Harnessing data for increased quality and safety of aged care

Royal Commission key findings

Data and information have been common themes throughout the Royal Commission into Aged Care Quality and Safety.

Providers and other healthcare organisations have not been able to access the right data in a timely manner to support and inform quality care, while consumers are unable to find relevant information to support their access to care services.

Aged care, like most care provider sectors, suffers from a surplus of data and a lack of ability to derive insights from that data. The majority of aged care providers using digital technologies use a combination of siloed systems that don’t support the use of data to enhance quality of care. This is compounded by the challenge that older Australians often have a primary care provider who is an independent general practitioner, and will maintain their own clinical records for their patients, which are “integrated” with the aged care facility’s records through a combination of photocopier, fax machine and/or copy/paste of information into the facility’s records.

Barriers to digital transformation in aged care

Past financial barriers to reliable technology now increasingly surmountable.

The financial landscape has contributed to this picture; with tight operational budgets and profit margins under pressure, providers often don’t feel that they are able to make investments in technology. There is also a perception that the aged care workforce will not adapt to digital workflows and documentation. However, past barriers to the implementation and use of digital solutions in aged care, are increasingly surmountable as:

The cost of appropriate end user devices continues to fall

More services being offered on a subscription basis thereby reducing capital costs

Workforce is increasingly digitally literate

Network connectivity is – in most parts of Australia – increasingly ubiquitous and affordable.

Improving the uptake of digital care management systems

Improving the availability of reliable and relevant clinical information to deliver better outcomes for older Australians.

As these barriers diminish, it is time to focus on improving the availability of reliable and relevant clinical information, as it is paramount to the ability of care workers and clinical staff to deliver positive and beneficial experiences and services to older Australians For example, having access to this information can protect against unwanted consequences related to the mismanagement of medication and maltreatment of residents.¹ Likewise, transitions between care settings for older Australians gives rise to heightened clinical safety risks, with sharing of current and relevant clinical information mitigating these risks.

The transition of older Australians from residential aged care to acute care hospitals, and then returning to residential aged care, is one of the key pain points, which has the ability to reduce the risk to the older person through the use of technology. However, aged care is a sector that is still highly dependent on paper for recording information as well as outdated mechanisms for sharing information, leading to delays, potential errors, and critical gaps in delivering quality care in both settings. The Royal Commission has recognised this with one of the key recommendations being that there should be universal adoption of digital care management systems within the aged care sector by 1 July 2022, and that these care records should interoperate with the My Health Record system (Recommendation 68).

Footnote:

1. Royal Commission into Aged Care Quality and Safety 2019. Statement of Johanna Westbrook. Canberra

Supporting transparency in aged care

The need for greater transparency in aged care was evident throughout the Royal Commission.

Data is key to improving transparency across several areas. In 2017, KPMG published our international research - Through the looking glass - A practical path to improving healthcare through transparency – which examined what was needed to create transparency in health care.

While the same research hasn’t been done at this stage for aged care, it’s easy to draw relevant corollaries. Key areas identified that are applicable to the aged care sector are outlined below:

Healthcare transparency (a) versus application to aged care (b).

1a.

Quality of healthcare: transparency of provider level performance measures, especially the quality of outcomes and processes.

1b.

Quality of care: transparency of provider level performance measures, especially the quality of outcomes and processes.

2a.

Patient experience: patient perceptions of their healthcare experience and outcomes.

2b.

Experience of Older Australians and their families: perceptions of their care experience and outcomes.

3a.

Finance: price and payments transparency, and the public nature of accounts for healthcare organisations.

3b.

Finance: price and payments transparency, and the public nature of accounts for providers.

4a.

Governance: open decision making, rights and responsibilities, resource allocation, assurance processes and accountability mechanisms.

4b.

Governance: open decision making, rights and responsibilities, resource allocation, assurance processes and accountability mechanisms.

5a.

Personal healthcare data: access, ownership, and safeguarding of patients’ individual health data.

5b.

Personal healthcare data: access, ownership, and safeguarding of older Australian’s individual health/care data.

6a.

Communication of healthcare data: the extent to which all the above is presented in an accessible, reliable and useful way to all relevant stakeholders.

6b.

Communication of care and healthcare data: the extent to which all the above is presented in an accessible, reliable and useful way to all relevant stakeholders.

Data is the key to improving transparency

For each of the six areas identified, data is the key to improving better transparency. Notably, adding an identifier within the National Minimum Data Sets to show whether a person is receiving aged care services and the type of those services is a huge step towards this (Recommendation 67). However, capturing this information shouldn’t be an additional data capture and reporting impost, but instead must be integrated within the workflows associated with providing care. This will require a significant shift in focus for the developers of systems that support care delivery, and once again, requires providers to have a clear technology strategy that enables integration of systems within their organisations and with the broader ecosystem.

Adopting technologies that have been shown to improve quality while also increasing efficiencies, such as electronic medication management solutions, help release staff from low value administrative tasks and direct their focus to the individual. In addition, utilising the national digital health infrastructure – not just My Health Record but secure messaging and electronic prescriptions for example, will contribute to increasing digitisation across the sector, with the resulting opportunity to improve transparency.

Where to next for aged care in Australia

Improving transparency in aged care in seven steps.

We have identified seven ways transparency can be improved in aged care through the use of data and technology:

A consistent strategy

Take the lead from innovative providers

Measure what matters to patients, residents and their families

Fewer measures, more meaningful data

Provide personalised price transparency

A give-and-take approach to safeguarding patient data

Promote independent narratives to improve understanding

You can read more about actioning these steps in our paper

Through the looking glass

A practical path to improving healthcare through transparency

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