The Implementation of Integrated Health Information Systems – Research Studies from 7 Countries Involving the InterRAI Assessment System

• Common language across settings.,

• Continuity of care,

• Improvement and standardization of observations,

• Involvement of several disciplines in the assessment (multidisciplinary).

• One single platform to exchange information.

• Common language across settings

• Holistic approach: Identifying early decline and domains that are not strictly “medical”

• Useful in interdisciplinary discussions

• Facilitates coordination of care by shared information, especially in situations of co-management i.e.

• Better and comprehensive assessment of resident’s needs

• Participation of residents and caregivers in their assessment

• Reinforcement of the multidisciplinary approach

• Improvement of gerontology knowledge

• Real time production of decision support information which can be shared by personnel.

• supports clinical decision-making/corporate decision-making

• facilitates individualised care planning and integrated care

• provides case-mix classification at management and systems level

• Common language across settings, Resource Utilisation

• Quality indicators

• Research

• Makes the demands of the work in older people’s care visible

• Helps to identify clients’ needs (how and what to observe) and create the individual care plan

• Helps to monitor client level outcomes

• Shows the quality of the performed work

• Helps the workers to discuss with relatives, and informal carers

• Common language across settings

• Decision support properties for assessors to inform care

• Transparent and objective review of assessment quality

• Supports prioritisation and eligibility processes

• One single platform (assessment record) to exchange information.

• Benchmarking across organisations.

• Resource planning.

• Evidence based decision making

policy makers:

• Decision support based on valid and comparable data

• Potential to support and monitor public health programs across the care continuum (quality, care trajectories, care expenses, alternative care structures, community-enhancing initiatives, comparisons)

• Interoperability for electronic health records and integration in data warehouse

• Focus from acute problems to prevention and identifying early decline

• The 2-step use of interRAI CU and the interRAI HC to differentiate length of assessment according to the care complexity is more efficient

• The change to broaden the assessors’ job to non-nursing disciplines is greatly appreciated (e.g. social workers, occupational therapist, nutritionist)

• Difficult to change existing practice and to change routine processes

• quality indicators produced by the assessment

For case managers using the interRAI HC:

• making the link between the comprehensive assessment and the care planning

• Legitimation of their role as case managers

• Police makers and care managers were not involved in the evaluation

• enables quality monitoring, benchmarking, and service improvement

• informs eligibility criteria for access to services

• supports prioritisation of services access based on assessed need

• targets priority groups or identifies groups that are at relative risk of adverse outcomes

Policy Makers:

• Enhances knowledge of client care populations

• Identifies service need/service improvements

• Informs allocation of resources and prioritisation of services based on real-time assessed needs

• Can determine eligibility for services

• Prioritises service users who are most in need

• Provision of data for performance monitoring and quality assurance

• Allows managers to track and compare their organisations’ responses to quality of care issues

• Better management of services/resources

• Demonstration of effective care/value for money

• Helps in dividing tasks between distinct professions, in units

• Shows gaps in staff knowledge/strengths in expertise and helps planning of further education of the existing staff, and recruiting new type workers

• Organisational leaders:

• tool for regulative procedures

• setting strategic/tactical goals for the organisation

• protects from false accusations (from media, individuals)

Regional leaders

• case-mix and quality comparisons of public and outsourced care providers Though benchmarking

• follow-up of performed policies

• issues of integrated care can be solved in the future

• Payment systems piloted

• National leaders/Policy makers:

• Creating new policies and follow-up of the outcomes (safety and quality of care, gate-keeping criteria, staffing ratio etc.)

• Identifying need for new legislations/guidelines

• Electronic records and IT infrastructure is not always available.

• Overlap with other instruments already used in the care practice.

• Low involvement of GPs.

• Time consuming at first but time saved after first assessment is filled out.

• Fear that clinical judgement will become redundant.

• Difficult to learn

• Needs specific coaching to integrate it into team processes on the field

• Overlap with existing assessments in use

• Fears of administrative charge (MDS-NH was purely used for funding)

• Software is often non-attractive as some vendors do not use the full potential and are not focused on user-friendliness

• Low involvement of GPs

• The locally-made derived versions in the Swiss context are different from the original internationally validated system and therefore

• confusing (Swiss version of RUGs, QIs, item content, development of RAI-like instruments…)

• Data literacy is often low

• Quality of trainings varies

• Technical software support for longitudinal data visualisations across settings is not developed yet in Switzerland

• No integration in national electronic health record yet

• For inter-institutional use, guidelines and communication structures are needed

• Fears of the standardisation practices

• Identification of work-organisation problems in nursing home

• Lack of connection between research purpose and a routine clinical utilization

• Lack of appropriation of other applications

• Length of assessment – time consuming

• ICT connectivity/offline use

• Software/hardware issues

• Perceived to be time consuming

• tardy integration into the Electronic Medical Record and the Nurses Records

• limited support to utilise the information to change practice.

• Need for education in how to assess the client needs interRAI-tools

• assessment process is time consuming

• bedside education of new workers is time consuming

• need for education how to lead and manage with help of interRAI-tools

• cautiousness among staff and leaders about how to use the tools (human makes the decisions)

• incompatibility or only partial compatibility of interRAI systems with patient/client records within jurisdictions

• incompatible software solutions have been a barrier for integrated care between jurisdictions

• Conceptual and terminology challenges for assessors changing from a subjective and narrative questionnaire type of assessment to a software supported and transparent assessment system with decision support properties.

• Trust and confidence in a new assessment process.

• Potential loss of clinical autonomy.

• Trust and confidence in the software system.

• Interoperability barriers if the software does not connect with other systems in use.

