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BelRAI	
  
Towards	
  integrated	
  care	
  evalua2on:	
  	
  the	
  Belgian	
  approach	
  	
  	
  
Jurgen	
  Berden	
  &	
  Dirk	
  Vanneste	
  
Text	
  version	
  
Text version - BelRAI - Towards integrated care evaluation:  the Belgian approach
Abstract	
  
In	
  Belgium,	
  a	
  web-­‐based	
  applica2on	
  (BelRAI)	
  allowing	
  a	
  mul2disciplinary	
  approach	
  during	
  and	
  aBer	
  the	
  
assessment	
  of	
  an	
  interRAI	
  instrument	
  has	
  been	
  developed.	
  This	
  unique	
  feature	
  offers	
  to	
  each	
  caregiver	
  the	
  
possibility	
  to	
  complete	
  the	
  online	
  instrument	
  parts	
  related	
  to	
  his/her	
  area	
  of	
  exper2se,	
  through	
  which	
  data	
  
is	
  more	
  accurate	
  and	
  2me	
  investment	
  required	
  from	
  each	
  caregiver	
  is	
  less.	
  
The	
  BelRAI	
  project	
  2010	
  has	
  implemented	
  three	
  interRAI	
  instruments	
  	
  -­‐	
  Home	
  Care,	
  Long	
  Term	
  Care	
  and	
  Acute	
  
Care	
  -­‐	
  in	
  some	
  of	
  the	
  Belgian	
  care	
  seOngs.	
  They	
  have	
  been	
  tested	
  as	
  an	
  integrated	
  health	
  informa2on	
  
system	
  that	
  permits	
  seamless	
  tracking	
  of	
  persons	
  with	
  the	
  poten2al	
  to	
  provide	
  person-­‐centered	
  
informa2on	
  that	
  transcends	
  mul2ple	
  care	
  seOngs.	
  
The	
  availability	
  of	
  an	
  integrated	
  mul2-­‐seOng	
  health	
  informa2on	
  system	
  offers	
  a	
  wide	
  array	
  of	
  opportuni2es	
  for	
  
clinicians,	
  administrators	
  and	
  researchers	
  to	
  improve	
  con2nuity	
  of	
  care,	
  from	
  both	
  efficiency	
  and	
  quality	
  of	
  
care	
  perspec2ves.	
  It	
  also	
  enables	
  evalua2ng	
  the	
  longitudinal	
  effects	
  on	
  the	
  micro-­‐level	
  (quality	
  of	
  care),	
  the	
  
meso-­‐level	
  (management)	
  and	
  the	
  macro-­‐level	
  (policy).	
  
Research	
  project	
  
Online	
  registra2on	
  interRAI	
  data	
  
Belgian	
  government	
  
BelRAI	
  is	
  a	
  research	
  project	
  	
  subsidized	
  by	
  the	
  FOD.	
  The	
  project	
  has	
  been	
  running	
  for	
  about	
  5	
  years	
  now.	
  
BelRAI	
  is	
  an	
  online	
  registra2on	
  plaWorm	
  for	
  interRAI	
  and	
  other	
  assessment	
  data.	
  
The	
  BelRAI	
  websites	
  are	
  mainly	
  driven	
  by	
  the	
  research	
  group	
  Lucas	
  from	
  the	
  university	
  of	
  Leuven	
  and	
  Pyxima	
  
NV,	
  a	
  spin-­‐off	
  company	
  also	
  a[ached	
  to	
  the	
  university	
  of	
  Leuven.	
  
Social & cultural
differences
•  3 languages
•  Belgian context
•  Specific settings  multiple changes
The	
  socio-­‐cultural	
  differences	
  in	
  Belgium	
  require	
  mul2ple	
  adapta2ons	
  to	
  specific	
  seOngs	
  and	
  local	
  customs:	
  the	
  
wording	
  of	
  the	
  instruments	
  should	
  be	
  adapted	
  to	
  the	
  prac2ce	
  of	
  German,	
  French	
  and	
  Dutch-­‐speaking	
  
caregivers	
  by	
  means	
  of	
  an	
  accurate	
  and	
  explicit	
  use	
  of	
  words	
  (vocabulary).	
  	
  
Since	
  we	
  are	
  using	
  the	
  instruments	
  in	
  different	
  seOngs	
  we	
  use	
  the	
  interRAI	
  SUITE	
  instruments.	
  
More	
  differences	
  
•  Acute	
  Care	
  
•  Home	
  Care	
  
•  Long	
  Term	
  Care	
  
Facility	
  
•  Zarit	
  Burden	
  
•  Economic	
  instrument	
  
•  WHO-­‐QoL-­‐8	
  
•  Katz	
  
RAI	
   Others	
  
In	
  addi2on	
  to	
  several	
  cultural	
  and	
  social	
  differences,	
  Belgium	
  has	
  many	
  different	
  governments:	
  6	
  to	
  be	
  precise;	
  6	
  
governments	
  for	
  about	
  10.5	
  million	
  people.	
  
We	
  also	
  have	
  different	
  research	
  projects	
  in	
  BELRAI;	
  this	
  means	
  interRAI	
  instruments	
  and	
  other	
  instruments	
  
(WHO-­‐QoL-­‐8,	
  Zarit-­‐12	
  BurdenScale,	
  …).	
  	
  
But	
  the	
  main	
  focus	
  is	
  on	
  the	
  interRAI	
  instruments	
  …	
  
Need for
multidisciplinarity
It	
  is	
  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.	
  
Every	
  caregiver	
  has	
  its	
  own	
  field	
  of	
  exper2se,	
  he	
  has	
  his	
  own	
  opinion	
  about	
  a	
  care	
  situa2on.	
  	
  
In	
  BelRAI	
  we	
  use	
  all	
  this	
  knowledge	
  of	
  all	
  the	
  involved	
  caregivers	
  while	
  collec2ng	
  the	
  data.	
  
Flexibility	
  
Mul2disciplinarity	
  
Instrument	
  
diversity	
  
Mul2lingual	
  
aspect	
  
Adaptability	
  
Support	
  
Belgian	
  
context	
  
Extensible	
  
When	
  talking	
  about	
  BelRAI	
  we	
  are	
  talking	
  about	
  different	
  aspects,	
  different	
  pieces	
  of	
  a	
  puzzle.	
  
So	
  when	
  talking	
  about	
  BelRAI	
  we	
  think	
  of	
  support	
  for	
  the	
  caregivers,	
  having	
  Belgian	
  instruments,	
  the	
  
mul2lingual	
  aspect,	
  flexible	
  building	
  blocks,	
  extensible	
  instruments,	
  a	
  wide	
  variety	
  of	
  instruments,	
  
adaptability	
  and	
  mul2disciplinarity.	
  
All	
  these	
  blocks	
  together	
  represent	
  the	
  BelRAI	
  VISION.	
  
SCENARIO	
  
A	
  story	
  about	
  the	
  BelRAI	
  vision	
  at	
  work	
  in	
  Belgium.	
  
We	
  are	
  very	
  pleased	
  to	
  introduce	
  you	
  to	
  our	
  friend	
  Derick	
  
Derick	
  Gartman	
  
101	
  years	
  old	
  
Single	
  
Lives	
  alone	
  
Hobbies:	
  roof-­‐jumping,	
  	
  	
  	
  
clubbing	
  ,	
  social-­‐networking	
  
Text version - BelRAI - Towards integrated care evaluation:  the Belgian approach
Derick	
  used	
  to	
  have	
  a	
  very	
  evenWul	
  life,	
  his	
  hobbies	
  are	
  roof-­‐jumping,	
  clubbing	
  and	
  social	
  networking,	
  but	
  lately	
  
his	
  health	
  condi2on	
  hasn’t	
  been	
  that	
  good	
  anymore.	
  
He	
  called	
  doctor	
  Fureman,	
  who	
  asked	
  Allison	
  –	
  the	
  home	
  health	
  care	
  nurse	
  –	
  to	
  visit	
  Derick	
  and	
  to	
  make	
  an	
  
assessment.	
  
Text version - BelRAI - Towards integrated care evaluation:  the Belgian approach
So	
  the	
  day	
  aBer,	
  nurse	
  Allison	
  visits	
  Derick.	
  Allison	
  works	
  in	
  a	
  home	
  health	
  care	
  organiza2on	
  and	
  she	
  has	
  a	
  lot	
  of	
  
experience	
  in	
  the	
  home	
  care	
  sector.	
  She	
  also	
  has	
  some	
  BelRAI	
  experience.	
  
