Aged Care eConnect
IT Readiness Survey of the Aged Care Sector, 2006
Summary of Findings in the IT Readiness Survey of the Aged Care Sector.
Introduction
As countries around the world grapple with issues around health and aged care service safety, quality, cost and access, many are seeking to reform care delivery with the assistance of enabling information and communication technologies.This document reports on the first survey of residential, community and home-based aged care service providers in Australia, the IT Readiness of the Aged Care Sector Survey that was carried out by CHIK Services in 2006 on behalf of the Australian Government Department of Health and Ageing (the Department). The Department last surveyed the Aged Care sector to assess its IT Readiness in 2002. That study was carried out by Albert Research1 and was limited to residential aged care settings.
The research benefited from the assistance of Aged Care Association Australia (ACAA) and Aged and Community Services Australia (ACSA) in ensuring the survey was well supported.
This report provides a starting point from which the Department and aged care sector stakeholders can gain and disseminate insights into the Australian Aged Care sector’s readiness for IT and to quantify the sector’s capability, knowledge and skills that will enable the sector’s inevitable transformation in coming years.
Research Methodology & Approach
The study aimed to identify the current level of information technology use within the aged care sector (residential and community) and the sector’s capacity to adopt eBusiness and eHealth initiatives and sought to address the following objectives:1. Identify the current investment in and level of IT usage across the aged care sector
2. Identify the sector’s capacity to become involved in future IT implementations
3. Identify issues surrounding the use of IT within the sector
4. Collect information regarding the level of awareness for particular activities
5. I dentify groupings amongst residential and community aged care services based on their capacity and current ability to utilise IT as part of their day to day activities, their interest and future plans.
The survey tool was designed following targeted consultation with key industry stakeholders.
Testing was carried out with two groups and every effort was taken to ensure the test groups were representative of the total population to be surveyed. Modifications were made between test phases and prior to final approval of the paper-based and online survey tools.
During the testing phase after much discussion regarding the diversity of organisational structures and mechanisms for managing IT across organisations, it was agreed that surveys would be issued to Approved Providers in addition to individual Services. Two options for survey completion were supported: an Approved Provider could complete the survey on behalf of a group of their Services where the use of IT was consistent across the organisation, or an individual Service could complete the survey on their own behalf.
In addition to considering motivation and capability for IT use, the allocated scores were analysed with a combination of motivation and capability to determine indications of overall readiness for the use of IT in:
- Managing the business (ad-hoc through institutionalised use of IT to manage the business);
- Managing client/resident information (including recording and managing client administrative and progressing to clinical information, capable of eBusiness with the Department); and
- The delivery of clinical care (using IT in clinical care interventions & sharing clinical information with other health providers, eg eHealth related activities)
The majority of services represented (91%, n=2815) are motivated in their use of IT with:
- 64% of services focussed on use within the organisation and
- 27% of services that have extended their focus to networking outside their organisation
- The majority of services represented (98%, n=3041) were assessed to have more than an ad-hoc usage of IT with 72.6% (n=2261) managing the business and some level of details regarding the client; and 25% of services demonstrate capability to use IT for internal business management.
- 71% of services demonstrate they have extended their IT usage from business applications to managing resident/client information.
- 32% of services either demonstrate or are approaching capability to use IT to support clinical care delivery.
Figure 1: Segmentation Analysis scatterplot, all Services
Readiness for IT in Clinical Care Delivery
- Although responses to questions about priorities for electronic information sharing indicate growing use of IT to support clinical care delivery, the analysis of all areas of response revealed a different picture with just under 2% of services demonstrating the capability to use IT in clinical care delivery and exchange information with external providers (including health care professionals) with a further 30% approaching this capability. This is reflected in Figure 3.
Figure 3: IT in Clinical Care Delivery, all services represented
Results were filtered by organisation size, location and service type with the picture emerging consistent with the results described above.
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Respondent Characteristics
When compared with total population figures the survey response proved to be representative in all areas.It is noted however, that a relatively small number (131 or 4%) of EACH services are overly represented in responses and the majority of these are operated by larger organisations that appear to use IT extensively to manage administration and care delivery. Due to this percentage figures for EACH services appear disproportionately high throughout this report.