• Trust and confidence in the data. Resources or knowledge to analise or use the data.

• Time consuming during the learning period.

• Translation into national languages (Dutch, French and German).

• Adaptation of the instruments and manuals to the Belgian social care and health care settings.

• Evaluation of the existing use of assessment instruments in general and interRAI in particular. Exploration of the context (clinical, political). Mapping of the stakeholders (roles – agendas).

• Translation into the French language.

• Selection of interRAI- system of Assessments and Customisation/locatisation of instruments, associated manuals, and CAPs for use in the Irish context.

• Translation into Icelandic

• Translation into Finnish and Swedish languages

• Transparent process to select interRAI (Tools Review).

• Business cases approved

• Project management infrastructure established.

• Active communication with the sector.

• Comparison between the instruments to make them compatible across settings.

• Developing a roadmap to introduce the newest generation interRAI Suite with focus on clinical use.

• Organisation of a conference to introduce the public health program to the field.

• Participation in comparative studies with interRAI LTCF and HC instruments

• Development of IT platform (Testing/Training and live applications) and associated eLearning System

• Establishment of interRAI Iceland committee which worked within the MOH and later within the Medical Director General.

• Back translation of the Finnish version. A version of Swedish translation received from Sweden, and modified according the language used in Finland.

• Acceptance from Māori for the items and assessment process.

• Customisation of demographic items and New Zealand English terms.

• Creation of an IT platform allowing professional caregivers from several disciplines to fill out the instruments in a multidisciplinary way (physicians, nurses, physiotherapists, occupational therapists, social assistants, etc.).

• Creation of a legal framework (a decree) enhancing electronic health records and a common language between health settings to reinforce coordination and continuity of care. Strong political signal for policy support.

• Creation of a non-profit organisation InterRAI France to promote the implementation.

• Development of Training Programme tailored to user groups (Assessors, Decision Makers, etc.)

• IT platform developed in Icelandic and compatible for all assessment forms.

• Creation of Educational model how to assess the needs, and understand the scales (Chydenius Institute)

• Building up a commercial feasible software for data collection and creation of individual care plan (RAIsoft.ltd)

• Creation of first version of benchmarking the outcomes of care including: 1) safe digital transference of the person level data (STAKES/THL)

• Creation of unit/organization organisation/national level feed-back reports

• Creation of different types of seminars according the needs of participants

• Single software platform developed.

• National training service developed.

• Contract with international software vendor.

• Contract with international e-learning system vendor.

• Adaptation of some CAPs to the Belgian care setting, with evidence-based guidelines.

• Defining, designing small-scale pilots. Guaranteeing the conditions: software, training, local support, project managers, budget, academic participation.

• Implementation of integrated care model with intensive case management

• Programme of User Acceptance Testing and Live Testing of IT system and associated processes/workflows.

• Small supportive group for training and supervision from within the Medical Directorate of Iceland.

• Collecting data of unit-level costs of care. Due to scattered way of governance, it turned out impossible to find or calculate information on costs, in compatible ways. In 2000 there were more than 400 independent regional jurisdictions, with non-compatible ways of calculating costs, in the country, and in 2022 still over 300.

• A (4 year) – national implementation project that encouraged ownership and autonomy at the local level as long as national project parameters were met.

• Change management techniques for clinicians and managers.

• Data services strategy developed.

• Demonstrations of the aggregated data and potential use to inform planning.

• Creation of an online manual for easy access while filling out the instruments – the BelRAI wiki website.

• Translation and adaptations to local context of multiple instruments with special attention to coherence between languages and between instruments.

• A top-down decision by the French national agency the “Caisse Nationale Solidarité Autonomie” (CNSA) to implement the interRAI HC for the case managers.

• 11-month pilot in 3 sites nationally

• Caregiver groups and organisations have established working groups around implementation and to work with quality indicators.

• Improving benchmarking reports

• Improving education

• Training experts

• -e-learning

• Improving contents of the seminars

• Strong sector engagement through meetings, conferences and successful pilots and projects.

• Focus on the value of interRAI assessment for the person’s role, their client’s welfare and their organisational efficiency.

• Organisation of training for professional caregivers and train-the-trainer to diffuse the knowledge in a more rapidly way.

• Multiple pilots of various interRAI instruments in diverse populations, diverse settings, with varying length in time and size.

• Development of a training program based on a dynamic software, making the links between the comprehensive assessment, the CAPS and the scales

• Development of implementation framework for roll out of interRAI implementation in CHO regions.

• Implementation evaluated by KPMG (MDS 2.0 and HC)

• Gaining mandatory implementation

• interRAI New Zealand established with ongoing funding from Ministry of Health for: Governance Board, Education and Support Service, Software Service, Data Services, Website and newsletters

• Development of e-learning.

• Regular free-of-charge conferences on evidence-based care and various forms of interRAI applications locally and internationally.

• Create a community of users and future users.

• Preparing upscaling from pilot to integration in routine use: train-the-trainer, e-learnings, funding, licensing, support

• Training the interRAI trainers of the case managers

• Development of IT equipping and support processes in conjunction with National HSE IT department.

• Establishment of an iterative process for introducing new interRAI assessment versions building on sector support for example introducing the Palliative Care assessment to the sector

• Building relationships with researchers and developing an interRAI research community

• Designing several pilot projects.

• Policy considerations.

• Preparation and rollout of the switch from MDS-version to Suite. Train-the-trainer, licensing software vendors, updates manuals, progress evaluation.

• Re-procurement exercise for alternative software provider following conclusion of initial contract.

• Undertaking and responding to independent reviews

• Implementation requirements (2005)

• The LTCF Implementation (2018)

• Review of Service Design (2020)