Comprehensive geriatric assessments gain importance in health and social care for the elderly. A Belgian health care study has been conducted on the use of the interRAI assessment instruments through online registration on the BelRAI web application. Most of the caregivers considered the instruments to be very useful in order to obtain a holistic view of their clients and to discover unknown ‘blind spots’, risks or problems. However, everybody has to admit that completing the assessment instruments correctly and at a constant high level is crucial in obtaining valuable information and subsequent outcomes. Eliminating the obstacles leading to the collection of poor or inferior data is necessary and has priority on the first level. Information about how to correctly fill out the interRAI assessment instruments must be accessible and nearby at all times. Furthermore, in-service training is a never ending story. In Belgium a web based application has been constructed which allows a multidisciplinary approach during and after the assessment. A unique feature of the Belgian online web application (BelRAI) is that each caregiver completes online instrument parts which are related to their area of expertise. In consequence of each item being filled out by a caregiver as an expert on his/her domain of caregiving, data is more accurate and time investment required from each caregiver is less. In addition to support the use of BelRAI, a second multilingual website (BelRAIWiki) has been constructed as an online manual. Every BelRAI item or outcome is linked to BelRAIWiki, so that every specific detail or explanation caregivers should know is just one click away. No more laborious or time-consuming situations with printed manuals. Because of BelRAIWiki being based on the Wiki concept, authorized researchers or experts are able to adapt the content at all times in order to offer up-to-date information in several languages, support in-service training and perform necessary adaptations to the evolving interRAI instruments and manuals. BelRAIWiki content is also public and accessible in Dutch (http://wiki.belrai.org/nl/) and French (http://wiki.belrai.org/fr/).

1. BelRAI Wiki An elegant assessment support tool for Belgian caregivers using BelRAI Dirk Vanneste - Lucas, KULeuven – Belgium Text version

3. Abstract Comprehensive geriatric assessments gain importance in health and social care for the elderly. A Belgian health care study has been conducted on the use of the interRAI assessment instruments through online registration on the BelRAI web application. Most of the caregivers considered the instruments to be very useful in order to obtain a holistic view of their clients and to discover unknown ‘blind spots’, risks or problems. However, everybody has to admit that completing the assessment instruments correctly and at a constant high level is crucial in obtaining valuable information and subsequent outcomes. Eliminating the obstacles leading to the collection of poor or inferior data is necessary and has priority on the first level. Information about how to correctly fill out the interRAI assessment instruments must be accessible and nearby at all times. Furthermore, in-service training is a never ending story. In Belgium a web based application has been constructed which allows a multidisciplinary approach during and after the assessment. A unique feature of the Belgian online web application (BelRAI) is that each caregiver completes online instrument parts which are related to their area of expertise. In consequence of each item being filled out by a caregiver as an expert on his/her domain of caregiving, data is more accurate and time investment required from each caregiver is less. In addition to support the use of BelRAI, a second multilingual website (BelRAIWiki) has been constructed as an online manual. Every BelRAI item or outcome is linked to BelRAIWiki, so that every specific detail or explanation caregivers should know is just one click away. No more laborious or time-consuming situations with printed manuals. Because of BelRAIWiki being based on the Wiki concept, authorized researchers or experts are able to adapt the content at all times in order to offer up-to-date information in several languages, support in-service training and perform necessary adaptations to the evolving interRAI instruments and manuals. BelRAIWiki content is also public and accessible in Dutch (http://wiki.belrai.org/nl/) and French (http://wiki.belrai.org/fr/).

4. Interface project - Focus 4 diverse instruments Technical group (prototype) HC and LTCF setting

5. Interface project - Focus At the beginning of the 2000s, we came to the conclusion that the scale used for measurement of dependence in the elderly showed several shortcomings for instance: a non-holistic view of the dependent elderly resulting in inadequate data collection, lack of feedback to caregivers, lack of a common language, insufficient support of the definition of an adequate care plan and insufficient improvement of multidisciplinarity and care continuity. After prior investigation (Qualidem), a work group decided to further investigate 4 assessment instruments selected from a list of 41, including RAI, in order to meet the objectives set by the work group. This interuniversity investigation called “INTERFACE” runs from 2003 up to the end of 2005 and includes testing of a web application prototype for the registration and processing of information on care needs of elderly patients, based on a national random sample of nursing homes, outpatient clinics, geriatric services, … focuses also on 4 instruments (RAI, Aggir, Pathos, Socios, …) in order to find out which instrument is most appropriate for utilization in Belgium.

