interRAI: a blueprint for establishing a national clinical software system


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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

  1. 1. interRAI a blueprint for establishing a national clinical software system Andrew Downes National interRAI Host manager
  2. 2. Session Objectives <ul><li>Describe: </li></ul><ul><ul><li>What interRAI is and why its important </li></ul></ul><ul><ul><li>The development of the NZ hosted model </li></ul></ul><ul><ul><li>Benefits and challenges implementation </li></ul></ul><ul><ul><li>Blueprint for a national clinical system </li></ul></ul>
  3. 3. What is interRAI? <ul><li>interRAI ( ) is a collaborative   network of researchers   in over   30 countries committed to improving health care for persons who are elderly, frail, or disabled. </li></ul><ul><li>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. </li></ul>
  4. 4. Kick off - 2003 Health of Older People Strategy <ul><ul><li>Gap between current and best practice </li></ul></ul><ul><ul><li>Need Evidence based approach </li></ul></ul><ul><ul><li>Assessment Process for Older People (2003)NZGG </li></ul></ul>
  5. 5. Recommendations <ul><li>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 </li></ul><ul><li>Standardisation of assessment processes across New Zealand is essential </li></ul><ul><li>A standardised assessment tool and standard methods of collecting, reporting and comparing data should be used </li></ul><ul><li>Tools for screening and assessment should be complementary parts of an integrated system </li></ul>
  6. 6. Review of available tools - interRAI fits the bill <ul><li>Provide evidenced based personal assessment </li></ul><ul><li>Reliable, valid, accessible information across a range of assessment domains </li></ul><ul><li>Very rich information, provides comprehensive picture of the individual, not always the case prior... </li></ul>
  7. 7. Good reasons to use interRAI <ul><li>Best practice </li></ul><ul><li>Normal assessment process automatically provides evidence based: </li></ul><ul><ul><li>Care planning guidelines (decision support), outcomes, risk profiles, casemix and quality of care indicators: </li></ul></ul><ul><ul><li>Scale from the person to the population </li></ul></ul><ul><li>Better services and outcomes </li></ul><ul><li>In a resource constrained environment allows (transparent) prioritisation of services to target care to those in need and with ability to benefit </li></ul><ul><ul><li>Individual and population levels </li></ul></ul>
  8. 8. NZ interRAI host - history <ul><li>Host model has been developing for a while </li></ul><ul><ul><li>5 DHB pilot 2004-06 </li></ul></ul><ul><li>National bus. Case 21 CEOs </li></ul><ul><li>National project (2008-12) </li></ul><ul><ul><li>20 organisations (12 DHBs) already hosted in some form </li></ul></ul><ul><ul><ul><li>> 50% of >65 population </li></ul></ul></ul><ul><ul><ul><li>> 400+ users and growing </li></ul></ul></ul><ul><li>Purpose is to provide access to the interRAI assessment tools </li></ul><ul><li>Very distributed models of care </li></ul><ul><ul><li>Mobile working is the norm and Mrs Jones’ home becomes the office </li></ul></ul>
  9. 9. The technical model <ul><li>Connection options </li></ul><ul><ul><li>Internet (https) </li></ul></ul><ul><ul><li>Secure health networks </li></ul></ul><ul><ul><li>Check in/check out </li></ul></ul><ul><li>Options take into account variety of factors </li></ul><ul><ul><li>Workflow </li></ul></ul><ul><ul><li>Telco coverage </li></ul></ul><ul><ul><li>‘ Ruralness’ </li></ul></ul><ul><ul><li>DHB/NGO/primary care provider </li></ul></ul>
  10. 10. Principles <ul><li>This will be a standardised implementation – there will be no essential differences between hosts nor between DHBs </li></ul><ul><li>Changes from the standard interRAI software will be made only with national interRAI user group agreement </li></ul><ul><li>There will be simple, national-level integration rather than complex, DHB-level integration </li></ul><ul><li>The system will not be treated as mission critical </li></ul><ul><li>The solution will scale to accommodate future user base increases and enhanced functionality </li></ul>
  11. 11. Challenges – national implementation <ul><li>How many times shall we do this? </li></ul><ul><ul><li>20 DHBs? </li></ul></ul><ul><ul><li>50+ DHBs and service providers </li></ul></ul><ul><ul><li>4 regions? </li></ul></ul><ul><li>Those who are doing it already and have the knowledge to continue </li></ul><ul><ul><li>Host across 2 DHBs Canterbury DHB and HIQ (IT Service Provider owned by Taranaki DHB) </li></ul></ul><ul><ul><li>‘ Mandate’, consolidate, standardise hosts </li></ul></ul><ul><ul><li>Endorsed by CIOs and national project </li></ul></ul>
  12. 12. Challenges – local implementation <ul><li>Technical implementation of standard client software for ‘check in check out’ locally </li></ul><ul><li>Strangely enough, each hosted organisation is different(!) </li></ul><ul><ul><li>Infrastructure, policies, processes </li></ul></ul><ul><ul><li>‘ Chalk and cheese’ </li></ul></ul><ul><ul><li>Consider niche system </li></ul></ul><ul><ul><li>Its a new model....requires a period of time for organisations to adjust to </li></ul></ul>
  13. 13. Single national SLA, holds host manager to account Challenges – host performance & governance
  14. 14. Advantages of the hosted model <ul><li>Over 5 years TCO is $4.5M less than if we’d have done this 20 times </li></ul><ul><li>Reduce integration complexity and cost </li></ul><ul><li>Scalable </li></ul><ul><li>Redundancy (failover within and across) </li></ul>
  15. 15. 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
  16. 16. Acknowledgements <ul><li>Chris Dever - Chief Information Officer, Canterbury District Health Board and the CDHB ICT team </li></ul><ul><li>Darren Douglass - Chief Health Information Officer, HIQ Ltd and the HIQ ICT team </li></ul><ul><li>Dr Brigette Meehan – Ministry of Health </li></ul><ul><li>Dr Nigel Millar – Chief Medical Officer CDHB (& NZ interRAI fellow) </li></ul><ul><li>Various ICT staff across hosted organisations </li></ul>