ALLISON	
  D.	
  
Home	
  health	
  care	
  nurse	
  
10	
  years	
  work	
  experience	
  
3	
  years	
  BelRAI	
  experience	
  
Works	
  in	
  HC	
  Organiza2on	
  
Communica2on	
  
Derick	
  tells	
  Allison	
  about	
  his	
  condi2on.	
  Allison	
  no2ces	
  that	
  the	
  situa2on	
  of	
  Derick	
  is	
  not	
  so	
  good.	
  So	
  she	
  wants	
  to	
  
know	
  more	
  about	
  Derick’s	
  condi2on.	
  	
  
She	
  proposes	
  to	
  complete	
  an	
  interRAI	
  home	
  care	
  assessment.	
  Because	
  it	
  is	
  the	
  first	
  2me	
  for	
  Derick,	
  Allison	
  
explains	
  all	
  about	
  it.	
  
Derick	
  agrees,	
  signs	
  an	
  informed	
  consent	
  and	
  asks	
  Allison	
  to	
  be	
  in	
  charge	
  (to	
  be	
  responsible)	
  of	
  the	
  data	
  and	
  to	
  
inform	
  his	
  doctor,	
  his	
  physiotherapist	
  and	
  the	
  other	
  home	
  health	
  care	
  nurse	
  about	
  his	
  situa2on.	
  	
  
Text version - BelRAI - Towards integrated care evaluation:  the Belgian approach
Home	
  again,	
  Allison	
  is	
  very	
  happy	
  to	
  live	
  in	
  Belgium	
  because	
  to	
  complete	
  an	
  interRAI	
  assessment	
  she	
  only	
  has	
  to	
  
log	
  in	
  onto	
  the	
  BelRAI	
  website.	
  
Login	
  procedure	
  
To	
  be	
  able	
  to	
  access	
  the	
  BelRAI	
  website,	
  nurse	
  Allison	
  has	
  to	
  use	
  her	
  eID.	
  By	
  law,	
  every	
  Belgian	
  ci2zen	
  has	
  an	
  eID,	
  
which	
  is	
  a	
  card	
  including	
  a	
  chip	
  –	
  comparable	
  to	
  a	
  credit	
  card	
  with	
  a	
  PIN	
  code.	
  When	
  using	
  a	
  card	
  reader	
  
connected	
  to	
  her	
  computer	
  (which	
  can	
  be	
  seen	
  on	
  the	
  leB	
  side	
  of	
  your	
  screen)	
  and	
  aBer	
  having	
  put	
  her	
  card	
  
in	
  the	
  card	
  reader,	
  Allison	
  will	
  be	
  able	
  to	
  log	
  in	
  onto	
  the	
  website.	
  	
  	
  
BELGIAN	
  PRIVACY	
  COMMISSION	
  
BELGIAN	
  GOVERNMENT	
  
Levels	
  of	
  security	
  
Electronic	
  ID	
  +	
  pincode	
  
Roles/	
  professions	
  from	
  
authenJcated	
  sources	
  
BelRAI	
  roles	
  
System	
  funcJons	
   QuesJon	
  types	
  
L
e
v
e
l	
  
1	
  
L
e
v
e
l	
  
2
&
3	
  
The	
  card	
  reader	
  is	
  one	
  of	
  the	
  security	
  measurements	
  BelRAI	
  contains.	
  
The	
  first	
  security	
  level	
  implies	
  that	
  the	
  data	
  from	
  the	
  card	
  reader	
  is	
  checked	
  by	
  a	
  central	
  Belgian	
  government	
  
system.	
  	
  	
  
The	
  Belgian	
  government	
  verifies	
  your	
  creden2als	
  and	
  passes	
  informa2on	
  to	
  BelRAI	
  regarding	
  who	
  you	
  are	
  and	
  
what	
  your	
  profession	
  is.	
  
On	
  the	
  basis	
  of	
  your	
  profession	
  BelRAI	
  can	
  determine	
  your	
  role	
  in	
  the	
  system.	
  Depending	
  on	
  that	
  role,	
  each	
  one	
  
of	
  you	
  has	
  different	
  access	
  rights.	
  This	
  means	
  we	
  can	
  determine	
  what	
  you	
  are	
  allowed	
  and	
  what	
  you	
  are	
  
not	
  allowed	
  to	
  do.	
  We	
  can	
  also	
  determine	
  which	
  kind	
  of	
  content	
  you	
  will	
  have	
  access	
  to.	
  	
  
All	
  these	
  security	
  seOngs	
  are	
  strictly	
  regulated	
  by	
  the	
  Belgian	
  privacy	
  commission,	
  which	
  is	
  also	
  a	
  government	
  
ins2tu2on.	
  
Text version - BelRAI - Towards integrated care evaluation:  the Belgian approach
Allison	
  is	
  logged	
  in,	
  goes	
  to	
  the	
  homepage,	
  and	
  sees	
  the	
  naviga2on	
  bar	
  at	
  the	
  top	
  of	
  the	
  page.	
  She	
  can	
  manage	
  
clients,	
  view	
  assessments,	
  generate	
  sta2s2cs,	
  etc.	
  (including	
  language	
  choice).	
  	
  
Below	
  the	
  naviga2on	
  bar,	
  she	
  can	
  see	
  some	
  quick	
  links.	
  At	
  the	
  bo[om	
  of	
  the	
  page,	
  there	
  is	
  a	
  small	
  security	
  
check	
  concerning	
  her	
  BelRAI	
  role	
  and	
  the	
  last	
  2me	
  she	
  logged	
  in.	
  
At	
  the	
  right	
  side	
  of	
  the	
  screen	
  she	
  can	
  see	
  the	
  assessments	
  she	
  has	
  been	
  involved	
  in	
  recently.	
  
Derick	
  
Geen zoekresultaten
Allison	
  wants	
  to	
  find	
  Derick.	
  She	
  navigates	
  to	
  the	
  client	
  screen	
  and	
  types	
  Derick’s	
  name	
  in	
  the	
  search	
  box.	
  
However,	
  Derick	
  is	
  not	
  in	
  the	
  system.	
  	
  	
  
Gartman	
  
Derick	
  
West	
  park	
  
België	
  
Belg	
  
123456789	
  
To	
  put	
  Derick	
  in	
  the	
  BelRAI	
  system,	
  Allison	
  has	
  to	
  create	
  a	
  profile	
  for	
  Derick.	
  This	
  is	
  not	
  a	
  problem	
  because	
  in	
  this	
  
par2cular	
  situa2on	
  Allison	
  has	
  enough	
  personal	
  informa2on	
  about	
  Derick	
  at	
  her	
  disposal	
  in	
  order	
  to	
  do	
  
that.	
  	
  
grants	
  access	
  via	
  
client	
  manager	
  
gives	
  client	
  
access	
  to	
  
grants	
  access	
  via	
  
client	
  manager	
  
gives	
  client	
  
access	
  to	
  
Jerry-­‐	
  physiotherapist	
  Dr.	
  Fureman	
   John	
  –	
  Home	
  care	
  nurse	
  
Allison	
  –	
  Home	
  care	
  nurse	
  
ABer	
  that,	
  Allison	
  points	
  herself	
  out	
  as	
  the	
  client	
  manager	
  of	
  Derick	
  in	
  the	
  system.	
  
Being	
  the	
  client	
  manager	
  of	
  Derick,	
  she	
  is	
  the	
  person	
  who	
  is	
  in	
  charge	
  of	
  all	
  Derick’s	
  data.	
  	
  
Doctor	
  Fureman	
  also	
  plays	
  a	
  central	
  role	
  in	
  the	
  health	
  care	
  organiza2ons.	
  Allison	
  points	
  out	
  doctor	
  Fureman	
  as	
  
a	
  client	
  manager,	
  too.	
  
She	
  also	
  gives	
  limited	
  access	
  to	
  the	
  physiotherapist	
  Jerry	
  and	
  the	
  other	
  home	
  care	
  nurse	
  John	
  (so	
  they	
  can	
  see	
  
things	
  they	
  “need	
  to	
  know”	
  for	
  the	
  caregiving	
  process).	
  	