Of the 77% (3111) of individual Services represented in the response:
- 73% (2268) provide Residential care services and 27% (843) provide community services - 23% (712) CACP and 4% (131) EACH.
- 31% were owned by Religious groups, 20% Charitable, 18% Community-based, 16%
- For the purpose of the survey analysis Services were assigned to 4 size ranges based on the number of allocated places or packages. The profile of the Services represented in the response to the survey was consistent with the overall population. Interestingly,
Snapshot of current Usage
- Computers used (100%, 3111 services): Close to 100% of services represented (99.8%, n=3102 services) have at least one computer in use (only 4 CACP and 1 residential service stated they did not use a computer). A total of 30,690 computers are used across the 3111 services represented.
- IT Processes centralised or decentralised (100%, 3111 services): The majority of community services (72%, n=612 services represented) and residential (70.5%, n=1598) manage IT centrally. Of the remainder, 17% of residential and community services represented manage IT in a fully decentralised manner, with residential more likely to do so. (As multiple responses were accepted figures do not tally to 100%). Size does not appear to affect the choice of business model, but there is a tendency for the more geographically remote services to have decentralised IT processes and procedures.
- Networks (100%, 3111 services): Only 7.7% (n=241) of the 3111 services represented are not networked. Of the 2869 services that are networked, 71% have a local (internal) network and of these, 30% have wireless connection available.
- Internet Connection (97%, 3029 services): ADSL (>512 Kbps) broadband use is consistently high across all care types (70-80%) and across ASGC locations (68-72%) other than Remote/Very Remote locations where ADSL broadband usage fell to 40% and dialup (34%) and satellite (8%) appear to take up the communications load.
- Devices in use (100%, 3111 services): respondents were asked to indicate which devices (multiple responses) are available to them. Digital cameras were most commonly cited (85.6% of all services), followed by CD/DVD-ROM (71.6%). More than half of all services (60.8%) use laptop computers.
- Technologies that support access to organisational information (94%, 2940 services): Over 70% (73.5% n=2940 services) have a website, 62% have an Intranet and 60.5% have a VPN for administrative or IT support use. Around 24% use a VPN for clinical purposes, 22.2% have an extranet and 17.7% use ASP technologies. Of those not using these technologies (26.5%), interest in the use of VPNs for clinical purposes was highest (31.9% n=938 services)
- Operating Systems (94%, 2921 services): Windows XP is by far the most commonly used operating system - selected by 87% (n=2554) of all responding services and consistent across care groups. Operating systems that are between 8-12 years old are also in use but to a lesser extent. Windows 95/98 was selected by 19% (549 services), Windows NT was selected by 9% (257 services) and Windows 3.x was selected by 1%, or 23 predominantly residential services. Technologies such as Citrix to support thin client computing were selected by around 17% (490 services). Note: multiple selections were allowed so responses do not tally to 100%.
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Table 2: Top Clinical uses of IT compared by Care type
Multiple responses allowed so totals do not equal 100%
- IT use in Clinical intervention: (50%, 1553 services): respondents were asked if their health professionals / IT staff use IT in their interventions with residents/clients (i.e. the assessment, evaluation and monitoring of a residents/clients care needs and the provision of specific medications or treatments). Multiple selections were allowed so responses do not tally to 100%. Only 50% of services are represented in the response (the lowest response for the survey) possibly indicating a lack of clarity in the question itself. Of the 50% services represented, IT is used more for assessment and evaluation purposes (70-80%) than for monitoring or providing medication or treatments.
- Management / Administrative of IT (100%, 3111 services): the top reasons for administration / management use of IT were roughly consistent across all care types.
Note: multiple selections were allowed so responses do not tally to 100%.
- Resident / Client use of IT (97%, 3024 services): Approximately 43% of responding services provide IT access for their residents or clients. Of these, the most popular purpose is to provide Internet access (33%), to play games or leisure pursuits (30%), for word processing (27%) and for email access (24%). Multiple responses were allowed.
