The benefits of integrations in healthcare

Attending the recent Health Informatics NZ Digital Health Week was a great opportunity to connect with others who are involved in digital health services to create solutions for the challenges that are present within health provision.  While there were many attending from Government agencies, there were also several of us from private organisations. 

As a Registered Nurse, Lead Auditor, and Founder of Healthcare Compliance Solutions Ltd, I came from an era that was burdened with vast paper-based methods of evidencing health services.  The history of documentation in health has been voluminous and fragmented.  This meant lots of pieces of information about a person could be held in multiple places and didn’t form a collective view of that person. Those providing care had to first know where the information was stored and then have the ability (and time) to access all relevant parts of the information.  Information (data) used to be written by different members of the health team in different places and not all those involved had visibility of what input their colleagues may have offered to base future care decisions on. While this is not only inefficient, it led to, on some occasions to insufficient and inaccurate record keeping, leaving patients, or in the case of aged residential care services residents, with unmet needs.

Hand-written records previously were scanned into a computer system, named and then uploaded. The original paper-based record then had to be filed or securely disposed of.  Not only a very time-consuming and taking care and support staff away from direct care duties.  With legacy tech stacks still in place across numerous organisations where multiple systems are used to store data, the retrieval of information is still fragmented, consequently maintaining the risk associated with paper-based system.

We incorporated FHIR standards and SNOMED coding into our cloud-based digital solution in an attempt to provide a solution to improve the visibility of health records and ultimately care outcomes.  This allows the easy access and automated transfer of digital data, so all information is available in one place.  Our clients in aged care, retirement villages, and community care have thereby been supported to have a more combined health record and in doing so, reduced risk of missed information.  The first steps have been completed with effective integrations of Medi-map, the electronic medication management system, and interRAI the nationally mandated assessment tool.

Information via the Medi-map integration auto-populates clinical indicators that were previously hand-written.  One healthcare organisation counted a total of 1400 events in a one-month period where previously a notation was being hand-written.  This one integration automation alone saves one aged care provider approximately 23.3 hours and with an average Registered Nurse hourly rate of $42, a saving of $979.86 per month ($11,758.32 annually).

Since 2012 all district funding offices for Te Whatu Ora (previously DHBs) have used interRAI as the digital tool for assessing older people's support needs for home and community support services. In 2015 interRAI was mandated as the assessment instrument for all Aged Residential Care (ARC) providers. Clinical assessment and long-term care planning were already being undertaken. Initially, this tool was not well received as it was seen as another nursing task, in addition to clinical assessments and long-term care planning, that the nurses were time-pressured to complete.

The time and financial savings from the interRAI integration have been even more significant as the nationally mandated assessment tool interRAI now auto-populates data directly into resident Care plans within HCSL digital systems. With API-based integrations, this workload which historically took on average 4 to 6 hours for an initial assessment, has been dramatically reduced.  Nurses using HCSL often feedback positively with the latest comment received stating “It saves a lot of RN time, we usually enter scores in the individual care plan sections which takes several minutes each time but with the integration, which is easy to access on the Dashboard, all scores are automatically entered in a few seconds.”

We look forward to collaborating more with the interRAI team to give time back for nurses to spend with their residents/patients. The benefits of interoperability make this time-saving possible! With two integrations completed and gaining efficiencies, this is the way forward for increasing access, visibility, and transparency for those involved in the healthcare team.

It’s quite simple in my view.  Interoperability allows for integration which in turn facilitates automation. This in turn is where further gains are achieved by leveraging time to do more with less.  This automation through integration will continue to be a strong focus of current and future development for HCSL services in aged care, retirement villages, and community care to improve health outcomes.

Article submitted December 8th, 2023 by;

Gillian Robinson, Registered Nurse, Bachelor of Nursing, Associate Fellow Australasian College of Health Service Management, Author, Founder of Healthcare Compliance Solutions Ltd.