  	
  
Text version - BelRAI - Towards integrated care evaluation:  the Belgian approach
So	
  when	
  Allison	
  looks	
  back	
  at	
  the	
  detail	
  page	
  of	
  our	
  client	
  Derick,	
  she	
  now	
  can	
  see	
  all	
  about	
  Derick’s	
  status:	
  	
  
•  his	
  profile	
  (on	
  top),	
  	
  
•  his	
  client	
  managers	
  Allison	
  and	
  doctor	
  Fureman	
  (leB	
  side)	
  and	
  
•  the	
  other	
  involved	
  caregivers	
  Jerry	
  and	
  John	
  (right	
  side).	
  
Text version - BelRAI - Towards integrated care evaluation:  the Belgian approach
Derick	
  being	
  known	
  by	
  the	
  system,	
  Allison	
  can	
  start	
  up	
  an	
  assessment	
  and	
  she	
  chooses	
  the	
  interRAI	
  home	
  care	
  
assessment	
  adapted	
  to	
  the	
  Belgian	
  context.	
  
Text version - BelRAI - Towards integrated care evaluation:  the Belgian approach
There	
  are	
  different	
  and	
  mul2ple	
  steps	
  to	
  be	
  taken	
  in	
  order	
  to	
  start	
  up	
  an	
  assessment,	
  and	
  being	
  the	
  central	
  
caregiver,	
  Allison	
  takes	
  responsibility	
  	
  and	
  points	
  herself	
  out	
  as	
  the	
  assessment	
  responsable.	
  
Text version - BelRAI - Towards integrated care evaluation:  the Belgian approach
Because	
  Allison	
  wants	
  to	
  bring	
  together	
  different	
  professionals	
  in	
  this	
  assessment	
  process	
  she	
  also	
  points	
  out	
  
other	
  par2cipants.	
  This	
  way	
  the	
  assessment	
  will	
  be	
  filled	
  out	
  more	
  professionally	
  and	
  2me	
  investment	
  and	
  
effort	
  will	
  be	
  shared.	
  
With	
  the	
  search	
  func2on	
  she	
  can	
  easily	
  find	
  the	
  caregivers	
  she	
  needs	
  for	
  this	
  assessment.	
  As	
  you	
  can	
  see	
  on	
  this	
  
screen	
  doctor	
  Fureman	
  and	
  Jerry	
  the	
  physiotherapist	
  have	
  already	
  been	
  selected.	
  
Text version - BelRAI - Towards integrated care evaluation:  the Belgian approach
Once	
  the	
  assessment	
  is	
  created	
  Allison	
  gets	
  an	
  overview	
  with	
  more	
  detailed	
  informa2on	
  on	
  this	
  page.	
  
Being	
  the	
  responsible	
  of	
  the	
  assessment,	
  Allison	
  has	
  access	
  to	
  all	
  ques2on	
  types.	
  (A	
  ques2on	
  type	
  is	
  a	
  collec2on	
  
of	
  related	
  ques2ons).	
  
Here	
  Allison	
  has	
  a	
  detailed	
  view	
  of	
  the	
  other	
  caregivers	
  involved:	
  doctor	
  Fureman	
  has	
  access	
  to	
  all	
  ques2ons.	
  
The	
  other	
  caregivers	
  have	
  default	
  access	
  to	
  ques2ons	
  related	
  to	
  their	
  own	
  profession,	
  which	
  can	
  s2ll	
  be	
  changed	
  
by	
  Allison	
  at	
  this	
  point.	
  	
  
Spread	
  the	
  word	
  
Allison	
  
Jerry	
  
John	
  	
  
Dr.	
  Fureman	
  
As	
  you	
  can	
  all	
  see	
  Allison	
  is	
  the	
  central	
  caregiver	
  for	
  this	
  assessment	
  and	
  being	
  a	
  very	
  responsible	
  person	
  she	
  
contacts	
  (mails/phones)	
  everyone	
  to	
  inform	
  them	
  about	
  the	
  new	
  assessment.	
  
At	
  this	
  moment	
  all	
  involved	
  caregivers	
  can	
  see	
  all	
  the	
  informa2on	
  they	
  need	
  to	
  know	
  (on	
  their	
  screens)	
  when	
  
they	
  log	
  in	
  onto	
  BelRAI.	
  
Text version - BelRAI - Towards integrated care evaluation:  the Belgian approach
ABer	
  a	
  few	
  hours,	
  doctor	
  Fureman	
  logs	
  in	
  and	
  no2ces	
  the	
  Home	
  Care	
  assessment	
  Allison	
  has	
  started.	
  He	
  clicks	
  
on	
  the	
  link	
  and	
  can	
  now	
  see	
  the	
  assessment.	
  
Text version - BelRAI - Towards integrated care evaluation:  the Belgian approach
At	
  the	
  leB	
  side	
  he	
  sees	
  all	
  the	
  different	
  sec2ons	
  that	
  are	
  included	
  in	
  the	
  Home	
  care	
  assessment.	
  Moreover,	
  he	
  
can	
  see	
  how	
  many	
  items	
  each	
  sec2on	
  includes,	
  as	
  well	
  as	
  the	
  number	
  of	
  items	
  he	
  has	
  already	
  answered.	
  	
  	
  
At	
  the	
  very	
  top	
  of	
  the	
  page	
  doctor	
  Fureman	
  sees	
  some	
  iden2fica2on	
  informa2on:	
  the	
  name	
  of	
  the	
  assessment,	
  
the	
  reference	
  date,	
  and	
  the	
  client	
  informa2on.	
  
In	
  the	
  middle	
  of	
  the	
  page,	
  doctor	
  Fureman	
  no2ces	
  the	
  different	
  items	
  and	
  decides	
  to	
  fill	
  out	
  the	
  item	
  “Falls”	
  in	
  
the	
  sec2on	
  “Health	
  condi2on”.	
  
Text version - BelRAI - Towards integrated care evaluation:  the Belgian approach
At	
  the	
  same	
  2me,	
  Jerry	
  –	
  the	
  physiotherapist	
  –	
  also	
  logs	
  in	
  onto	
  BelRAI	
  and	
  starts	
  filling	
  out	
  the	
  Home	
  Care	
  
instrument.	
  He	
  only	
  sees	
  2	
  sec2ons	
  of	
  the	
  assessment,	
  which	
  are	
  the	
  parts	
  he	
  has	
  access	
  to.	
  This	
  means	
  his	
  
job	
  will	
  be	
  done	
  quicky.	
  	
  
Text version - BelRAI - Towards integrated care evaluation:  the Belgian approach
John	
  –	
  a	
  home	
  care	
  nurse	
  –	
  wants	
  to	
  fill	
  out	
  the	
  sec2on	
  “ADL”.	
  He	
  has	
  a	
  problem,	
  though.	
  He	
  is	
  new	
  in	
  the	
  
organiza2on	
  and	
  finds	
  the	
  informa2on	
  he	
  gets	
  on	
  his	
  screen	
  too	
  complicated,	
  he	
  doesn’t	
  have	
  a	
  clue…	
  So,	
  
John	
  clicks	
  on	
  the	
  li[le	
  blue	
  help	
  icon	
  and	
  the	
  BelRAIWiki	
  (*)	
  pops	
  up	
  with	
  some	
  extra	
  informa2on	
  serving	
  
as	
  a	
  guide	
  through	
  this	
  item.	
  
*	
  The	
  BelRAIWiki	
  provides	
  the	
  caregivers	
  with	
  all	
  necessary	
  informa2on	
  concerning	
  all	
  the	
  interRAI	
  instruments	
  and	
  the	
  output/
outcome.	
  BelRAIWiki	
  is	
  also	
  linked	
  directly	
  to	
  the	
  BelRAI	
  website.	
  Every	
  specific	
  detail	
  or	
  informa2on	
  caregivers	
  should	
  know	
  
is	
  just	
  “one	
  click	
  away”.	
  The	
  content	
  of	
  the	
  BelRAIWiki	
  is	
  informa2ve	
  and	
  holds	
  an	
  instruc2ve	
  plaWorm	
  to	
  centralize	
  and	
  to	
  
spread	
  informa2on	
  about	
  the	
  InterRAI	
  tools	
  and	
  the	
  Belgian	
  BelRAI	
  project.	
  
4	
  days	
  later	
  
Four	
  days	
  later	
  Allison	
  wants	
  to	
  get	
  some	
  output.	
  	
  
Being	
  the	
  responsible	
  of	
  the	
  assessment	
  she	
  has	
  access	
  to	
  all	
  ques2ons	
  and	
  answers.	
  
