&utm_medium=email&utm_source=TMR+List&utm_campaign=f3b7329b45-EMAIL_CAMPAIGN_2022_07_22_12_47&utm_medium=email&utm_term=0_620ca5063b-f3b7329b45-45307559&mc_cid=f3b7329b45&mc_eid=ee5e2e4d17
The Northern Territory has a territory wide EHR - My eHealth Record. I think Faux is a bit confused or is the intention to champion openEHR? Whatever she is on about it is Yet another example to administrative darling using a domain they no nothing about to explain another domain they now little about and end up doing themselves any favours. I am sure Faux is an intelligent person but on this occasion I am not sure the best foot was put forward.
So what Dr Margaret Faux is saying is that after 10 years MyHR is useless, to at least a subset of the population and healthcare providers. A subset of the population that might actually get some benefit from the system.
BTW, a better URL for the article is
https://medicalrepublic.com.au/were-still-in-the-travellers-cheque-phase/73331
The full link identifies who you are and that you are on The Medical Republic's mailing list.
Everything from ?utm_source= and after can be deleted.
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