Workforce access to IT
- Staff access to IT (97%, 3028 services): Respondents were asked to indicate the percentage range of staff that have access to a computer located in their workplace.
- Access for visiting staff (95.6%, 2977 services): just over half the responding services provide computer access for visiting staff such as GPs, agency or other non-staff health care professionals.
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Security Processes
- IT Security policies & procedures (87%, 2722 services): Respondents were asked what percentage of staff are aware of and trained in IT security policies & procedures. Of those responding, 27% (n=745) stated that all of their staff are aware and trained, however the next most common response (11%, n=289 services) was that none of their staff were.
- Controlling Access to information (95%, 2941 services): Most services represented in responses appear to be using controls to manage access to information effectively – 93% (n=2739) assign staff with passwords, 83% (n=2450) assign staff to a level of access relevant to their role and 81% (n=2941) assign a unique ID for each staff member.
- IT Security features used (97%, 3010 services): The majority (97%, n=2921) of services represented use virus protection software with 93% (n=2795) using automated virus database updates. Almost 95% of services represented in responses perform backups of their data with 75% (n=2269) store these backups off site. Firewalls are in use by 84% (n=2515) of services represented and 71% (n=2150) only allow IT staff to install software.
Investing in IT
A series of questions were asked to build a picture of the sector’s level and perception of IT investments.- The questions relating to IT budgets and IT decision makers were answered by around 50-60% of total respondents (it is not clear if the lower level of response for these questions reflects the level of access to such information by the respondent)
- IT as a percentage of organisational budget (58%, 869 respondents): 42% (n=365) of respondents to this question indicated that IT represented 1% or less of their organisation’s budget, however the average was 3.8% (range 0% to 30%) which is higher than expected.
- Who (which role) makes decisions about IT? (55%, 820 respondents): When asked to identify the job title of the most senior person responsible for IT-related decisions (i.e. Chief Executive Officer, Director of Nursing etc) many respondents provided a person’s name, thus diminishing the value of the response. Of those responses that did address the question, the most common response was CEO/Owner (40%, n=250), or the Chief
- Is IT viewed as a cost or an investment? (83%, 1240 respondents representing 2732 services): Approximately three quarters (72%, n=1970) of services represented in a response to this question consider IT to be an investment with the reminder viewing it as a cost.
- Computer replacement policy (94%, 1398 respondents representing 2985 services):
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Planning for the future
- Plan for business process review with IT implementations (95%, 2964 services): Many services (83%, n=2459 responding to this question) indicate that they plan for and subsequently review changes in business processes when implementing IT.
- Strategic planning priorities - Management/admin or Clinical purposes (100%, 3111 services): The majority (79%, n=2476) of services represented consider strategic planning for management/administrative IT as a priority, whilst only 10% view IT planning for clinical purposes as a priority. Non-respondents represented 18-20% of services.
Working together to stay informed
- Communication preferences (90% (1343) of respondents): respondents were asked to indicate how they would like to be kept informed about aged care / health sector IT developments. The top 4 selections were via Peak bodies (66%, n=986), via email (60%, n=904), via an Electronic “IT in Aged Care” newsletter (58%, n=874), or via the Payment Essentials newsletter (57%, n=854).
- Awareness of government initiatives: Respondents were asked to rate their awareness of 5 Government health IT related initiatives using a scale from ‘no awareness’ to ‘high level of awareness and understanding’. In general, awareness of the initiatives was low. Aged Care eBusiness and the Clinical IT in Aged Care project had the highest awareness levels with 38% and 33% of respondents respectively being either ‘aware’ or ‘highly aware’ of these initiatives.
- Follow up authorised by respondent: Over half (53%, n=792) the respondents indicated their interest in being contacted for follow-up research, only about 1% (n=19) did not want to be contacted further and 91% (n=1368) provided contact details for the people who compiled the survey responses in their organisation.
- Additional comments: The survey encouraged respondents to add comments and suggestions as to how the Department and/or industry bodies can maximise the sector’s capacity to take up IT and eHealth initiatives. Of the 1493 respondents, 28% (n=419) provided additional comments that were grouped into 20 themes. The most common comments were a) requests for guidance on IT-related purchases and decisions, and b) requests for funding for software, hardware, support and training.