She	
  takes	
  a	
  look	
  and	
  no2ces	
  that	
  the	
  physiotherapist	
  and	
  the	
  other	
  home	
  care	
  nurse	
  have	
  given	
  DIFFERENT	
  
ANSWERS	
  to	
  the	
  first	
  ques2on	
  on	
  SKIN	
  CONDITION.	
  	
  
She	
  contacts	
  both	
  colleagues	
  and	
  confronts	
  them	
  with	
  their	
  opinions.	
  ABer	
  a	
  brief	
  consulta2on	
  she’s	
  able	
  to	
  
form	
  a	
  be[er	
  image	
  of	
  the	
  situa2on	
  and	
  to	
  formulate	
  a	
  more	
  exact	
  or	
  precise	
  answer	
  to	
  that	
  ques2on.	
  	
  
She	
  leaves	
  the	
  other	
  NOT	
  CONFLICTING	
  ANSWERS	
  untouched.	
  
She	
  also	
  answers	
  a	
  few	
  ques2ons	
  her	
  colleagues	
  had	
  not	
  been	
  able	
  to	
  answer	
  due	
  to	
  a	
  lack	
  of	
  informa2on.	
  	
  
Once	
  the	
  assessment	
  is	
  completed	
  and	
  checked,	
  Allison	
  lets	
  the	
  system	
  process	
  the	
  answers.	
  
Text version - BelRAI - Towards integrated care evaluation:  the Belgian approach
On	
  this	
  page	
  Allison	
  sees	
  all	
  calculated	
  CAPs,	
  Scales,	
  and	
  nursing	
  and	
  medical	
  health	
  profiles.	
  	
  
First	
  of	
  all	
  the	
  CAPs;	
  on	
  the	
  leB	
  side	
  all	
  the	
  possible	
  CAPs	
  concerning	
  the	
  Home	
  Care	
  situa2on.	
  On	
  the	
  right	
  side	
  
the	
  calculated	
  results	
  or	
  scores.	
  
With	
  a	
  click	
  on	
  the	
  blue	
  icons	
  Allison	
  can	
  connect	
  with	
  the	
  BelRAIWiki	
  website	
  (*)	
  and	
  get	
  more	
  general	
  
informa2on	
  about	
  the	
  concerned	
  CAP	
  or	
  more	
  informa2on	
  	
  about	
  	
  the	
  calculated	
  outcome	
  and	
  guidelines.	
  	
  
*	
  The	
  BelRAIWiki	
  provides	
  the	
  caregivers	
  with	
  all	
  necessary	
  informa2on	
  concerning	
  all	
  the	
  interRAI	
  instruments	
  and	
  the	
  output/
outcome.	
  BelRAIWiki	
  is	
  also	
  linked	
  directly	
  to	
  the	
  BelRAI	
  website.	
  Every	
  specific	
  detail	
  or	
  informa2on	
  caregivers	
  should	
  know	
  
is	
  just	
  “one	
  click	
  away”.	
  The	
  content	
  of	
  the	
  BelRAIWiki	
  is	
  informa2ve	
  and	
  holds	
  an	
  instruc2ve	
  plaWorm	
  to	
  centralize	
  and	
  to	
  
spread	
  informa2on	
  about	
  the	
  InterRAI	
  tools	
  and	
  the	
  Belgian	
  BelRAI	
  project.	
  
Text version - BelRAI - Towards integrated care evaluation:  the Belgian approach
Same	
  thing	
  concerning	
  the	
  Scales.	
  
Again	
  at	
  the	
  leB	
  side	
  all	
  possible	
  scales	
  concerning	
  the	
  Home	
  Care	
  situa2on	
  with	
  the	
  CHESS,	
  MAPLe	
  and	
  PURS	
  
included;	
  on	
  the	
  right	
  side	
  the	
  calculated	
  scores	
  concerning	
  this	
  assessment.	
  
Again	
  all	
  scales	
  and	
  results	
  are	
  linked	
  to	
  the	
  BelRAIWiki	
  website.	
  
Text version - BelRAI - Towards integrated care evaluation:  the Belgian approach
The	
  other	
  page	
  shows	
  the	
  possibility	
  to	
  produce	
  two	
  health	
  profiles:	
  one	
  is	
  a	
  collec2on	
  of	
  more	
  nursing-­‐oriented	
  
items,	
  CAPs	
  or	
  scales	
  and	
  the	
  other	
  collects	
  more	
  medical-­‐oriented	
  output.	
  
When	
  the	
  assessment	
  is	
  closed	
  by	
  Allison	
  the	
  caregivers	
  that	
  have	
  filled	
  out	
  the	
  assessment	
  and	
  	
  other	
  persons	
  
that	
  have	
  been	
  granted	
  access	
  to	
  Derick’s	
  profile	
  can	
  take	
  a	
  look	
  at	
  the	
  results	
  online	
  (aBer	
  having	
  logged	
  
in	
  onto	
  BelRAI	
  using	
  their	
  eID).	
  	
  
On	
  that	
  basis	
  health	
  care	
  can	
  be	
  evaluated	
  and	
  adjusted.	
  
A	
  walk	
  in	
  the	
  park	
  …	
  
Aaaah	
  
Derick	
  is	
  feeling	
  be[er	
  and	
  decides	
  to	
  go	
  for	
  a	
  walk	
  in	
  the	
  southern	
  (French-­‐speaking)	
  part	
  of	
  the	
  country.	
  
Unfortunately,	
  he	
  has	
  an	
  accident	
  and	
  ends	
  up	
  in	
  the	
  hospital.	
  
Text version - BelRAI - Towards integrated care evaluation:  the Belgian approach
Derick	
  is	
  examined	
  by	
  doctor	
  Mouse	
  and	
  the	
  French-­‐speaking	
  nurse	
  Marie.	
  
Doctor	
  Mouse	
  doesn’t	
  know	
  Derick	
  and	
  wants	
  to	
  know	
  more	
  about	
  his	
  condi2on	
  before	
  going	
  into	
  ac2on.	
  
Text version - BelRAI - Towards integrated care evaluation:  the Belgian approach
He	
  logs	
  in	
  onto	
  the	
  BelRAI	
  website	
  and	
  takes	
  a	
  look	
  at	
  Derick’s	
  details.	
  	
  
However,	
  he	
  can	
  only	
  see	
  some	
  iden2fica2on	
  informa2on	
  and	
  Derick’s	
  client	
  managers.	
  	
  
All	
  the	
  other	
  informa2on	
  is	
  not	
  accessible	
  to	
  him.	
  
gives	
  client	
  
access	
  to	
  
gives	
  client	
  
access	
  to	
  
Dr.	
  Mouse	
  
Allison	
  
Marie	
  
Doctor	
  Mouse	
  contacts	
  Allison	
  and	
  explains	
  the	
  situa2on	
  to	
  her.	
  
Allison	
  understands	
  and	
  grants	
  doctor	
  Mouse	
  and	
  nurse	
  Marie	
  access	
  to	
  Derick’s	
  informa2on.	
  	
  	
  
Text version - BelRAI - Towards integrated care evaluation:  the Belgian approach
Doctor	
  Mouse	
  logs	
  in	
  onto	
  BelRAI.	
  
On	
  Derick’s	
  client	
  detail	
  page	
  he	
  sees:	
  
•  Derick’s	
  profile,	
  
•  His	
  client	
  managers	
  Allison	
  and	
  doctor	
  Fureman,	
  
•  himself	
  and	
  nurse	
  Marie	
  also	
  having	
  access	
  and	
  
•  the	
  home	
  health	
  care	
  group	
  with	
  the	
  other	
  caregivers	
  (the	
  physiotherapist	
  and	
  the	
  other	
  home	
  care	
  nurse).	
  
At	
  this	
  moment	
  he	
  also	
  has	
  access	
  to	
  previous	
  assessments,	
  in	
  this	
  case	
  the	
  home	
  care	
  assessments,	
  and	
  the	
  
calculated	
  results	
  or	
  output	
  concerning	
  Derick’s	
  health	
  condi2on.	
  
Text version - BelRAI - Towards integrated care evaluation:  the Belgian approach
Nurse	
  Marie	
  is	
  French-­‐speaking	
  but	
  this	
  is	
  not	
  a	
  	
  problem	
  in	
  BelRAI.	
  
Nurse	
  Marie	
  can	
  switch	
  to	
  her	
  own	
  language	
  and	
  consult	
  everything	
  in	
  French.	
  	
