Interview: David Cooke, NEC Australia

In late 2009, the two peak bodies for the aged care industry – Aged Care Association Australia (ACAA), which represents the private aged care sector, and Aged & Community Services Australia (ACSA), which covers charitable and not-for-profit providers – got together to set up a council to help improve the use of IT in the industry and navigate national issues such as electronic health record and eHealth.

Both organisations saw the immediate and long-term benefits of using IT to improve productivity and quality of care for aged care residents. Due to a number of reasons – mostly cost, but also a little reluctance on the part of the industry – the uptake of IT has been slow in this quite conservative sector.

The Aged Care Industry IT Council (ACIITC) has since made a number of recommendations to change this, including investigating the use of cloud computing on a sector-specific basis. The cloud offers many benefits for aged care, most obviously its lower cost base than traditional on-premise IT systems, and it was thought there would be productivity improvements in a sector which survives on very tight margins.

According to David Cooke, head of health and aged care solutions with NEC Australia, the council identified a trend towards cloud computing and thought it would make sense to have a cloud capability within aged care that had a level of endorsement from the sector. So ACAA and ACSA put out an expression of interest to companies capable of developing a sector-specific cloud offering.

NEC was subsequently endorsed as the industry partner of cloud computing, and in July 2010, the NEC cloud platform was launched to the industry with the endorsement of both ACSA and ACAA. Several aged care software vendors moved to cloud-delivered offerings, including ion.my.care, Autumncare, iCare, Leecare, Gold Care, Health Metrics and Clintel.

The subsequent 18 months have been spent more in an education and confidence-building phase than any great progress, Mr Cooke says. “If you consider the aged care industry on a continuum of technology and business capability, there are some providers which are very advanced in IT and they have very advanced services within their own organisations – an example is Sundale in Queensland which has a number of different locations and a very sophisticated private cloud IT infrastructure.

“At the other extreme is the relatively small individual care providers that have almost no IT. So the thinking was that we would bring those in the middle to the lower level of capability on this journey, and we have proceeded to do that over the past 18 months. In parallel, there has been a significant effort by the independent software vendors, particularly the clinical system providers, to bring their offerings into a suitable form for offering over a network.”

Consistent with more general experience, there still hasn't been a great uptake of the service beyond early adopters, but this is mainly due to the necessity of building up confidence in the cloud in all sectors, not just aged care. Mr Cooke says the cloud trend got a kick when Microsoft began delivering its product over the cloud and Google apps started getting traction in the commercial market. “I think there has been a building of confidence in cloud-delivered services over the past two years which perhaps wasn't there when we first launched this,” he says.

“It has been a process of education in terms of an alternative IT offering. If you consider that traditionally a care provider would have had a balance sheet with IT assets, an operating expense with maybe two or three staff who they fought hard to recruit and then keep – we had to explain to them that there is an alternative model and what it looked like. They had to be at the right stage of their depreciation cycle to think – we do need to do a refresh, we might look at this.”

Several of the software vendors who have provided their product to the cloud offering had already started adapting their products to be cloud-enabled, including Leecare and Clintel, and most now offer their clinical systems in some form of cloud or hosted system, Mr Cooke says. This changes the game for those providers who do not yet have a clinical system to deliver productivity and e-health integration roadmaps for their organisations, he says.

“There are now a number of mature solutions. It is now more about is the organisation ready for the change, is it ready to consider a different model? Some care providers are actually looking at other applications to go to the cloud first, such as hosted voice, as a lot of local companies are identifying potential savings, particularly if they have to do a refresh of their traditional PABX. NEC is in a good position to do an on-premise or a cloud-based PABX depending on their individual circumstances.”

Initially NEC and the council envisaged providing a tailored service to the industry, whereby aged care providers would consult with NEC on their needs and NEC would provide a solution. However, it has since become a trend that providers are first consulting software vendors about a business need or actual product, which then turns into a discussion of whether it should be offered on-premise or through the cloud.

“That is probably a slight difference to how we thought it would work 18 months ago,” Mr Cooke says. “We do get contacted many times a month by aged care providers wanting a more holistic view of what they are doing. They say they have this infrastructure, we've now acquired this facility or we want to network this, so it may come from what they are trying to do as a business and that guides what they might consider as a technology pathway. It has become much more consultative relationship.

“We probably have less than 15 providers using the service, and that is partly because we've successfully explained the benefits of the cloud and they've gone and put one in themselves! So we think it is predominantly an education campaign for at least the first 12 months but as I say we are constantly getting requests for a whole of technology review, of which one element might be the cloud.”

Clinical software is the most popular cloud application on the NEC network, partly because that was what the council identified as a missing piece in the industry's IT adoption, Mr Cooke says. “The more generic needs were generally being met but the requirements of aged care providers are unique in Australia due to the specific Medicare eHealth and funding process.”

He believes there are no great concerns within the industry about the cloud – they have already bought on to the logic that the application itself is the key and where it comes from is not so important, he says. “Some quite sophisticated operators are happy to operate over the cloud, but overlaid on this is the continued talk of the NBN roll-out. If connectivity is a concern now, which it would be for some providers in the more remote areas, they know that eventually they will have good connectivity and therefore the cloud should be considered in their plans, possibly not this year but perhaps next year.”

The aged care industry is also eagerly awaiting the federal government's response to a report into the industry by the Productivity Commission. For at least two years now investment in aged care has been at an all-time low, whether it be buying new bed licences, new premises or new technology, as the government decides how to reform the way aged care is delivered and funded.

At present, it is funded through the Aged Care Funding Instrument (ACFI), a rather unwieldy system that is nonetheless far superior to the way the industry was funded in the past. It is widely expected that the Productivity Commission's recommendation that aged care residents pay more for their care through accommodation bonds will be accepted. Once that occurs, the business environment will be more certain and the industry will then be able to look at long and short-term investment, including in IT.

In the meantime, the application cloud offering is still out there for the industry to take advantage of, including wider sets of solutions to business needs such as voice, video and telehealth. NEC is broadening what it offers to the industry through the cloud besides software applications. One of the company's big interests is telehealth, and with funding from the government for telehealth in aged care facilities, it is a quickly developing field. At the Information Technology for Aged Care (ITAC) conference, being held on April 19 and 20 in Melbourne, NEC will be discussing its cloud, telehealth and voice offerings.

“For smaller facilities, telecoms costs are possibly not that significant, but what I think is happening is we are hitting a change between the type of PABX they might have traditionally has on-premise and what operators might need to interconnect to expanded multi-location facilities,:” Mr Cooke says.

“They may have had PABX in for maybe 12 years or so and it's time for a refresh, so they are considering do we go IP; do we go on-premise; do we go unified communication; and finally do we look to put it in the cloud.

“The trend that's emerging is the upside from all these productivity gains in terms of higher, faster, quicker, more accurate, more responsive systems.”

Posted in Australian eHealth

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