Aged care and eHealth: the state of play

Written by Michael Wong on .

Pulse+IT spoke to aged care consultant Jennifer Dunne about where the industry is currently positioned with eHealth capability, and where it needs to go.

Ms Dunne’s background is in project management in health, social services and banking. Before she started her consultancy, she worked at iCareHealth as the program manager for eHealth.

Pulse+IT: What’s the state of play with the PCEHR system in the aged care sector?

JENNIFER DUNNE: The aged care vendor panel is a really good opportunity for the companies who got on to it to build the technology [that will link the sector to the PCEHR].

The technology is pretty good, but it hasn’t been focused on aged care. The software [development] is really focused on the acute sector and the GP sector.

I’m a big advocate for NEHTA and the way they’ve carried out their promises. There are obviously gaps – things that haven’t worked out as well as they expected them to. But I still think, overall, their approach was the right one.

The one big issue I see is that they are trying to have a one-product-fits-all, and it doesn’t quite work that way.

Pulse+IT: What do developers need to do to address that?

JD: Part of the problem is the software vendors, and part of it is NEHTA. A lot of the vendors have decided that it’s not their problem, but it is.

The HI Service part of it, I think everybody should just get over it and do it. The contract included, as an example, the provision of receiving a discharge summary, publishing an event summary, publishing a shared health summary and point-to-point secure messaging.

It’s really good for aged care facilities to receive a discharge summary, but what NEHTA haven’t been able to build yet is the ability for an aged care facility to send a discharge summary.

That’s an area that NEHTA haven’t really thought about how it would work in the aged care sector. Because you are sending people from the aged care sector to the acute sector quite regularly, you want to be able to send information.

This is known as a transfer form in the industry, and it’s not going to have the same information as a discharge summary, such as pathology results.

The ability to pick up information and send it to the hospital, when you’re putting someone in the back of an ambulance, is huge. And that is still not on NEHTA’s service list.

If you look at the event summary and the shared health summary – again, there are sections within those that are not relevant to the aged care sector.

The feedback I had from iCareHealth’s early adopters was that generating a shared health summary within a facility would be unlikely.

They would be interested to see what a GP would provide – so reading it would be of interest to them, but they did not think that generating a shared health summary would add value.

With the event summary, there is no clinical rationale behind what constitutes an event. So in an aged care setting, an event could be something like bed-wetting or abuse or serious falls or a heart attack. So there’s no guideline to say what is clinically relevant as an event.

I can understand that from NEHTA’s perspective – they probably want to see how it goes over the next 12 to 24 months.

Early adopters would only create an event when they knew that it was going to be clinically relevant to somebody else.

Software vendors need to take responsibility for education and change management, and work with early adopters, because it is the aged care industry that knows the answers to these questions.

Pulse+IT: Is the backward flow of information from NEHTA and the vendors panel to the industry good enough, or does that need to be improved?

JD: It needs to be hugely improved – I imagine it’s not happening at all yet. There are a lot of industry forums happening throughout the year, and there’s an opportunity to use those. But they’re not the only way to do it.

There was a lot of money that went to McKinsey and PricewaterhouseCoopers and others about the huge change program, and I’m not seeing [results from] that in aged care yet.

iCareHealth did not have a lot of customers calling us, saying, “When’s it coming? What do we need to do to get ready?”

So no excitement had been generated by industry. I think NEHTA, McKinsey, and PricewaterhouseCoopers should have done an aged care campaign that got a lot of information out to industry, got them excited, invigorated, and getting ready for the software.

There’s quite a lot that organisations have to do before they can start using the software. The software comes later, to my mind.

Pulse+IT: Does aged care have enough money for eHealth?

JD: Technology-wise, yes. If you can afford a technology solution today, you’re probably not going to be pay a lot more money to have a PCEHR stack in your software.

On the change management side, it’s more difficult, because you don’t have project or change managers in full-time roles in most aged care organisations – certainly not the smaller end. Then you’re relying on paying your software vendor to provide professional services to come in and do it for you, or finding a contractor to do it.

It’s a good six months’ work for a person in an aged care organisation to get their organisation ready and the project up and running – and that could be 12 months if it’s a really big organisation.

Pulse+IT: Does the aged care industry see the value of eHealth?

JD: It has taken a while. I think they are getting there. The problem with residential aged care is that the person you are looking after is in your facility, so that any information about that person once they are in your facility is in your control.

So the areas where you provide a lot more benefit is pre-admission, and then information about a person when they go to the acute sector or perhaps to a specialist if they go outside and come back.

I think the aged care sector at large struggled to see the value of eHealth for quite a while.

There are approximately 80,000 beds which do not have an IT solution in place. So about 50 per cent of aged care beds are still working on a paper-based solution.

Pulse+IT: Do nurses working in aged care have enough knowledge of eHealth?

JD: I guess if you are following industry-body information or if you’re serviced by an aged care software vendor, you’d be receiving some information. I think you’d have a decent enough understanding of what eHealth is, but not what it means.

So unless somebody has taken the time to sit down and have a conversation with you about what it means, go through the benefits and get your feedback – and unless you can adapt because of that – then, no, I don’t think you can understand what it means.

Pulse+IT: What about secure messaging in aged care?

JD: I don’t know of any aged care software vendors who have actually gone live with SMD yet.

My gut feeling is that most aged care software vendors will go to a third party such as Argus or HealthLink. There’s a really good argument for that – the work has already been done, it will be maintained.

I imagine that SMD will be legislated at some point, but there has to be a pragmatic view on that. It won’t happen overnight.

Pulse+IT: If you had the power to make three things happen in eHealth for aged care, what would they be?

JD: The first two things are going to be in change, and the last is going to be in technology.

The first one would be a national marketing campaign for aged care. And this isn’t just for people working in aged care, or the software providers looking after them, or the aged care providers. It would be for people starting to age in the community and, almost more importantly, to their family members.

And that campaign can be done through GPs, aged care organisations, Medicare Locals, as an example. There’s tons of opportunity for that.

Number two has got to be funding for aged care software organisations for change. Let’s KPI them so we know they’re definitely spending the money in the right way – with this funding they would be responsible for educating their customers, just like their customers are responsible for educating residents and family members.

The last is a proper review in the aged care space, and making sure there is a pipeline of work that has in it aged care-specific technology documents coming through over the next 12-24 months.

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