  
When	
  filling	
  out	
  an	
  Acute	
  Care	
  assessment	
  with	
  a	
  click	
  on	
  a	
  chosen	
  previous	
  assessment	
  (blue	
  –	
  li[le	
  menu	
  on	
  
the	
  right)	
  she	
  has	
  the	
  opportunity	
  to	
  automa2cally	
  take	
  over	
  the	
  answers	
  of	
  a	
  previous	
  assessment	
  for	
  a	
  
whole	
  sec2on	
  at	
  once	
  and	
  if	
  needed	
  adapt	
  some	
  answers	
  to	
  the	
  current	
  situa2on.	
  
Text version - BelRAI - Towards integrated care evaluation:  the Belgian approach
Secondly,	
  with	
  the	
  help	
  of	
  a	
  history	
  menu	
  she	
  can	
  also	
  consult	
  and	
  take	
  over	
  previous	
  answers	
  for	
  each	
  ques2on	
  
separately.	
  
Text version - BelRAI - Towards integrated care evaluation:  the Belgian approach
Once	
  the	
  Acute	
  Care	
  assessment	
  is	
  completed	
  and	
  checked,	
  nurse	
  Marie	
  lets	
  the	
  system	
  process	
  the	
  answers.	
  	
  
By	
  means	
  of	
  this	
  page	
  Marie	
  can	
  consult	
  all	
  calculated	
  CAPs,	
  Scales,	
  and	
  nursing	
  and	
  medical	
  health	
  profiles	
  in	
  
her	
  own	
  language.	
  
Again	
  all	
  results	
  are	
  public	
  for	
  the	
  involved	
  caregivers.	
  
2	
  weeks	
  later	
  
Two	
  weeks	
  later	
  Derick’s	
  condi2on	
  has	
  improved,	
  he	
  is	
  feeling	
  much	
  be[er	
  and	
  he	
  is	
  allowed	
  to	
  leave	
  the	
  
hospital.	
  
Text version - BelRAI - Towards integrated care evaluation:  the Belgian approach
Despite	
  all	
  that	
  doctor	
  Mouse	
  advices	
  Derick	
  a	
  short	
  stay	
  in	
  a	
  Long	
  Term	
  Care	
  Facility	
  in	
  order	
  to	
  strenghten	
  up	
  
before	
  going	
  home.	
  
Text version - BelRAI - Towards integrated care evaluation:  the Belgian approach
ABer	
  admission,	
  same	
  story	
  again	
  in	
  the	
  Long	
  Term	
  Care	
  Facility.	
  	
  
When	
  assessing	
  Derick’s	
  situa2on	
  all	
  involved	
  caregivers	
  can	
  consult	
  the	
  previous	
  assessments:	
  the	
  Home	
  Care	
  
and	
  Acute	
  Care	
  assessments.	
  
4	
  weeks	
  later	
  
Four	
  weeks	
  later	
  Derick	
  goes	
  home	
  and	
  is	
  very	
  pleased	
  to	
  meet	
  Allison	
  again.	
  
Text version - BelRAI - Towards integrated care evaluation:  the Belgian approach
Derick	
  being	
  home	
  again,	
  for	
  Allison	
  and	
  her	
  team	
  it	
  is	
  no	
  problem	
  at	
  all	
  to	
  consult	
  all	
  the	
  previous	
  assessments	
  	
  	
  	
  	
  	
  
and	
  the	
  related	
  output	
  CAPs,	
  Scales,	
  health	
  profiles	
  and	
  sta2s2cs	
  so	
  they	
  can	
  have	
  a	
  direct	
  view	
  on	
  Derick’s	
  
condi2on.	
  
END	
  SCENARIO	
  
SOUTH	
  PARK	
  ©2010	
  ComedyPartners.	
  All	
  Rights	
  Reserved	
  
This	
  is	
  the	
  end	
  of	
  a	
  short	
  story	
  showing	
  us	
  an	
  example	
  of	
  how	
  things	
  can	
  go	
  in	
  Belgium.	
  
Text version - BelRAI - Towards integrated care evaluation:  the Belgian approach
Project	
  status:	
  tests	
  in	
  different	
  parts	
  of	
  the	
  country.	
  
Different	
  seOngs:	
  HC,	
  AC,	
  and	
  LTCF	
  (2011:	
  Pallia2ve	
  Care,	
  Mental	
  Health,	
  …)	
  	
  
BelRAI	
  
ProducJon	
  site	
  WIKI	
  AcceptaJon	
  site	
  Dev.	
  site	
  
Caregivers	
  &	
  
research	
  teams	
  
Development	
  &	
  
research	
  teams	
  
Caregivers	
  
BelRAI	
  includes	
  four	
  websites:	
  
•  a	
  development	
  site;	
  
•  an	
  accepta2on	
  site:	
  educa2on	
  &	
  demonstra2on	
  (dummy	
  data);	
  
•  a	
  produc2on	
  site:	
  real	
  data;	
  and	
  	
  
•  the	
  BelRAIWIKI:	
  online	
  help,	
  maintained	
  by	
  researchers	
  and	
  always	
  available	
  
e-­‐Health	
  
In	
  a	
  standard	
  model	
  a	
  caregiver	
  uses	
  the	
  BelRAI	
  website	
  separately	
  from	
  his	
  other	
  soBware.	
  
BelRAI	
  with	
  applicaJon	
  integraJon	
  
e-­‐Health	
  
BelRAI	
  is	
  working	
  on	
  a	
  system	
  that	
  will	
  enable	
  access	
  to	
  the	
  interRAI	
  data	
  through	
  the	
  exis2ng	
  (health	
  care)	
  
applica2on(s)	
  of	
  the	
  organiza2ons.	
  
Future	
  
We	
  emphasize	
  2	
  areas:	
  the	
  content	
  &	
  the	
  technical	
  part.	
  
We	
  con2nue	
  to	
  improve	
  and	
  create	
  new	
  features	
  on	
  both	
  levels,	
  always	
  keeping	
  the	
  focus	
  on	
  the	
  caregivers	
  and	
  
the	
  pa2ents.	
  
New	
  instruments	
  
New	
  algorithms	
  
Extra	
  staJsJcs	
  &	
  benchmarking	
  tools	
  
CMS	
  
We	
  are	
  currently	
  working	
  on	
  new	
  instruments:	
  Pallia2ve	
  Care	
  &	
  Mental	
  Health	
  (also	
  other	
  non-­‐interRAI	
  
instruments).	
  
Implementa2on	
  of	
  new	
  algorithms:	
  RUGs,	
  etc.	
  
We	
  are	
  extending	
  the	
  stats	
  on	
  an	
  organiza2onal	
  &	
  individual	
  level	
  (&	
  care	
  plan).	
  
We	
  are	
  taking	
  another	
  step	
  in	
  the	
  development	
  of	
  a	
  Content	
  Managing	
  System	
  allowing	
  us	
  the	
  online	
  crea2on	
  
of	
  new	
  instruments.	
  
Text version - BelRAI - Towards integrated care evaluation:  the Belgian approach
We	
  are	
  nego2a2ng	
  with	
  interRAI	
  so	
  as	
  to	
  become	
  an	
  official	
  interRAI	
  soBware	
  vendor.	
  
Text version - BelRAI - Towards integrated care evaluation:  the Belgian approach
Conclusion:	
  
•  More	
  than	
  5	
  years	
  ago	
  everything	
  started	
  with	
  the	
  choice	
  of	
  an	
  assessment	
  instrument	
  	
  InterRAI	
  
instruments.	
  
•  We	
  feel	
  BelRAI	
  is	
  growing	
  thanks	
  to	
  the	
  flexible	
  approach	
  and	
  vision	
  we	
  have	
  been	
  loyal	
  to.	
  	
  
•  Today,	
  BelRAI	
  seems	
  to	
  be	
  ready	
  to	
  be	
  taken	
  to	
  the	
  next	
  level.	
  
Presenters	
  
Jurgen	
  Berden	
  	
  
Managing	
  Director	
  Pyxima	
  
Jurgen.Berden	
  @pyxima.com	
  
Dirk	
  Vanneste	
  	
  
Researcher	
  Lucas	
  
Dirk.Vanneste@med.kuleuven.be	
  
Lucas:	
  A.	
  Declercq,	
  J.	
  Mello,	
  L.	
  Vesen2ni	
  	
  
Idea	
  &	
  Artwork	
  by	
  Jurgen	
  Berden	
  –	
  Content	
  by	
  Dirk	
  Vanneste	
  &	
  Jurgen	
  Berden	
  –	
  Pictures	
  courtesy	
  of	
  
flickr.com	
  &	
  Jurgen	
  Berden	
  -­‐	
  SOUTH	
  PARK	
  ©2010	
  Comedy	
  Partners.	
  All	
  Rights	
  Reserved.	
  Comedy	
  Central,	
  
South	
  Park	
  and	
  all	
  related	
  2tles,	
  logos	
  and	
  characters	
  are	
  trademarks	
  of	
  Comedy	
  Partners.	
  	