Success Stories
- Respondents were encouraged to provide details of IT developments or projects that support aged care (directly or indirectly) and are working well. Details of 861 projects were provided by 531 respondents and of these 65% (n=346) were happy to be contacted by the Department. Projects submitted were assigned to 10 categories with the most common being a) office automation, administration, financial, HR, rostering (180 instances) and b) clinical care planning / assessment projects (130 instances).
Comparisons with Previous Studies
In 2002, the Department conducted a survey of residential services that explored IT infrastructure, connectivity, workforce skills and capacity/interest in carrying out business related transactions electronically2. It achieved a 52% response rate.Responses to the 2002 and the current 2006 study were both shown to be representative of the sector at the time the survey was carried out.
Overall, the picture is of a sector that is interested and engaged in the use of IT and is maturing in its equipment, its connectivity, its provision of staff training and in the proportion of services actively using IT to “run the business.
In 2006 the majority of aged and community care services:
- are using at least one computer: in 2006 only 5 do not, compared with 31 services in 2002
- are connected to the Internet at reasonable speeds: in 2002, 47% used 56Kbs dialup; in 2006 the figure is down to 15%, while 68.8% are connected to ADSL Broadband
- use current operating systems: 87.4% use Windows XP in 2006, compared with 57% using Windows 98 in 2002
- use office productivity tools to run the business.
- provide their staff with IT training: 76.7% now provide formal training, compared with 47% in 2002
- are keen to be kept informed, predominantly via industry associations such as ACAA and ACSA and with information pushed to them via electronic means (email and IT-specific electronic newsletters)
A moderate increase (67% up to 79.6%) was noted in the number of services that use IT to manage resident details.
Discussion
This research provides a rich and comprehensive data source and responses represent 77% (3111) Services across the country that are representative of the sector as a whole.The findings demonstrate significant movement in patterns of IT usage and preparedness for e-Business uptake since the last survey (restricted to residential aged care) was conducted in 2002, with the majority of organisations investing in additional infrastructure, upgrading their PCs and their telecommunications capacity. Only 5 Services (0.2%) do not use computers in their organisation. Usage rates were broadly consistent across all care types, although EACH/D Services (representing a much smaller proportion of services) were always somewhat ahead.
It is no great surprise to find that IT is currently used to support the sector’s immediate priority of managing business aspects of the service. When IT is used or considered of interest for clinical purposes the main focus is on care planning, research via the Internet and accessing/storing client/ resident information. Interestingly, fewer than 25% of Services indicate their interest in using IT to manage medications, and in general data capture is quite separate from care provision.
Factors influencing this more cautious approach to IT to support clinical care delivery include the difference in level of risk and investment, change management and staff training requirements and the availability of suitable products (and necessary standards). This is consistent with other health sectors.
While the majority of services have centralised IT processes and procedures, more remote services prefer a decentralised model.
The majority of Services have invested in specialised software to manage internal business processes such as rostering, reporting, client billing, email and payroll. A smaller proportion exchange or provide information externally to support business operations and an emerging trend is the provision of access to IT for residents/clients and their relatives/carers.
It is of some concern that this apparently rapid uptake of management and to a lesser extent, clinical software, appears to be occurring with little understanding of concepts such as interoperability that is particularly important to engender effective information sharing between and within organisations.
In order for existing and future software investments to be most effective it will be particularly important that the Department and Aged Care associations deliver clear and consistent messages to help Services and Approved Providers understand the importance of standards and software compliance in line with the work of the National E-Health Transition Authority 3 which was established by the Council of Australian Governments to develop and set standards, and common building blocks that support better ways of electronically collecting and securely exchanging health information.
Figures relating to investment, planning, staff access, training and support services bring the focus sharply back to the main game of ‘business’ or ‘administrative’ use.
Access to mobile communications and data capture devices at point of care is at relatively low levels consistent with other health care settings (such as hospitals) and is reflective of the differences between clinical practice (mobile, team based) and administrative practice (sedentary, often sole responsibility).
