The aged care sector is currently undergoing changes that are placing increased focus on quality of care and reporting of clinical outcomes. This article examines the role of digital health solutions in the aged care sector, and the policy settings that could be considered in order to maximise benefits.
Approximately 90% of residential aged care beds are managed using digital information systems, including software that assists in the management of clinical information, medication and resident management. About 90% of beds are covered by clinical software, and 40% for medication management software.
The key drivers for uptake of digital solutions in aged care have been government policy and funding requirements. In 2005, the Commonwealth implemented a range of initiatives, including infrastructure funding for upgrades to residential aged care facilities. Many facilities used this funding of around $1,000 per bed to invest in digitisation and most have prioritised software systems that help them with accreditation reporting and maximise their Aged Care Funding Instrument (ACFI) funding.
Digitisation has a key role in helping to address some key issues in the sector:
- Over 90% of aged care residents have at least one medication-related problem, with an average of 3.2 problems per person. Up to 17% of unplanned hospital admissions from aged care facilities are due to inappropriate medications.
- Issues with the quality of care are becoming increasingly apparent, as emerging through the Royal Commission into Aged Care Quality and Safety. This will lead to an increased focus on enforcing standards and accreditation, transparency on how providers are performing against these standards, and the need for providers to report meaningfully and accurately against these measures. As the incoming accreditation standards have an increased focus on consumer choice and respecting resident preferences, compliance and transparency around these measures will also become more important.
- Transitions of care are high risk and inefficient without transfer of good quality information both for transition from community into the aged care facility, and for planned and emergency hospital admissions.
The role of digital technology
As elsewhere in health sector, technology has a role to play, alongside policy and funding enablers, in supporting providers to deliver safer and higher quality care to consumers. There are some key ways for digital health to support quality care and sustainability of the sector:
- Wider use of electronic medication management systems can help to reduce errors and harm to residents, through accurately documenting what medications are prescribed, and how and when they are administered to the resident. Connecting medication information digitally between aged care facilities, GPs and pharmacy would significantly help to improve medication safety, especially across transitions of care, such as planned or emergency hospital admissions.
- Digital records have a key role to play in supporting how care is provided and driving compliance and auditing against accreditation standards. Once aged care facilities have high quality, codified data, it can enable software systems to provide alert and decision support for members of the care team, enabling better informed decision making.
- Digital information systems can also facilitate consumer-directed care, by ensuring that resident and family preferences are recorded, transparent, and acted upon by various members of the care team.
- Higher quality data will also be a key driver in producing meaningful, transparent and robust reporting. Capturing and reporting data as a by-product of clinical and administrative workflows will enhance data quality and minimise burden of compliance.
- As an increasing proportion of low needs care is delivered in the home, over time the service needs in residential aged care will become increasingly clinically complex, and will require more clinically sophisticated information systems to manage these care needs. These systems will need to evolve to enable management and reporting of care outcomes and adherence with care pathways and best practice medication management.
- Digital consumer engagement tools will enable resident information to be accessible by family and carers through portals and apps, and will be an important engagement mechanism for residents and their families.
Policy enablers for benefits realisation
Adoption of technological tools alone will not drive quality in aged care. In order for benefits to be realised from digital technology, policy and funding enablers must be in place:
- Aligning aged care accreditation standard reporting requirements with quality measures: Reporting processes for compliance with standards will drive investment and activity by aged care providers, including in digital technology and data quality. If accreditation standards reporting requirements align with quality measures, the effectiveness of that reporting will be optimised.
- Aligning funding criteria and claiming information requirements so as to reward aged care providers using quality clinical systems, workflows and data. A key lesson from digital health adoption is to leverage clinical and administrative processes where possible, rather than introduce additional requirements to capture information for a separate purpose. Support change management and transition.
Support change management and transition
Changes to standards, clinical quality requirements and digital systems are likely to require residential aged care providers to undertake organisational and workforce changes. If these changes are to be successfully implemented, providers will need support in transitioning. The pressures on aged care providers and their software providers in 2019-20 due to the incoming standards.