  

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Text version - BelRAI - Towards integrated care evaluation: the Belgian approach

  • 1. BelRAI   Towards  integrated  care  evalua2on:    the  Belgian  approach       Jurgen  Berden  &  Dirk  Vanneste   Text  version  
  • 3. Abstract   In  Belgium,  a  web-­‐based  applica2on  (BelRAI)  allowing  a  mul2disciplinary  approach  during  and  aBer  the   assessment  of  an  interRAI  instrument  has  been  developed.  This  unique  feature  offers  to  each  caregiver  the   possibility  to  complete  the  online  instrument  parts  related  to  his/her  area  of  exper2se,  through  which  data   is  more  accurate  and  2me  investment  required  from  each  caregiver  is  less.   The  BelRAI  project  2010  has  implemented  three  interRAI  instruments    -­‐  Home  Care,  Long  Term  Care  and  Acute   Care  -­‐  in  some  of  the  Belgian  care  seOngs.  They  have  been  tested  as  an  integrated  health  informa2on   system  that  permits  seamless  tracking  of  persons  with  the  poten2al  to  provide  person-­‐centered   informa2on  that  transcends  mul2ple  care  seOngs.   The  availability  of  an  integrated  mul2-­‐seOng  health  informa2on  system  offers  a  wide  array  of  opportuni2es  for   clinicians,  administrators  and  researchers  to  improve  con2nuity  of  care,  from  both  efficiency  and  quality  of   care  perspec2ves.  It  also  enables  evalua2ng  the  longitudinal  effects  on  the  micro-­‐level  (quality  of  care),  the   meso-­‐level  (management)  and  the  macro-­‐level  (policy).  
  • 4. Research  project   Online  registra2on  interRAI  data   Belgian  government  
  • 5. BelRAI  is  a  research  project    subsidized  by  the  FOD.  The  project  has  been  running  for  about  5  years  now.   BelRAI  is  an  online  registra2on  plaWorm  for  interRAI  and  other  assessment  data.   The  BelRAI  websites  are  mainly  driven  by  the  research  group  Lucas  from  the  university  of  Leuven  and  Pyxima   NV,  a  spin-­‐off  company  also  a[ached  to  the  university  of  Leuven.  
  • 6. Social & cultural differences •  3 languages •  Belgian context •  Specific settings  multiple changes
  • 7. The  socio-­‐cultural  differences  in  Belgium  require  mul2ple  adapta2ons  to  specific  seOngs  and  local  customs:  the   wording  of  the  instruments  should  be  adapted  to  the  prac2ce  of  German,  French  and  Dutch-­‐speaking   caregivers  by  means  of  an  accurate  and  explicit  use  of  words  (vocabulary).     Since  we  are  using  the  instruments  in  different  seOngs  we  use  the  interRAI  SUITE  instruments.  
  • 8. More  differences   •  Acute  Care   •  Home  Care   •  Long  Term  Care   Facility   •  Zarit  Burden   •  Economic  instrument   •  WHO-­‐QoL-­‐8   •  Katz   RAI   Others  
  • 9. In  addi2on  to  several  cultural  and  social  differences,  Belgium  has  many  different  governments:  6  to  be  precise;  6   governments  for  about  10.5  million  people.   We  also  have  different  research  projects  in  BELRAI;  this  means  interRAI  instruments  and  other  instruments   (WHO-­‐QoL-­‐8,  Zarit-­‐12  BurdenScale,  …).     But  the  main  focus  is  on  the  interRAI  instruments  …  
  • 11. It  is  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.   Every  caregiver  has  its  own  field  of  exper2se,  he  has  his  own  opinion  about  a  care  situa2on.     In  BelRAI  we  use  all  this  knowledge  of  all  the  involved  caregivers  while  collec2ng  the  data.  
  • 12. Flexibility   Mul2disciplinarity   Instrument   diversity   Mul2lingual   aspect   Adaptability   Support   Belgian   context   Extensible  
  • 13. When  talking  about  BelRAI  we  are  talking  about  different  aspects,  different  pieces  of  a  puzzle.   So  when  talking  about  BelRAI  we  think  of  support  for  the  caregivers,  having  Belgian  instruments,  the   mul2lingual  aspect,  flexible  building  blocks,  extensible  instruments,  a  wide  variety  of  instruments,   adaptability  and  mul2disciplinarity.   All  these  blocks  together  represent  the  BelRAI  VISION.  
  • 14. SCENARIO   A  story  about  the  BelRAI  vision  at  work  in  Belgium.  
  • 15. We  are  very  pleased  to  introduce  you  to  our  friend  Derick   Derick  Gartman   101  years  old   Single   Lives  alone   Hobbies:  roof-­‐jumping,         clubbing  ,  social-­‐networking  
  • 17. Derick  used  to  have  a  very  evenWul  life,  his  hobbies  are  roof-­‐jumping,  clubbing  and  social  networking,  but  lately   his  health  condi2on  hasn’t  been  that  good  anymore.   He  called  doctor  Fureman,  who  asked  Allison  –  the  home  health  care  nurse  –  to  visit  Derick  and  to  make  an   assessment.  
  • 19. So  the  day  aBer,  nurse  Allison  visits  Derick.  Allison  works  in  a  home  health  care  organiza2on  and  she  has  a  lot  of   experience  in  the  home  care  sector.  She  also  has  some  BelRAI  experience.  
  • 20. ALLISON  D.   Home  health  care  nurse   10  years  work  experience   3  years  BelRAI  experience   Works  in  HC  Organiza2on  
  • 22. Derick  tells  Allison  about  his  condi2on.  Allison  no2ces  that  the  situa2on  of  Derick  is  not  so  good.  So  she  wants  to   know  more  about  Derick’s  condi2on.     She  proposes  to  complete  an  interRAI  home  care  assessment.  Because  it  is  the  first  2me  for  Derick,  Allison   explains  all  about  it.   Derick  agrees,  signs  an  informed  consent  and  asks  Allison  to  be  in  charge  (to  be  responsible)  of  the  data  and  to   inform  his  doctor,  his  physiotherapist  and  the  other  home  health  care  nurse  about  his  situa2on.    
  • 24. Home  again,  Allison  is  very  happy  to  live  in  Belgium  because  to  complete  an  interRAI  assessment  she  only  has  to   log  in  onto  the  BelRAI  website.  
  • 26. To  be  able  to  access  the  BelRAI  website,  nurse  Allison  has  to  use  her  eID.  By  law,  every  Belgian  ci2zen  has  an  eID,   which  is  a  card  including  a  chip  –  comparable  to  a  credit  card  with  a  PIN  code.  When  using  a  card  reader   connected  to  her  computer  (which  can  be  seen  on  the  leB  side  of  your  screen)  and  aBer  having  put  her  card   in  the  card  reader,  Allison  will  be  able  to  log  in  onto  the  website.      
  • 27. BELGIAN  PRIVACY  COMMISSION   BELGIAN  GOVERNMENT   Levels  of  security   Electronic  ID  +  pincode   Roles/  professions  from   authenJcated  sources   BelRAI  roles   System  funcJons   QuesJon  types   L e v e l   1   L e v e l   2 & 3  
  • 28. The  card  reader  is  one  of  the  security  measurements  BelRAI  contains.   The  first  security  level  implies  that  the  data  from  the  card  reader  is  checked  by  a  central  Belgian  government   system.       The  Belgian  government  verifies  your  creden2als  and  passes  informa2on  to  BelRAI  regarding  who  you  are  and   what  your  profession  is.   On  the  basis  of  your  profession  BelRAI  can  determine  your  role  in  the  system.  Depending  on  that  role,  each  one   of  you  has  different  access  rights.  This  means  we  can  determine  what  you  are  allowed  and  what  you  are   not  allowed  to  do.  We  can  also  determine  which  kind  of  content  you  will  have  access  to.     All  these  security  seOngs  are  strictly  regulated  by  the  Belgian  privacy  commission,  which  is  also  a  government   ins2tu2on.  
