Nurses working in the aged care sector were anxious for the release of the Royal Commission into Aged Care Quality and Safety report late last year, given the knowledge that this sector is well behind in the use and application of technology and has no clear information and communications technology strategy.
Clinicians working in this sector have not been able to access the right data in a timely manner to support and inform quality care, and clients and carers have been unable to locate relevant information to support their access to care services. Reliable data is integral to informing and evaluating care delivery and supporting the adoption of improved models of care and new technologies. The nursing workforce has been the main contributor to the data collected in this sector, having the additional burden of ensuring the data is high quality, comprehensive, and complete, and the information, knowledge, and wisdom derived from the data is used effectively in decision making and activities for continuous improvement. Compounding this is the increased expectation for higher digital health capability in aged care nurses.
The aged care nursing workforce needs to operate in a technology-enabled environment for efficient clinical, business and operational systems so that person-centred care is enabled. Secure use of data throughout the system and solutions to reduce the administrative burden of data collection are long overdue. Real-time or near real-time data collection and sharing at the frontline of care delivery is also needed, at the governance level for the organisation and amongst organisations when a client is transferred between care provider / clinicians. Lastly, the variable use of digital record keeping for clinical and administrative information management, including My Health Record, need to be consolidated with enhanced system integration/interoperability to reduce duplication and risk of errors.
Despite the report highlighting the need for greater transparency in aged care and the knowledge that digital tools and technology have the potential to transform the aged care system both in the home and in residential aged care facilities, less than ten of the 124 recommendations mention digital health or related concepts such as data and information governance.
The present structure of aged care providers – essentially separate individual predominantly private operators – does not encourage sharing of ideas or improvements. The recommended Aged Care Research and Innovation Fund will provide the much needed funding for innovation, and being government funded, any new innovations and developments will be available to all market stakeholders.
The suggested national aged care data asset is welcomed, given the collection and reporting of quality indicators is completed manually. It is a requirement to physically view the client to search for pressure injuries rather than report on pressure injuries that are already recorded. From that point, facilities are required to manually enter that data into the government portal or third-party website. It is hoped that consideration will be given to accurate and automatic collection and reporting of data accurately, and limiting manual processes and multiple data entry.
The report highlighted the need for interoperability of information and communication systems, with many organisations still using paper out of necessity for recording and sharing information despite having digital systems in place. Unfortunately, forward thinking organisations currently see little value in investing in digital clinical systems as they do not interact with other systems. Whilst their locally used system might provide several benefits to care activities, transitions for clients between care settings necessitates faxing information to hospitals and general practice surgeries. Additionally, because general practitioners must record information in both their practice management software program and the aged care facility’s system, they often enter the notes in their program and fax or email copies to the facility. Duplication also exists with medication management – administration is signed for digitally at the facility, however ordering or advising pharmacy of changes necessitates another system to be used. Surely a digital platform enabling care plans and health summaries to be seamlessly updated by ambulance officers, hospitals, general practitioners, and aged care facility clinicians could be made available, as well as access for relatives and carers of pertinent information. After all, it is 2021!
Members have your say: Log on to the Nurses and Midwives Community of Practice on the Institute Social Link to read more.
Berni Zipf
Quality and Clinical Support Manager, Fresh Hope Care
Cedar Yin CHIA
Manager, Systems & Reporting, Catholic Healthcare