1Service providers have a range of reforms to prioritise why should we put the adoption of interRAI into our top priority list?
interRAI supplies a robust framework for assessment that ensures all important care issues are addressed.
Robust data used in interRAI systems supply the basis of a universal Minimum Data Set for aged care that is integrated into the care delivery process, reducing regulatory reporting burden.
interRAI systems also supply the essential information for multiple internal and external administrative functions so there is a very significant efficiency dividend in adopting it.
2What specific Royal Commission and government reform agendas will the implementation of interRAI assist in addressing?
Recommendation 23: Using quality indicators (QI) for continuous improvement
interRAI systems can produce a wealth of quality measures that would efficiently support the current Government mandatory QI program, and also deliver an expanded set of measures for local use by providers with no additional data burden.
Multiple recommendations relate to issues around shared care and transitions across care settings, that require or involve sharing of information, including:
Recommendation 109: ICT Architecture and investment in technology and infrastructure…
…refers to the better use of data for research and development, including sub-recommendations 1a, ii. data and information that is accessible, complete, accurate and up to date, and iii. standardised systems and tools to make the user experience easy and efficient, with minimal separate portals and a single point of entry for older people and approved providers.
As interRAI systems are built using user friendly observations and tools that meet international standards, and are in widespread use internationally, they would contribute substantially to each of these recommendations.
3Are there examples of conformant software?
Over 40 software vendors hold licences to deliver interRAI systems internationally. At least two of those companies – based internationally - have a presence in the Australian market. Currently, two other Australian vendors that have a presence in both Australia and New Zealand (where interRAI systems are mandated for aged care) have a strong appetite to utilise interRAI systems in Australia.
4What resources are available to train our key personnel?
Staff at The University of Queensland (UQ) have an extensive training history for small to medium scale implementations. Where large scale implementation is required (i.e., at a government level) the team at UQ would be able to support a training agency that develops a training infrastructure for government roll-out. For example, in Canada the Canadian Institute for Health Information has undertaken that role, while in New Zealand the Department of Health has developed this capability. There are also private companies that provide interRAI training internationally.
5What direct benefits will be realised for (a) our Clients and Residents, (b) to our workflows, (c) our services’ interface with other sectors like acute care ?
Clients and residents are assured that their needs are comprehensively assessed at arrival and at regular intervals using an international standard. The assessment, with inbuilt algorithms and triggers, automatically finds problems that require special attention, thus supporting consistent standards of care.
interRAI systems can produce automated profiles that can form the basis of a report to the resident/consumer or family member. This would also supply a status summary and list of active care plans to support routine reporting to residents/consumers and family members.
interRAI systems are designed primarily to support assessment, care planning and review. interRAI assessments and tools form the backbone of clinical / care assessment. Because the data is robust, it can automatically serve local administrative and regulatory reporting - using a collect once, use many times approach. This enables administrative reporting to align with the clinical workflows. It is recommended that interRAI assessments are formally reviewed quarterly, along with the care plan, thus linking reporting with the clinical work cycle. In Australia, the same process can generate the mandatory and other local quality indicators.
Reflecting Aristotle’s belief “the whole is greater than the sum of the parts” the elements of the interRAI systems together form a holistic suite that share common data items and can derive products like scales (e.g., for Activities of Daily Living (ADL), cognitive function, pain). They are built according to the mantra ‘speaking the same language to support continuity of care’. This means that care providers can ‘read’ assessments produced in various settings with ease. UQ is currently building the infrastructure to enable the long-term care version of interRAI to be shared among software platforms using the HL7/FHIR solution.
6Our organisation is very interested about the return on investment from our new implementations. What would you suggest might be some of the areas that we might realise improvements in the quality of care that we provide to older people, as well as efficiencies and cost reduction?
interRAI systems enhance quality of care and support efficient service operation, including in the areas of:
- Structured assessment which ensures that common problems are not overlooked.
- Automated ‘triggers’ calculated from the assessment that highlight (a.) problems that require further in-depth assessment and are likely to improve with targeted interventions, and (b.) the risks for which preventive strategies are known to be effective.
- Integrated scales and risk assessment tools which enable precise monitoring of resident/client health status and that can supply alerts when deterioration is detected.