6. Interface project - Conclusions RAI most added value Improves quality of care Stimulates cooperation

7. Interface project - Conclusions In the end we can conclude that RAI meets best the determined objectives and that it offers a surplus value in the domain of care quality control and enhances integrated care, since information is transferable between the different instruments as individuals shift from service type or care setting. Another benefit is the creation of a common language among professionals working with elderly or chronically ill persons in health and social care.

8. BelRAI project - Focus Adapts assessment instruments to Belgian context Online registration interRAI data Research implementation feasibility Real life test cases

9. BelRAI project – Focus At the beginning of 2006, a feasibility study concerning the implementation of RAI in Belgium was started by an interuniversity team. The objectiveswere: analyzing of the conditions for implementation, starting up of a pilot project for a fully automized, uniform and web-based (online) registration of interRAI data in Belgium, adapting of the Interface web application, adapting of the instruments to the Belgian context, large-scale testing in actual situations (successive projects in different Belgian care sectors) and providing of in-the-field training and coaching of the participating multidisciplinary teams.

10. BelRAI project - Conclusions “Completing the assessment instruments correctly and at a constant high level is crucial in obtaining valuable information and subsequent outcomes.”

11. BelRAI project - Conclusions Two very important conclusions of the BelRAI project are: Completing the assessment instruments correctly and at a constant high level is crucial in obtaining valuable information and subsequent outcomes. Eliminating the obstacles leading to the collection of poor or inferior data is necessary: information about how to correctly fill out the interRAI assessment instruments must be accessible and nearby at all times.

12. BelRAI project - Conclusions “Eliminating the obstacles leading to the collection op poor or inferior data is necessary ” …

13. BelRAI obstacles

14. BelRAI obstacles Certain barriers and resistance to the use of the instruments need to be removed or countered as well. This process involves a cultural change in professional organizations. So we have the following barriers: The socio-cultural differences in Belgium require multiple adaptations to specific settings and local customs: the wording of the instruments should be adapted to the practice of German, French and Dutch-speaking caregivers by means of an accurate and explicit use of words (vocabulary). As the interRAI tools are always evolving the creation of a very flexible web application is obvious. It is also necessary to bring together and train professionals with different backgrounds and from various disciplines so that they can work together in the process of assessing the elderly person and make use of the output. The right tools can help them to act that way. There were also many questions about controllability and manageability of data related to health services, population health, health human resources and so on. There was also a great concern about deontology and ethics concerning the online use of the InterRAI instruments.

15. 3 languages Specific settings  multiple changes Social & cultural differences

16. Evolving content

17. Need for multidisciplinarity

18. Privacy ?

19. Belgian solutions “Belgian” instruments More flexibility Privacy policy Reorientate BelRAI application

20. Belgian solutions At this moment the BelRAI web application provides the interRAI LTCF, the interRAI Home Care and the interRAI Acute Care translated in Dutch, French and German and adapted to the Belgian context. BelRAI provides also CAPs and Scales based on the latest algorithms. Quality Indicators and RUGs are being prepared for 2010. Two years ago there was the creation of a completely new software architecture. The web application BelRAI has a totally flexible structure and being the work of the project members, the project does not depend on external developers or software vendors. Furthermore it is possible to adapt the entire content with a Content Management System. The application makes it also possible for the caregivers to work in a multidisciplinary way: the online instrument parts can be filled out by the caregivers depending on their expertise. Each item being filled out by a caregiver as an expert in his/her domain of caregiving, data is more accurate and time investment required from each caregiver is less. Furthermore the web application meets the high standards concerning privacy policies in Belgium. The admittance to BelRAI is regulated by the e-health web application of the Belgian government.

