Health Information Manager opportunities in the digital transformation of the aged care sector // Janine Carter

Health Information Manager opportunities in the digital transformation of the aged care sector

Janine Carter

Back in the late 1980s I began my health information management career in the public aged care sector. After several years working in various health information management, information technology and project management roles in acute health, I have recently returned to the not-for-profit aged care sector at an exciting time, where the skills of a Health Information Manager (HIM) can contribute to supporting safe and effective care as technology develops into a key component of clinical practice.

The value of data driven business in aged care has become more evident through the recent Royal Commission into Aged Care Quality and Safety (the Royal Commission), which has not only relied on verbal accounts from residents and their families and clinicians, but also historical data from manual and electronic medical, incident and complaints records. Data from aged care providers as well as the assessments stored on the My Aged Care portal, General Practitioner (GP) records and other health professional records have been referenced to evaluate the delivery of care and the flow of information throughout the aged care journey in the growing residential and community sectors.

The Royal Commission has made a number of observations about the quality and accessibility of data and information and the impact it has on care delivery. The Royal Commission Interim Report noted that ‘The person’s information does not always make its way from the assessment services to their My Aged Care client record, resulting in inconsistent screening or multiple unnecessary assessments’ (2019a). The lack of integration between My Aged Care records and aged care clinical applications has led to fragmented records that can cause difficulties in the flow of information from the aged care assessment process through to admission into community or residential services. In addition, evidence given during the Royal Commission includes statements such as ‘Documentary assessment and monitoring was unsystematic, inaccurate and did not provide a clear picture of the care required or being given’ (2019b). As HIMs, we need to advocate for and facilitate a move to more integrated records across the continuum of care in the aged care sector. We also need to push for effective clinical documentation within aged care facilities through policies and best practice information systems designed in collaboration with clinical staff.

Aged care providers manage a range of contracted care providers as well as their own skilled and unskilled workforce, making information management more complex to design and govern. HIMs can assist aged care providers in ensuring a single, integrated record can be accessed by all employed and contracted care providers, including GPs, geriatricians, nurses, personal carers, lifestyle assistants, pastoral carers and a wide range of allied health providers. Having experience with forms and system design, clinical workflow, information management processes and system administration is a perfect foundation for implementing best practice information governance in aged care.

The provision of care by GPs, who are not usually employed by aged care providers, often requires documentation in both the facility medical record and their practice management software, creating duplication and inefficiency as well as risk of gaps in either or both records. Giving evidence at the Royal Commission, Dr Tay, a GP, states, ‘I think you highlight an issue in relation to clinical notes for visiting GPs. We, at the moment, have an issue around duplication’ (2019b). In some cases, handwritten GP notes are scanned and uploaded and/or transcribed by a nurse into the resident’s clinical record, creating risk to clinical care and legal compliance.

Similarly, medications are recorded in the GP practice software and the aged care provider record, either in an electronic or paper-based medication chart. With the change in legislation supporting paperless scripts and increased integration in electronic medication systems, there are significant opportunities to streamline the medication management process and improve medication safety and efficiency. This is an exciting change that will allow seamless integration between GPs, pharmacies and aged care providers to improve efficiency and, more importantly, resident safety. The expertise of a HIM is a perfect fit for ensuring this progressive change is managed in a way that provides safe, efficient and legally compliant medication workflow from prescription to dispensing and administration.

The Aged Care Industry Information Technology (IT) Council is focused on research into the use of technology in the aged care sector and the implementation of innovative solutions to improve health and safety outcomes, such as artificial intelligence, sensor devices and closed-loop medication management solutions. The Aged Care Industry IT Council digital roadmap (2017) looks at a plan for the short, medium and long term strategies to strengthen the use of technology in the aged care residential and community sectors, including the importance of integrated systems These strategies provide exciting opportunities for HIMs to work actively with other clinical and technical professionals to improve the adoption and use of technology.

The process of adopting and use of technology is not easy, as noted by Barnett et al. (2019):

‘Sweeping aged care reform coupled with transformation and global acceptance of the internet has resulted in Government and Industry struggling to comprehend and adapt to the change brought on by the ubiquitous growth of data and information.’ While it grapples with technical infrastructure and clinical documentation challenges, the aged care sector is continuing to adopt electronic medical record software as well as smart technologies such as sensor and safety devices and clinical assessment and monitoring apps, transforming the way information is managed within facilities and between the aged, acute and community sectors. Although this is a positive venture and has significant potential to improve resident care, it requires strong change management, governance and expertise to ensure the benefits are realised. It also requires a strategic approach to ensure systems are implemented in a structured and integrated way.

In addition, the value of a good digitisation and information governance framework and robust systems is becoming clearer as privacy and data breach legislation continues to evolve and data breaches themselves become more prevalent in health. The pressure of clinical and financial accountability grows as organisations increase efficiency to reduce costs. Aged care publications are increasingly reporting on the need for better governance and design and it is important for HIMs to play an active role in that process. Nick Lambrou (2020) noted in the Australian Ageing Agenda that:

‘Unfortunately, the legacy systems that many aged care providers still use have poor design with little or no connectivity. It demands a framework that can provide the right information at the right time by unlocking and analysing all data.’ While the article is focused on technical connectivity, the implications for information flow are equally relevant.