- interRAI systems generate information that assists in service planning, caseload analysis and quality improvement through automated quality indicators (including many other Quality Indicators (QI) beyond the mandated measures). They utilise the same clinical data as that required for day-to-day care.
If the Department of Health and Ageing (DoHAC) adopted interRAI systems as the basis of the proposed minimum data set (as is the case in many countries), associated data burden would be almost completely eliminated, as the data matches that already utilised in day-to-day care. It is feasible for the Australian National Aged Care Classification (AN-ACC) to be calculated from interRAI data – this would further eliminate data burden.
If all clinical software solutions currently in use embedded the interRAI systems, the software vendors could invest heavily in development of clinical and decision support systems without fear that the data foundation would be changed.
interRAI systems adhere to the necessary ‘collect once, use many times’ principle that is often quoted but rarely applied in aged and community care in Australia. Implementation of this principle leads to significant reduction in data burden, a reduction in data errors, and improved documentation accuracy.
If interRAI systems were utilised for initial screening, eligibility assessment (ACAT), and home care, then data flows would be streamlined across all platforms; status could be compared across settings and along the client/patient journey; and staff in all settings could readily read and understand assessments conducted elsewhere.
7Achieving best practice in our implementations is a critical consideration for our service. What resources and help might be available to our service in achieving best or leading practice? Are there User Groups that we can be involved in and where do we access these?
With few exceptions, to date interRAI systems have enjoyed little uptake in Australia. Therefore, the expertise in training and implementation is limited to experts based within the interRAI Australia Coordinating Centre at UQ. Based on our observations in interRAI nations, governments and other organisations quickly invest in development of support systems, at scale.
8Our procurement is now being focused internationally to ensure we strive for the best in breed of approaches globally. Could you point out some international deployments which we might investigate?
Mature examples include several provinces in Canada, multiple states in the USA (home care), and nationally in New Zealand, Belgium, Switzerland and Finland. interRAI Australia can make introductions either through the interRAI fellowship, government agencies or individual provider organisations. The method of implementation and deployment of sophisticated systems like interRAI is highly dependent on factors such as the structure of the care program, the mechanism of quality control and funding, ownership arrangements, and government priorities. Therefore, approaches vary considerably.
9Why is considering interRAI a better option over other approaches? Is there any contemporary evidence that you can direct us to?
The evidence has been thoroughly and systematically investigated by a research team at UQ according to criteria agreed by the ACIITC and an industry expert panel. The team (who were not interRAI affiliated) produced a report supplying an exhaustive list of the relevant publications up to early 2023. Register your interest to receive a copy of this report by contacting ACIITC firstname.lastname@example.org or www.aciitc.com.au
10I'm a clinician. What is the value of interRAI systems for me?
- Ensures recording of all the essential information to provide care.
- Designed to provide reliable information for you to share with colleagues and other organisations, etc.
Provides accurate risk assessment to support preventive care.
- Includes many composite scales that enable you to monitor your client's progress over time.
- Prompts you to attend to issues that require priority attention, based on evidence.
- Replaces a lot of the fragmented pieces of assessment that you are currently obliged to record.
- Reduces the burden that might be imposed on you by administrators as your clinical information will be used for administrative reporting within and beyond your organisation - removes double data entry.
11 What do CAPs mean in interRAI?
In interRAI, CAPs stand for Clinical Assessment Protocols. They include many domains such as social welfare, cognition and mental health, and functional performance. These protocols are designed to assist assessors in creating strategies to support individuals dealing with complex clinical conditions. They aid assessors in identifying those who may benefit from additional support resources.
12What is an interRAI instrument?
An interRAI instrument is a comprehensive assessment tool used in healthcare and aged care settings to gather detailed information about an individual's health, functional abilities, and social circumstances. These assessments are designed to provide a holistic view of a person's needs and are typically used to inform care planning and decision-making.
The interRAI instruments are standardised and cover various domains such as medical history, cognitive function, mobility, nutrition, and more, depending on the specific version of the instrument. They are typically completed by trained assessors, such as healthcare professionals or social workers, and are used to assess and monitor the needs of individuals in settings like hospitals, long-term care facilities, or community care programs.
The data collected through interRAI assessments helps in tailoring care plans, resource allocation, and evaluating the effectiveness of interventions, ultimately improving the quality of care for individuals in these settings.