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interRAI: a blueprint for establishing a national clinical software system

interRAI: a blueprint for establishing a national clinical software system



Andrew Downes

Andrew Downes
National Host manager, interRAI
(4/11/10, Civic 1, 11.30)



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    interRAI: a blueprint for establishing a national clinical software system interRAI: a blueprint for establishing a national clinical software system Presentation Transcript

    • interRAI a blueprint for establishing a national clinical software system Andrew Downes National interRAI Host manager
    • Session Objectives
      • Describe:
        • What interRAI is and why its important
        • The development of the NZ hosted model
        • Benefits and challenges implementation
        • Blueprint for a national clinical system
    • What is interRAI?
      • interRAI ( www.interRAI.org ) is a collaborative   network of researchers   in over   30 countries committed to improving health care for persons who are elderly, frail, or disabled.
      • Their goal is to promote evidence-based clinical practice and policy   decisions through the collection and interpretation of high quality data about the characteristics and outcomes of persons served across a variety of health and social services settings.
    • Kick off - 2003 Health of Older People Strategy
        • Gap between current and best practice
        • Need Evidence based approach
        • Assessment Process for Older People (2003)NZGG
    • Recommendations
      • Assessment of older people should be comprehensive and multidimensional as this leads to provision of services to improve health and well-being of the older person and their carers
      • Standardisation of assessment processes across New Zealand is essential
      • A standardised assessment tool and standard methods of collecting, reporting and comparing data should be used
      • Tools for screening and assessment should be complementary parts of an integrated system
    • Review of available tools - interRAI fits the bill
      • Provide evidenced based personal assessment
      • Reliable, valid, accessible information across a range of assessment domains
      • Very rich information, provides comprehensive picture of the individual, not always the case prior...
    • Good reasons to use interRAI
      • Best practice
      • Normal assessment process automatically provides evidence based:
        • Care planning guidelines (decision support), outcomes, risk profiles, casemix and quality of care indicators:
        • Scale from the person to the population
      • Better services and outcomes
      • In a resource constrained environment allows (transparent) prioritisation of services to target care to those in need and with ability to benefit
        • Individual and population levels
    • NZ interRAI host - history
      • Host model has been developing for a while
        • 5 DHB pilot 2004-06
      • National bus. Case 21 CEOs
      • National project (2008-12)
        • 20 organisations (12 DHBs) already hosted in some form
          • > 50% of >65 population
          • > 400+ users and growing
      • Purpose is to provide access to the interRAI assessment tools
      • Very distributed models of care
        • Mobile working is the norm and Mrs Jones’ home becomes the office
    • The technical model
      • Connection options
        • Internet (https)
        • Secure health networks
        • Check in/check out
      • Options take into account variety of factors
        • Workflow
        • Telco coverage
        • ‘ Ruralness’
        • DHB/NGO/primary care provider
    • Principles
      • This will be a standardised implementation – there will be no essential differences between hosts nor between DHBs
      • Changes from the standard interRAI software will be made only with national interRAI user group agreement
      • There will be simple, national-level integration rather than complex, DHB-level integration
      • The system will not be treated as mission critical
      • The solution will scale to accommodate future user base increases and enhanced functionality
    • Challenges – national implementation
      • How many times shall we do this?
        • 20 DHBs?
        • 50+ DHBs and service providers
        • 4 regions?
      • Those who are doing it already and have the knowledge to continue
        • Host across 2 DHBs Canterbury DHB and HIQ (IT Service Provider owned by Taranaki DHB)
        • ‘ Mandate’, consolidate, standardise hosts
        • Endorsed by CIOs and national project
    • Challenges – local implementation
      • Technical implementation of standard client software for ‘check in check out’ locally
      • Strangely enough, each hosted organisation is different(!)
        • Infrastructure, policies, processes
        • ‘ Chalk and cheese’
        • Consider niche system
        • Its a new model....requires a period of time for organisations to adjust to
    • Single national SLA, holds host manager to account Challenges – host performance & governance
    • Advantages of the hosted model
      • Over 5 years TCO is $4.5M less than if we’d have done this 20 times
      • Reduce integration complexity and cost
      • Scalable
      • Redundancy (failover within and across)
    • Single national SLA, holds host manager to account Host service contracts Central support (Ministry of Health) Single interRAI host (or other system) Clinical lead & ‘ community of interest’ clinical reporting & research A good reason to do this
    • Acknowledgements
      • Chris Dever - Chief Information Officer, Canterbury District Health Board and the CDHB ICT team
      • Darren Douglass - Chief Health Information Officer, HIQ Ltd and the HIQ ICT team
      • Dr Brigette Meehan – Ministry of Health
      • Dr Nigel Millar – Chief Medical Officer CDHB (& NZ interRAI fellow)
      • Various ICT staff across hosted organisations