Innovative Technologies in Community CareAllan Turner

CIO, Silver Chain Group

AustraliaNovember 2011

The Australian Landscape

• The Productivity Commission Report; Caring for Older Australians, August 2011 notes;

– Ageing of the Australian population—by 2023, 20% of the population will be over 65 years of age

– Preference for independent living arrangements and choice– Increase in morbidity among aged and management of chronic conditions

(diabetes, dementia, arthritis, visual and hearing impairments)– Reduced access to carers and family support– High and unmet demand for limited number of community care packages (of

services)– Decline in demand for residential low care– Restriction of high care residential places to ‘extra service’ places that attract

higher accommodation bonds

The Australian Landscape

ACAA 30th Annual Congress (November 2011)

• Productivity Commission Review and Reform– The release of the aged care report from the Productivity Commission raises the

prospect of unprecedented reform of aged care. Will the Government take up this challenge?

• Residential Care, Community Care and Retirement Living Interface– As is the case in many overseas jurisdictions Australia is gradually seeing a coming

together of care and accommodation systems that had previously operated in silos. Will this trend continue?

• Innovative Service Models– Will tomorrow's consumer be happy to accept todays solutions? Will technology

change the face of care options? Will future consumers take much greater management of their healthcare and health data?

• Community– Australians are emphatic that they wish to stay in their own home and live

independently for the rest of their lives. Is this aspiration sustainable?

About Silver Chain Group

Statistics 2010:2011

Hours of care: 1,619,124

Clients assisted: 62,337

Clients visited per day: 4,943

Occasions of service: 2,271,426

Klms travelled : 20,797,206

Staff (Volunteers): 3,380 (411)

Revenue $193 million

Our PurposeTo create, build and sustain

community capacity to optimise health and wellbeing for

individuals in their homes and communities

• Health Care– Home Hospital, Hospital in the Home Program, Post-Acute Care,

Community Nursing– Diabetes, wound and continence management and advice clinics– In-home palliative care– Remote nursing

• Community Care– Home and Community Care (HACC) - personal care, domestic

assistance, social support, respite– Community Aged Care Packages / EACH Packages– Independence Programs: Home Independence Program, Personal

Enablement Program, Social Enablement– HACC Regional Assessment service – metro wide

• Commonwealth Respite and Carelink Centre – Aged care information gateway and manage brokering of respite for carers

• Training and Education

Silver Chain major programs

ComCare and ComCare Mobile

ComCarePatients/

Clients

Patient Record

Patient Eligibility

Referrals

Assessments and Care Plans

Service Delivery

Clinical Record

Discharge

Equipment Management

Wound Management

Record of services, consumables, etc...

Clinical actions, indicators, diagnosis...

Schedule

Single/Group

Client Demographics, Alerts, Client History, Previous Diagnoses...

Record source of referral and services requested

Contract and Clinical Eligibility

Assessments using “Questionnaires”; Care

Plans generated

Assign client to a Round and Schedule

ComCarePatients/

Clients

Patient Record

Patient Eligibility

Referrals

Assessments and Care Plans

Service Delivery

Clinical Record

Discharge

Equipment Management

Wound Management

Commissioners/Management

Contract Management

Block Contracts/Fees for

Service

Service and Clinical Costs by Client and

Groups

Finance System

Reporting to Funders

Management Reporting

Record of services, consumables, etc...

Clinical actions, indicators, diagnosis...

Schedule

Single/Group

Client Demographics, Alerts, Client History, Previous Diagnoses...

Record source of referral and services requested

Contract and Clinical Eligibility

Assessments using “Questionnaires”; Care

Plans generated

Assign client to a Round and Schedule

Care Packages

ComCarePatients/

Clients

Patient Record

Patient Eligibility

Referrals

Assessments and Care Plans

Service Delivery

Clinical Record

Discharge

Equipment Management

Wound Management

Care Providers

Organisation Chart

Care Provider Records

Rosters

Timesheets

Candidate (recruitment)

Tracking

Training

Occupational Safety & Health

Car Fleet Allocations

Messaging

Commissioners/Management

Contract Management

Block Contracts/Fees for

Service

Service and Clinical Costs by Client and

Groups

Payroll SystemFinance System

Reporting to Funders

Management Reporting

Nursing Manuals

Automatic Completion using Mobile Technology and Google Maps

ComCare Modules and Process Flows

Procedure manuals...

Record of services, consumables, etc...

Clinical actions, indicators, diagnosis...

Record of employment applications...

Organisation(s), Positions, postings and

employees...

Scheduled/ completed, position/employee...

