Q&A with SomerCare's Damien Malone

Damien Malone is the director of nursing and facility manager at the SomerCare aged care facility on Victoria's Mornington Peninsula. He was also recently elected to the committee of HISA's aged care special interest group. He spoke to Pulse+IT about the challenges for IT in aged care and how technology needs to make life easier, not more complex, for the sector.

Pulse+IT: You are both the director of nursing at SomerCare and the facility manager, which is quite unusual.

Damien Malone: The way we are structured is that I take the overall operational control for the organisation. My role is to be the day-to-day operations person on site to oversee not only the clinical side but also the maintenance, catering, cleaning and other services. I take more of a strategic overview of the day-to-day operations of the business and I have a deputy director of nursing who is more focused on the day to day clinical side of things and providing clinical support on the floor.

I think it's good value having someone with a clinical background in that senior management role. I hear that a lot of places are reverting back to a business manager being the overall manager with a director of nursing or clinical coordinator doing the clinical side, but I think sometimes the risk is that they see the dollars and cents but not the same understanding of the clinical requirements and the implications of the dollar and cents decisions.

Pulse+IT: Tell me about SomerCare.

DM: We are a 100-bed facility with 50 per cent extra services. We have 17 dementia-specific beds and we provide a range of high, low, ageing-in-place and respite care. We are a family-owned business and whilst SomerCare has been around for 10 years, the owners have been in aged care since about 1978, and they are committed to providing excellence in aged care.

Pulse+IT: What sort of clinical or management software do you use?

DM: We moved to SARAH Residential in November last year. SARAH is not hugely publicised, particularly down in Victoria, but it's popular in Queensland and has a following there and in NSW. This is the third site I've used SARAH at.

When the government provided facilities with $1000 per resident in about 2004 to try to encourage IT in aged care, I did a lot of research at the time into the different packages available, and we chose to go with SARAH because it provides an all-business solution. It's residential, maintenance, documentation, quality control, supplier, employee, payroll – it does everything. You can basically run your entire business out of SARAH. It also has the capacity to support independent living units, which is something that was important to other places where I've used it.

SARAH automates and alerts a lot of functions. The main aim is to put the information in once and let the software transfer it to the right spots. A behaviour added to the behaviour chart will trigger an incident report and a progress note where applicable, carry the data to the ACFI and even prompt a compulsory report in the right circumstances. One of the most recent alerts is when people are filling in their bowel charts, if two separate staff in the facility indicate someone has had watery bowels then SARAH automatically generates an alert to the registered nurse, deputy director of nursing and director of nursing that they need to investigate further in case there is a gastro outbreak.

SARAH is currently not web-based so it's different technology to a lot of systems on the market – it's in database form – but every piece of information you put into SARAH you can pull back. That's what I like – I don't like collecting information just for the sake of collecting information. It needs to be easily usable. An example is with our incident and infection reporting. It used to take our quality officer maybe a day to pull all of the information together – we can generate that information in about 30 seconds in SARAH. In the future developments such as SARAH 2, which will be either locally or web hosted, medication management, biometric time keeping for payroll, eHealth integration and advancement of the online claiming gateway will be added to the system along with the other improvements which are made every month. To best of my knowledge they were the first providers to build in the new NPI and systems for monitoring the requirements for the government's recent dementia supplement which has made for easy integration at SomerCare.

Pulse+IT: What about other infrastructure such as a nurse call system?

DM: We are in the process of upgrading our nurse call system at the moment and getting a new one. It's quite an interesting challenge because a lot of people will say theirs will do everything in the world. It's an exciting time in technology and we are all trying to do things better and more efficiently than we have been, but you don't want to buy something that is above everyone's heads and too complex. In saying that you don't want to buy something that will just do for today and doesn't have the potential to grow into tomorrow. One of our biggest challenges in aged care is that we are getting the drip-down technology from hospitals, and we are not getting things that are specifically tailored to what we need and the services we need to provide. Also as residents' care needs increase and access to qualified staff decreases, we need smart systems which will make the work easier and more efficient.

Pulse+IT: What about eHealth and the PCEHR?

DM: Our provider is in the process of interrelating with that so that we can become part of the PCEHR. What we see as important is picking information out of the health record and bringing it down into SARAH so you have that intercommunication between the two systems.

Pulse+IT: What role do you think the HISA aged care SIG plays and what are you going to pursue as an area of interest?

DM: I wanted to be involved in the SIG so that there was a clinical focus. We have a great range of academics and industry, but we need some of the on-the-floor people who will take up technology and use it, representing what works and what doesn't work, because usability is such a key. One of my goals is to bring a working perspective to the group and complement the skills of the other people who are involved.

There are not the same incentives and funding in the aged care sector as in the public health sector, so I think it's important that people get out and share their stories, share the successes and the failures, so that the limited dollars we've got in aged care for IT are being used well. There needs to be a group out there that is influencing the way that technology is being used and providing some feedback to manufacturers and industry to say these are the kinds of things we need to make life easier in the trenches, so to speak.

Pulse+IT: What is the main challenge in terms of applying IT to aged care?

DM: I don't know that you can limit it to one. There are so many competing demands where you can say that IT will have an important benefit. We still have an ageing workforce in aged care so having technology that is easy to use, that doesn't frighten people, is really important. Lots of people are doing great things but we need to make sure we have smart development that makes it easier and not more complex. At the end of the day, you want staff at the bedside to be able to document with one or two presses of a button as opposed to having complex systems that you have to go in and out of all the time.

Nursing staff are in short supply and the capabilities aren't as great as in other industries, so we need to use our technology to prop us up. I'm a firm believer in automating as much as you can and taking human error out as much as you can, whether it be the night call on the reception desk flicking over automatically at five and not relying on someone to press the button, or the front doors to the facility locking themselves at five o'clock and not relying on the RN who is trying to do medications or looking after the person who has had a fall and then having to go and do a manual task. Wherever we implement technology it has to add value, and where we can automate, take the human error out of it. It seems simple but for many facilities these little bits of technology are as important and provide benefits to residents, staff and families as much as a PCEHR will.

Posted in Aged Care

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