  • 30. Allison  is  logged  in,  goes  to  the  homepage,  and  sees  the  naviga2on  bar  at  the  top  of  the  page.  She  can  manage   clients,  view  assessments,  generate  sta2s2cs,  etc.  (including  language  choice).     Below  the  naviga2on  bar,  she  can  see  some  quick  links.  At  the  bo[om  of  the  page,  there  is  a  small  security   check  concerning  her  BelRAI  role  and  the  last  2me  she  logged  in.   At  the  right  side  of  the  screen  she  can  see  the  assessments  she  has  been  involved  in  recently.  
  • 32. Allison  wants  to  find  Derick.  She  navigates  to  the  client  screen  and  types  Derick’s  name  in  the  search  box.   However,  Derick  is  not  in  the  system.      
  • 33. Gartman   Derick   West  park   België   Belg   123456789  
  • 34. To  put  Derick  in  the  BelRAI  system,  Allison  has  to  create  a  profile  for  Derick.  This  is  not  a  problem  because  in  this   par2cular  situa2on  Allison  has  enough  personal  informa2on  about  Derick  at  her  disposal  in  order  to  do   that.    
  • 35. grants  access  via   client  manager   gives  client   access  to   grants  access  via   client  manager   gives  client   access  to   Jerry-­‐  physiotherapist  Dr.  Fureman   John  –  Home  care  nurse   Allison  –  Home  care  nurse  
  • 36. ABer  that,  Allison  points  herself  out  as  the  client  manager  of  Derick  in  the  system.   Being  the  client  manager  of  Derick,  she  is  the  person  who  is  in  charge  of  all  Derick’s  data.     Doctor  Fureman  also  plays  a  central  role  in  the  health  care  organiza2ons.  Allison  points  out  doctor  Fureman  as   a  client  manager,  too.   She  also  gives  limited  access  to  the  physiotherapist  Jerry  and  the  other  home  care  nurse  John  (so  they  can  see   things  they  “need  to  know”  for  the  caregiving  process).      
  • 38. So  when  Allison  looks  back  at  the  detail  page  of  our  client  Derick,  she  now  can  see  all  about  Derick’s  status:     •  his  profile  (on  top),     •  his  client  managers  Allison  and  doctor  Fureman  (leB  side)  and   •  the  other  involved  caregivers  Jerry  and  John  (right  side).  
  • 40. Derick  being  known  by  the  system,  Allison  can  start  up  an  assessment  and  she  chooses  the  interRAI  home  care   assessment  adapted  to  the  Belgian  context.  
  • 42. There  are  different  and  mul2ple  steps  to  be  taken  in  order  to  start  up  an  assessment,  and  being  the  central   caregiver,  Allison  takes  responsibility    and  points  herself  out  as  the  assessment  responsable.  
  • 44. Because  Allison  wants  to  bring  together  different  professionals  in  this  assessment  process  she  also  points  out   other  par2cipants.  This  way  the  assessment  will  be  filled  out  more  professionally  and  2me  investment  and   effort  will  be  shared.   With  the  search  func2on  she  can  easily  find  the  caregivers  she  needs  for  this  assessment.  As  you  can  see  on  this   screen  doctor  Fureman  and  Jerry  the  physiotherapist  have  already  been  selected.  
  • 46. Once  the  assessment  is  created  Allison  gets  an  overview  with  more  detailed  informa2on  on  this  page.   Being  the  responsible  of  the  assessment,  Allison  has  access  to  all  ques2on  types.  (A  ques2on  type  is  a  collec2on   of  related  ques2ons).   Here  Allison  has  a  detailed  view  of  the  other  caregivers  involved:  doctor  Fureman  has  access  to  all  ques2ons.   The  other  caregivers  have  default  access  to  ques2ons  related  to  their  own  profession,  which  can  s2ll  be  changed   by  Allison  at  this  point.    
  • 47. Spread  the  word   Allison   Jerry   John     Dr.  Fureman  
  • 48. As  you  can  all  see  Allison  is  the  central  caregiver  for  this  assessment  and  being  a  very  responsible  person  she   contacts  (mails/phones)  everyone  to  inform  them  about  the  new  assessment.   At  this  moment  all  involved  caregivers  can  see  all  the  informa2on  they  need  to  know  (on  their  screens)  when   they  log  in  onto  BelRAI.  
  • 50. ABer  a  few  hours,  doctor  Fureman  logs  in  and  no2ces  the  Home  Care  assessment  Allison  has  started.  He  clicks   on  the  link  and  can  now  see  the  assessment.  
  • 52. At  the  leB  side  he  sees  all  the  different  sec2ons  that  are  included  in  the  Home  care  assessment.  Moreover,  he   can  see  how  many  items  each  sec2on  includes,  as  well  as  the  number  of  items  he  has  already  answered.       At  the  very  top  of  the  page  doctor  Fureman  sees  some  iden2fica2on  informa2on:  the  name  of  the  assessment,   the  reference  date,  and  the  client  informa2on.   In  the  middle  of  the  page,  doctor  Fureman  no2ces  the  different  items  and  decides  to  fill  out  the  item  “Falls”  in   the  sec2on  “Health  condi2on”.  
  • 54. At  the  same  2me,  Jerry  –  the  physiotherapist  –  also  logs  in  onto  BelRAI  and  starts  filling  out  the  Home  Care   instrument.  He  only  sees  2  sec2ons  of  the  assessment,  which  are  the  parts  he  has  access  to.  This  means  his   job  will  be  done  quicky.    
  • 56. John  –  a  home  care  nurse  –  wants  to  fill  out  the  sec2on  “ADL”.  He  has  a  problem,  though.  He  is  new  in  the   organiza2on  and  finds  the  informa2on  he  gets  on  his  screen  too  complicated,  he  doesn’t  have  a  clue…  So,   John  clicks  on  the  li[le  blue  help  icon  and  the  BelRAIWiki  (*)  pops  up  with  some  extra  informa2on  serving   as  a  guide  through  this  item.   *  The  BelRAIWiki  provides  the  caregivers  with  all  necessary  informa2on  concerning  all  the  interRAI  instruments  and  the  output/ outcome.  BelRAIWiki  is  also  linked  directly  to  the  BelRAI  website.  Every  specific  detail  or  informa2on  caregivers  should  know   is  just  “one  click  away”.  The  content  of  the  BelRAIWiki  is  informa2ve  and  holds  an  instruc2ve  plaWorm  to  centralize  and  to   spread  informa2on  about  the  InterRAI  tools  and  the  Belgian  BelRAI  project.  
  • 58. Four  days  later  Allison  wants  to  get  some  output.     Being  the  responsible  of  the  assessment  she  has  access  to  all  ques2ons  and  answers.   She  takes  a  look  and  no2ces  that  the  physiotherapist  and  the  other  home  care  nurse  have  given  DIFFERENT   ANSWERS  to  the  first  ques2on  on  SKIN  CONDITION.     She  contacts  both  colleagues  and  confronts  them  with  their  opinions.  ABer  a  brief  consulta2on  she’s  able  to   form  a  be[er  image  of  the  situa2on  and  to  formulate  a  more  exact  or  precise  answer  to  that  ques2on.     She  leaves  the  other  NOT  CONFLICTING  ANSWERS  untouched.   She  also  answers  a  few  ques2ons  her  colleagues  had  not  been  able  to  answer  due  to  a  lack  of  informa2on.     Once  the  assessment  is  completed  and  checked,  Allison  lets  the  system  process  the  answers.  
  • 60. On  this  page  Allison  sees  all  calculated  CAPs,  Scales,  and  nursing  and  medical  health  profiles.     First  of  all  the  CAPs;  on  the  leB  side  all  the  possible  CAPs  concerning  the  Home  Care  situa2on.  On  the  right  side   the  calculated  results  or  scores.   With  a  click  on  the  blue  icons  Allison  can  connect  with  the  BelRAIWiki  website  (*)  and  get  more  general   informa2on  about  the  concerned  CAP  or  more  informa2on    about    the  calculated  outcome  and  guidelines.     *  The  BelRAIWiki  provides  the  caregivers  with  all  necessary  informa2on  concerning  all  the  interRAI  instruments  and  the  output/ outcome.  BelRAIWiki  is  also  linked  directly  to  the  BelRAI  website.  Every  specific  detail  or  informa2on  caregivers  should  know   is  just  “one  click  away”.  The  content  of  the  BelRAIWiki  is  informa2ve  and  holds  an  instruc2ve  plaWorm  to  centralize  and  to   spread  informa2on  about  the  InterRAI  tools  and  the  Belgian  BelRAI  project.  