Staff skill levels have developed since the last substantive study, and significantly more training is made available for administrative/management staff, with most training sourced from external providers. Services in ‘remote’ or ‘very remote’ locations are less likely to receive formal IT training. Not surprisingly, the larger the service size, the more likely its staff are to receive training.
Overall, IT support reflects the “business” orientation of the sector, with most support available during normal office hours during the week. Although viewed as satisfactory by the majority, IT support is an issue for the more remote services (as availability decreases with increasing remoteness), smaller services and those services owned by state governments. It appears that services in Queensland appear to manage IT support provision more equitably.
Access to and regular use of IT and email is significantly higher for administrative/management staff and the dichotomy of access between administrative/management and clinical/carer staff impacts the effectiveness of electronic communication that is targeted at the clinical workforce. Just over 50% of Services provide computer access to visiting GPs, allied health, agency staff or other ‘nonstaff’ health professionals.
Sharing information electronically with the Department and ACATs are clear priorities for Services. While electronic information sharing with GPs, hospitals and pharmacies was of significant interest, it was not considered an immediate priority, a further reflection of the perceived barriers and the sector’s focus on business rather than clinically related IT use.
Although the provision of formalised IT training has increased, it is heavily geared towards administrative or management staff and is less likely to be available to the more remote services and for services owned by private companies, local government or community owned services.
Staff awareness of security policies is relatively low and although access and data security controls appear to be in place in many instances, this area warrants more attention as the sector moves towards greater reliance on electronically held information and information sharing.
In relation to drivers and barriers to IT uptake, the main driver is to run the business better with a secondary theme to make the workplace more effective for staff. Consideration of barriers to IT adoption brought forward some new themes for consideration – workforce skills, the associated high cost and managing change in the workplace.
It is clear that IT Motivation and IT Capability are linked. The more motivated an organisation is, the more IT capability it displays. While smaller organisations tend to have the most low-scoring outliers, the picture built up through this analysis is of a sector that is moving forward together. A small number of ‘leaders’ display clinical capability but the strongest message relates to eBusiness with 31% of services already capable of managing client information in addition to carrying on eBusiness and a further 61% approaching this capability. Inner Regional locations demonstrate the highest proportion of Services that are currently eBusiness capable and less urban locations evidence progressively larger percentages of Services with limited readiness for e-Business.
In general, awareness of government initiatives is not high, with the highest level of awareness related to eBusiness initiatives – this fits with the sector’s current focus on using IT to “run the business.
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Conclusions and Recommendations
Results of this comprehensive and representative survey indicate that the Australian residential and community aged care sector has matured in its use of IT since the last study carried out in 2002 and Services represented in responses clearly view the use of IT for business purposes as a key priority.The use of IT for clinical purposes does not appear to be an immediate priority, although it is of significant interest as a future direction. In considering the combination of motivation and capability to define readiness, only 51 Services (less than 2%) were identified as using IT in clinical care delivery as compared with 982 Services (31%) that are considered ‘e-Business Capable’ using IT to manage the business including client administration and care related information and a further 1890 Services (61%) that are considered to be approaching eBusiness readiness.
The level of response elicited by this survey is indicative of a sector that is motivated and is actively engaged or planning to be actively engaged in the use of IT. It is also a strong indicator of the sense of pride respondents have in their achievements to date.
Not only did respondents take the time to complete this survey, around one third also took the time to provide additional comments, 91% of respondents provided their contact details and more than half the respondents (56%) stated they were interested in being contacted to participate in followup research.
The strongest message to emerge from extra comments is the need for guidance and leadership related to IT purchases and decisions. This guidance is sought predominantly from Government, from industry peak bodies or independent entities to support the sector’s move to the next stage of development.
1 Results of Research into the Residential Aged Care Industry’s use of Computers and the Internet, Albert Research Pty Ltd on behalf of the Department of Health and Ageing, July 2002
http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-rescare-racs_itrpt.htm
2 Residential Aged Care Industry’s Use of Computers and the Internet (Albert Research, 2002).
3 National E-Health Transition Authority http://www.nehta.gov.au
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