Incident, accident recording etc...

Assign Care Providers to Rosters; GeoCode using Google Mapping...

Employee details, service centre, hours of work, classification, qualifications

Vehicle allocation, Maintenance, Accidents

Mileage etc

Continuous Improvement

Process Mapping

Schedule

Single/Group

Client Demographics, Alerts, Client History, Previous Diagnoses...

Record source of referral and services requested

Contract and Clinical Eligibility

Assessments using “Questionnaires”; Care

Plans generated

Assign client to a Round and Schedule

Care Packages

• Large and mobile workforce – need to be able to provide and capture up to date information 24/7

• Enables our nurses to be able to access information about clients such as their details, referrals, diagnosis, alerts, contacts and services. 

• Enables nurses to record in real time the clients assessment details and information about wound care. 

The Mobile Application

Clients Assessments Admission wizard

Contacts Clinical details Messages

Access comments Wound management Alerts

Service details Schedule/roster Maps and GPS tracking

Task details Timesheet OSH checklist

Client equipment Manuals (nursing & quality) Continuous Improvements

The (WA) Mobile Users (total group mobile users 2,000+)

The Mobile Devices

The Mobile Benefits

Clients

Better care

Increased privacy

Reduced errors

Less hospital visits

Improved quality of life

Staff

Greater safety

Better information

Feel connected

Reduce travel time

Reduce paperwork

Organisation

Reduce overheads

Improve unit costs

Efficient processes

Increased productivity

Reduce travel time

Better information

The Business Cycle

DATA

INFORMATION

KNOWLEDGE

UNDERSTANDING

COMMUNICATION

ACTION

ComCare

Random pieces of available information

Mobile Timesheets

DATA

INFORMATION

KNOWLEDGE

UNDERSTANDING

COMMUNICATION

ACTION

“Oh no something else I have to learn and worried that it was going to that

will take up time…….“But now yeah it great, its been very

easy to learn”

• Auto download of care workers workload / timesheet

• Updated daily for today and 4 days ahead

• Data recorded in real time and submitted daily

• 600 mobile timesheet users

Savings ProjectTotal savings

(est.)*

Timesheets (TS) - messaging $60,000

TS - Carrier voice contract $180,000

TS - Calls to Customer Operations $620,000

TS - Remove paper system $500,000

TS – Total estimated savings per year $1,360,000

Mobile Timesheets

DATA

INFORMATION

KNOWLEDGE

UNDERSTANDING

COMMUNICATION

ACTION

• 16,784 wounds total

• 2,456 active wounds

• 20,316 assessments

• 21,551 treatment plans

• 14,469 treatments

• 353,071 dressings

• 5,943 Notes

Wound Care

“With the phone we can bring wound care in real time with real data.”………

“We can now prove the worth of the work our nurses have been doing for years.”

Wounds

ComCare Travel Smart Stay Safe

Travel Efficiencies

• A days nursing activity at a location after optimisation: 62 hours of travel reduced to 27 hours and 3708 kms reduced to 1620 kms

• A nursing round after sequencing: Saving = 1 hr 42 mins & 53 km

• Savings potential $6,000,000 per year

Route Optimisation and Visit Allocation (ROVA)

ROVA considersTravel distance to first client.Travel distance between clients.Travel distance home from clientTime provider is early for a visitTime provider is late for a visitThe preferred providerVisits occurring outside of shiftProviders identified not suitableThe provider ideally suited

Uses genetic algorithms (mimics natural evolution)Potential savings ≈ $millions

A Connected Workforce

ComCare Process Flows

ComCare Reporting

KPI Reporting

• Directs peoples behaviour

• Makes performance visible and focuses attention

• Clarifies expectations and provides objectivity

• Improves execution and promotes consistency

• Country nursing unit cost fell by 40% in 3 months

• Central assessment recording saving $250,000 per year

• At one centre cost per 1 direct hr fell by 11% saving

$24,000 per month

KPI Reporting

Telehealth

Hospital admissions of Silver chain clients over 5 ½ yrs 67,674 individuals 286,185 admissions Average LOS 7.6 days Any one day Silver chain clients use 1,085 beds 51% had a diagnosis of chronic diseaseRandomised control trial 120 chronic heart failure 80 chronic obstructive pulmonary diseaseFindings Per person cost savings = $2,931 per year High level of Client satisfaction Increased self confidence, control and awareness Improved sense of security and reduced anxiety

Telehealth

Summary

Improve client care and increase

capacity

Drive down Logistics costs and reduce

inefficiencies

E: aturner@silverchain.org.au

M: +61 419 907 357