  • 62. Same  thing  concerning  the  Scales.   Again  at  the  leB  side  all  possible  scales  concerning  the  Home  Care  situa2on  with  the  CHESS,  MAPLe  and  PURS   included;  on  the  right  side  the  calculated  scores  concerning  this  assessment.   Again  all  scales  and  results  are  linked  to  the  BelRAIWiki  website.  
  • 64. The  other  page  shows  the  possibility  to  produce  two  health  profiles:  one  is  a  collec2on  of  more  nursing-­‐oriented   items,  CAPs  or  scales  and  the  other  collects  more  medical-­‐oriented  output.   When  the  assessment  is  closed  by  Allison  the  caregivers  that  have  filled  out  the  assessment  and    other  persons   that  have  been  granted  access  to  Derick’s  profile  can  take  a  look  at  the  results  online  (aBer  having  logged   in  onto  BelRAI  using  their  eID).     On  that  basis  health  care  can  be  evaluated  and  adjusted.  
  • 65. A  walk  in  the  park  …   Aaaah  
  • 66. Derick  is  feeling  be[er  and  decides  to  go  for  a  walk  in  the  southern  (French-­‐speaking)  part  of  the  country.   Unfortunately,  he  has  an  accident  and  ends  up  in  the  hospital.  
  • 68. Derick  is  examined  by  doctor  Mouse  and  the  French-­‐speaking  nurse  Marie.   Doctor  Mouse  doesn’t  know  Derick  and  wants  to  know  more  about  his  condi2on  before  going  into  ac2on.  
  • 70. He  logs  in  onto  the  BelRAI  website  and  takes  a  look  at  Derick’s  details.     However,  he  can  only  see  some  iden2fica2on  informa2on  and  Derick’s  client  managers.     All  the  other  informa2on  is  not  accessible  to  him.  
  • 71. gives  client   access  to   gives  client   access  to   Dr.  Mouse   Allison   Marie  
  • 72. Doctor  Mouse  contacts  Allison  and  explains  the  situa2on  to  her.   Allison  understands  and  grants  doctor  Mouse  and  nurse  Marie  access  to  Derick’s  informa2on.      
  • 74. Doctor  Mouse  logs  in  onto  BelRAI.   On  Derick’s  client  detail  page  he  sees:   •  Derick’s  profile,   •  His  client  managers  Allison  and  doctor  Fureman,   •  himself  and  nurse  Marie  also  having  access  and   •  the  home  health  care  group  with  the  other  caregivers  (the  physiotherapist  and  the  other  home  care  nurse).   At  this  moment  he  also  has  access  to  previous  assessments,  in  this  case  the  home  care  assessments,  and  the   calculated  results  or  output  concerning  Derick’s  health  condi2on.  
  • 76. Nurse  Marie  is  French-­‐speaking  but  this  is  not  a    problem  in  BelRAI.   Nurse  Marie  can  switch  to  her  own  language  and  consult  everything  in  French.     When  filling  out  an  Acute  Care  assessment  with  a  click  on  a  chosen  previous  assessment  (blue  –  li[le  menu  on   the  right)  she  has  the  opportunity  to  automa2cally  take  over  the  answers  of  a  previous  assessment  for  a   whole  sec2on  at  once  and  if  needed  adapt  some  answers  to  the  current  situa2on.  
  • 78. Secondly,  with  the  help  of  a  history  menu  she  can  also  consult  and  take  over  previous  answers  for  each  ques2on   separately.  
  • 80. Once  the  Acute  Care  assessment  is  completed  and  checked,  nurse  Marie  lets  the  system  process  the  answers.     By  means  of  this  page  Marie  can  consult  all  calculated  CAPs,  Scales,  and  nursing  and  medical  health  profiles  in   her  own  language.   Again  all  results  are  public  for  the  involved  caregivers.  
  • 82. Two  weeks  later  Derick’s  condi2on  has  improved,  he  is  feeling  much  be[er  and  he  is  allowed  to  leave  the   hospital.  
  • 84. Despite  all  that  doctor  Mouse  advices  Derick  a  short  stay  in  a  Long  Term  Care  Facility  in  order  to  strenghten  up   before  going  home.  
  • 86. ABer  admission,  same  story  again  in  the  Long  Term  Care  Facility.     When  assessing  Derick’s  situa2on  all  involved  caregivers  can  consult  the  previous  assessments:  the  Home  Care   and  Acute  Care  assessments.  
  • 88. Four  weeks  later  Derick  goes  home  and  is  very  pleased  to  meet  Allison  again.  
  • 90. Derick  being  home  again,  for  Allison  and  her  team  it  is  no  problem  at  all  to  consult  all  the  previous  assessments             and  the  related  output  CAPs,  Scales,  health  profiles  and  sta2s2cs  so  they  can  have  a  direct  view  on  Derick’s   condi2on.  
  • 91. END  SCENARIO   SOUTH  PARK  ©2010  ComedyPartners.  All  Rights  Reserved  
  • 92. This  is  the  end  of  a  short  story  showing  us  an  example  of  how  things  can  go  in  Belgium.  
  • 94. Project  status:  tests  in  different  parts  of  the  country.   Different  seOngs:  HC,  AC,  and  LTCF  (2011:  Pallia2ve  Care,  Mental  Health,  …)    
  • 95. BelRAI   ProducJon  site  WIKI  AcceptaJon  site  Dev.  site   Caregivers  &   research  teams   Development  &   research  teams   Caregivers  
  • 96. BelRAI  includes  four  websites:   •  a  development  site;   •  an  accepta2on  site:  educa2on  &  demonstra2on  (dummy  data);   •  a  produc2on  site:  real  data;  and     •  the  BelRAIWIKI:  online  help,  maintained  by  researchers  and  always  available  
  • 98. In  a  standard  model  a  caregiver  uses  the  BelRAI  website  separately  from  his  other  soBware.  
  • 99. BelRAI  with  applicaJon  integraJon   e-­‐Health  
  • 100. BelRAI  is  working  on  a  system  that  will  enable  access  to  the  interRAI  data  through  the  exis2ng  (health  care)   applica2on(s)  of  the  organiza2ons.  
  • 102. We  emphasize  2  areas:  the  content  &  the  technical  part.   We  con2nue  to  improve  and  create  new  features  on  both  levels,  always  keeping  the  focus  on  the  caregivers  and   the  pa2ents.  
  • 103. New  instruments   New  algorithms   Extra  staJsJcs  &  benchmarking  tools   CMS  
  • 104. We  are  currently  working  on  new  instruments:  Pallia2ve  Care  &  Mental  Health  (also  other  non-­‐interRAI   instruments).   Implementa2on  of  new  algorithms:  RUGs,  etc.   We  are  extending  the  stats  on  an  organiza2onal  &  individual  level  (&  care  plan).   We  are  taking  another  step  in  the  development  of  a  Content  Managing  System  allowing  us  the  online  crea2on   of  new  instruments.  
  • 106. We  are  nego2a2ng  with  interRAI  so  as  to  become  an  official  interRAI  soBware  vendor.  
  • 108. Conclusion:   •  More  than  5  years  ago  everything  started  with  the  choice  of  an  assessment  instrument    InterRAI   instruments.   •  We  feel  BelRAI  is  growing  thanks  to  the  flexible  approach  and  vision  we  have  been  loyal  to.     •  Today,  BelRAI  seems  to  be  ready  to  be  taken  to  the  next  level.  
  • 109. Presenters   Jurgen  Berden     Managing  Director  Pyxima   Jurgen.Berden  @pyxima.com   Dirk  Vanneste     Researcher  Lucas   Dirk.Vanneste@med.kuleuven.be   Lucas:  A.  Declercq,  J.  Mello,  L.  Vesen2ni     Idea  &  Artwork  by  Jurgen  Berden  –  Content  by  Dirk  Vanneste  &  Jurgen  Berden  –  Pictures  courtesy  of   flickr.com  &  Jurgen  Berden  -­‐  SOUTH  PARK  ©2010  Comedy  Partners.  All  Rights  Reserved.  Comedy  Central,   South  Park  and  all  related  2tles,  logos  and  characters  are  trademarks  of  Comedy  Partners.