21. More obstacles Workload Education Support

22. More obstacles As we all know workload is a very important issue: there were many complaints about the fact that people had to copy the same data over and over again. To limit time investment and to facilitate filling out the assessment instruments an integration with already existing healthcare applications will be introduced in 2010. Furthermore in-service training, education and support is a never ending story. The quality of information flowing up to the caregivers is very much determining for the quality of the assessments. Educational models must be created, tested and introduced in the field of education and professional care settings.

23. TIME !! Everybody knows it by now …introducing these multidimensional instruments causes a major change process and takes time.

24. The WIKI solution A website Providing information Free community site In a non-technical way In multiple languages Always accessible

25. The WIKI solution To provide the caregivers with the necessary information and to replace the manuals a second multilingual website, a wiki, has been constructed as a flexible online manual, teacher and helpdesk, … So what is a wiki? A wiki is a website that uses wiki software, allowing the easy creation and editing of any number of interlinked Web pages, using a simplified and not technical markup language. Wikis are often used to create collaborative websites and to power community websites. Wikipedia is one of the best-known wikis. It is originally described as "the simplest online database that could possibly work.”

26. BelRAIWiki Focus on Belgian context Dutch & French, German soon

27. BelRAIWiki So we used this Wiki concept for our BelRAIWiki. The content of the BelRAIWiki is informative and holds an instructive platform to centralize and to spread information about the InterRAI tools and the Belgian BelRAI project. The content is online, public and also multilingual: BelRAIWiki is accessible in Dutch (http://wiki.belrai.org/nl/) and French (http://wiki.belrai.org/fr/); later also in German.

28. BelRAI Wiki Managed by multiple researchers

29. BelRAIWiki managed by multiple researchers BelRAIWiki being based on the Wiki concept, authorized researchers or experts are able to adapt the content at all times in order to offer up-to-date information in several languages, in-service support training and perform necessary adaptations to the evolving interRAI instruments and manuals.

31. Examples: A BelRAIWiki page about the Physical restraints CAP. The same page about the Physical restraints CAP but with the simplified markup language as a set of annotations to text that describes how it is to be structured, laid out or formatted.

33. Linking together BelRAI application interRAI /MDS Project CAPs Privacy Provides information Scales Logging … BelRAIWiki windows open in BelRAI appl. & public url Provides information

34. Linking together With the help of the BelRAI web application it is possible to realize a comprehensive online assessment and based on that information various forms of output are produced. With the help of the BelRAIWiki it is possible to provide all the information concerning the InterRAI tools and the Belgian BelRAI project. A third logical phase consists in linking these two websites together in a way that every specific detail or information caregivers should know is just ‘one click away’.

35. e.g. Wiki opens text in assessment instrument

36. e.g. Wiki opens image in assessment instrument

37. e.g. Wiki opens text in calculated CAP

38. Information 1 click away RAI manuals & outcome BelRAI project information Information en guidance (FAQ, lexicon, …) BelRAI application usage

39. Information 1 click away This information includes: information on the InterRAI assessment instruments, general information on CAP’s, CAP triggers, Scales,… and information on the calculated outcome. There is also information about the BelRAI project: for instance the BelRAI application usage and details about the Belgian privacy policy. More common information includes a helpdesk, FAQ, lexicon, downloads, hyperlinks to other care programs, training facilities and so on …

40. Manuals Home Care, LTCF , AC Multi-level information Sections, questions, answers Results, result groups, ... Additional information Graphics, tables, images, …

41. _

44. Outcome CAPs Settings Activation codes Triggers Scales

53. Wiki links Dutch: http://wiki.belrai.org/nl/ French: http://wiki.belrai.org/fr/ public demo site BelRAI application coming soon!

54. Thanks for your attention Dirk Vanneste, researcher Lucas Email: dirk.vanneste@med.kuleuven.be url: http://www.kuleuven.ac.be/lucas Lucas: Anja Declercq, Johanna Mello Special thanks to Jurgen Berden, pyxima NV All pictures courtesy of