HIMs can contribute to the aged care sector by applying a similar skillset as those applied in an acute or community service, but the increased adoption of technology makes it the perfect time to be involved in the sector. HIMs have the required skills to ensure that data governance is considered as these technologies expand in the aged care sector and that effective information flow is supported within and across systems and services through integration and data standards.

Involving HIMs in clinical software procurement ensures the evaluation is based on more than a technical perspective, resulting in more well-rounded and robust systems. Similarly, as aged care clinical software becomes more prevalent, HIMs can utilise their ‘forms’ design skills to contribute to software user interface design, ensuring information can be collected in a way that supports clinical practice by creating logical workflows, using structured and standardised responses where appropriate, applying logic within and between fields for example. HIMs can also represent aged care providers on customer advisory boards for software and other technology companies to ensure efficient design and workflow and legal compliance are considered with software development.

Despite International Classification of Diseases coding generally not being used in the aged care sector, the ability to adopt diagnostic code sets and provide mapping to the Aged Care Funding Instrument (ACFI) is a natural extension of the coding competency (ACFI is the current funding tool in the Australian aged care sector). Understanding diagnosis coding systems, funding models and casemix can be applied in the aged care sector to ensure quality diagnostic data can be collected and reported on in a meaningful way. The clinical coding skillset also provides insight into clinical workflow and disease management as well as having the clinical vocabulary to converse with clinicians in their language.

This level of understanding facilitates decision making associated with information management, including what information is required, who needs to access it and how it needs to be presented. It allows HIMs to confidently evaluate how a clinical information system needs to be implemented in many environments, whether it is aged care, critical care or obstetric services. As the aged care industry moves away from the current ACFI funding model, HIMs can advise on how data can be used to support the new funding instrument and what the impact will be on documentation and data collection. The Department of Health is conducting trials of the Australian National Aged Care Classification (AN-ACC) funding assessment tool across Australian aged care facilities as a potential replacement for ACFI.

HIMs can make a significant contribution to policies and procedures associated with information governance, including retention, storage and destruction of paper and electronic records, privacy policies and education, data quality audits, etc. As more information is being collected and systems become more complex, it is critical that aged care providers have well-structured processes that facilitate effective data collection, retention and retrieval to meet clinical and legal requirements.

As HIMs have extensive knowledge of the data within their organisations, they can play an integral role in defining, analysing and writing reports to support clinical decision making, evaluate outcomes and plan future services. Although the reporting requirements will vary from the acute sector, aged care providers rely on information to identify clinical deterioration and demonstrate compliance with aged care standards. This is becoming increasingly important as aged care providers are required to provide evidence of care given and justification for treatments, such as antimicrobial orders, chemical or physical restraint, etc. HIMs can ensure this information is readily available and monitored to identify anomalies or trends.

There are many opportunities for HIMs in the aged care sector as information systems and smart technologies begin to transform the way data is collected and managed. The skillsets of HIMs can be applied to a range of roles within the sector and can have a positive impact on information governance to support safe and effective clinical care through collaboration with clinical and technical teams. It is an interesting, challenging and rewarding time to work in the sector with opportunities to drive some of the strategic change around information management that will come from the Royal Commission as well as from new technologies, standards and funding tools.

References

Aged Care Industry Information Technology Council (2017). Technology Roadmap for Aged Care in Australia. Available at: http://aciitc.com.au/wp-content/uploads/2017/06/ACIITC_ TechnologyRoadmap_2017.pdf (accessed 14 August 2020).

Barnett K, Livingstone A, Margelis G, Tomlins G and Young R (December 2019) Aged & Community Sector Technology & Innovative Practice: A report on what the research and evidence is indicating. Aged Care Industry Information Technology Council. Available at https:// www.aciitc.com.au/

Lambrou N (2020). Can you demonstrate compliance? Australian Ageing Agenda. Available at: https://www.australianageingagenda. com.au/technology/can-you-demonstrate-compliance/ (accessed 15 March 2020).

Royal Commission into Aged Care Quality and Safety (2019a). Royal Commission into Aged Care Quality and Safety Interim Report: Neglect. Available at: https://agedcare.royalcommission.gov.au/publications/ interim-report (accessed 14 August 2020).

Royal Commission into Aged Care Quality and Safety (2019b). Statement of Dr Eric Tay. Auscript Australasia Pty Ltd. Transcript of Proceedings in the Matter of the Royal Commission into Aged Care Quality and Safety. Available at: https://agedcare.royalcommission. gov.au/sites/default/files/2019-12/transcript-10-july-2019.pdf (accessed 14 August 2020).

Janine Carter BAppSc(MRA), Dip(ProjMan), GradDip(Admin) Clinical Systems Advisor, Uniting Agewell Email: jcarter3@unitingagewell.org