Residential aged care organisations in Australia have been slow to not only move to digital clinical information systems but embrace the benefits of digitalisation in general. The Royal Commission into Aged Care Quality and Safety (Royal Commission) and others have stated that the residential aged care sector as a whole has not kept up with even other healthcare sectors in the use and application of technology1,2. The Australian Aged Care Industry Information Technology Council has recently completed a review of digital maturity of systems in use in aged care and the final report indicated that electronic clinical systems are only used by 59% of aged care organisations3.
My Health Record (MHR) is federal government initiative to enable all Australians to keep an online summary of their key health information. Dating back to the 2010 May budget, establishing a personally controlled electronic health record was viewed as an opportunity to facilitate person-centred care, support informed consumer decision making, enhance quality and safety of care, reduce waste and inefficiency, and improve continuity and health outcomes for the recipients of healthcare4. Those providing healthcare can access and contribute data, including records of medications, hospital visits, allergies, vaccinations, pathology results and advanced healthcare directives5. Anticipated benefits of a personally controlled electronic health record are improved availability of key health information in an emergency and strengthened care connectivity5. These benefits and potentially improved healthcare for persons of all ages could be realised if the record is contemporary and readily accessible.
As highlighted by the Royal Commission, those living in residential aged care are a population cohort that typically has many health issues and comorbidities1. The assumption that those in residential aged care would benefit greatly from having current health information available in the MHR through seamless data integration is reasonable. In fact, the Royal Commission came to this conclusion and proposed the use of MHR in its final report through Recommendation 68 (Universal adoption by the aged care sector of digital technology and My Health Record)1. This recommendation requires all aged care providers to use a digital clinical care system (including electronic medication management) that is conformant, interoperable, and kept up to date with the MHR. This is, of course, with the consent of the resident (or their named representative). The report also required this to be achieved by 1 July 2022. In the Australian Government response to the May 2021 final report of the Royal Commission into Aged Care Quality and Safety6, the government accepted this recommendation and supported the adoption of the MHR by June 2023, citing that interoperability would be introduced in stages to enable data exchange, including to the MHR. It is starting to become evident, however, that meeting even this second target date may not be possible.
The current reality within the residential aged care sector is unprecedented. The Royal Commission reported on chronic staff shortages and how often staff are only able to deliver basic care with little time to provide additional support to residents. The ongoing effects of the pandemic has had a further negative impact on not only staff time availability, with the additional staff workload required to ensure safe infection prevention and control practices but also because of staff shortages due to illness or staff being furloughed. There are other changes occurring within the sector currently such as preparation for the residential aged care funding reform with the Australian National Aged Care Classification (AN-ACC) scheduled to replace the Aged Care Funding Instrument (ACFI) from 1 October 20227. Additionally, many residential aged care facilities full accreditation site visits by the Aged Care Quality and Safety Commission (ACQSC) were delayed during the pandemic. The unannounced visits are now occurring again on an increased schedule with the ACQSC attempting to “catch up”. Preparation within the sector is also taking place for the introduction of the Aged Care Star Rating system to be implemented by the end of 20228. While all the changes and initiatives are largely welcomed, it does require time for staff to perform them, and clearly demonstrates that the capacity for residential aged care staff timewise to directly or indirectly enter data into the MHR is non-existent.
At recent conferences, including the 4th Annual Aged Care Tech Forum and the Information Technology Across Care (ITAC2022) conference, there have been presentations outlining the progress that is beginning for information technology change within the residential aged care sector9. Funds have been allocated in the last two federal budgets toward developing interoperability between aged care digital clinical systems and the MHR and the use of electronic medication charts. Aged care digital clinical software vendors who are currently compliant for digital integration have been named and together they represent a major proportion of clinical systems in use within residential aged care. Moving forward there are several key initiatives happening concurrently – one being the Department of Health and Aged Care (DoHAC) consulting with residential aged care stakeholders to develop an aged care data strategy. The Australian Digital Health Agency are also working with vendors, the Digital Health CRC, and DoHAC on interoperability following a two-year program of work that has been developed.
It is starting to become evident that the June 2023 goal for interoperability and use of the MHR in residential aged care was quite optimistic, however there is now a sense that there is movement and change is happening. Attention is being focussed on attaining the goal of interoperability which will improve digitalisation within residential aged care immensely. Interoperability will allow effortless digital communication between not only MHR but also with local hospitals and medical practitioners through their practice software. It could then be extended to pharmacies and pathology laboratories. Staff in residential aged care would benefit immensely from having easy access to the full medical digital record for the resident, allowing them the time to do what they need to do, take care of the resident.
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Bernie Zipf RN GradDipNursing (Geront) MNursing (Geront), July 2022