24 January 2020 Royal Commission GPO Box 1151 Adelaide SA 5001 AC I ITC Aged Care Industry Information Technology Council Dear Aged Care Quality and Safety Commission, AWF.660.00116.0001_0001 I write to you on behalf of the Australian Aged Care Industry Information Technology Council (ACllTC) to present a submission to the Royal Commission into Aged Care Quality and Safety Consultation Paper One. The Aged Care Industry Information Technology Council would like to submit the attached report which includes the following documents: • 2017 released Technology Roadmap for Aged Care in Australia; • 2017 released Developing a Technology Roadmap for the Australian Aged Care Sector: Literature Review; and • 2019 released Aged and Community Sector Technology and Innovative Practice -A Report on what the Research and Evidence is indicating. Any considerations of a new Aged and Community Care service system must focus the opportunities for incorporated technology and innovation can have. ACllTC work demonstrates the potential and the growing body of evidence that technology and more innovative approaches will bring to the section. I take this opportunity to invite the Royal Commissioners and Commission staff to attend our premier Innovation Technology in Aged Care Conference (ITAC) which will be held in Brisbane 3rd and 4th March 2020. This conference with showcase best practice and leading-edge aged and community service deployment. If you require any further information or would like to hear more from the Aged Care Industry Information Technology Council please contact ACllTC Secretariat via Yours Sincerely, Dr eorge Margelis Independent Chair Aged Care Industry Information Technology Council W: www.aciitc.com.au Contact Details Secretariat E: aciitc.com.au P: Building 1, Gateway Office Park, 747 Lytton Road, Murarrie, OLD, 4172 M: W: www.aciitc.com.au Chair Dr George Margelis E:
Transcript
24 January 2020
Royal Commission GPO Box 1151 Adelaide SA 5001
AC I ITC Aged Care Industry
Information Technology Council
Dear Aged Care Quality and Safety Commission,
AWF.660.00116.0001_0001
I write to you on behalf of the Australian Aged Care Industry Information Technology Council (ACllTC) to present a submission to the Royal Commission into Aged Care Quality and Safety Consultation Paper One.
The Aged Care Industry Information Technology Council would like to submit the attached report which includes the following documents:
• 2017 released Technology Roadmap for Aged Care in Australia; • 2017 released Developing a Technology Roadmap for the Australian Aged Care Sector: Literature
Review; and • 2019 released Aged and Community Sector Technology and Innovative Practice -A Report on what
the Research and Evidence is indicating.
Any considerations of a new Aged and Community Care service system must focus the opportunities for incorporated technology and innovation can have. ACllTC work demonstrates the potential and the growing body of evidence that technology and more innovative approaches will bring to the section.
I take this opportunity to invite the Royal Commissioners and Commission staff to attend our premier Innovation Technology in Aged Care Conference (ITAC) which will be held in Brisbane 3rd and 4th March 2020. This conference with showcase best practice and leading-edge aged and community service deployment.
If you require any further information or would like to hear more from the Aged Care Industry Information Technology Council please contact ACllTC Secretariat via email~
Yours Sincerely,
Dr eorge Margelis Independent Chair Aged Care Industry Information Technology Council E:~ W: www.aciitc.com.au
The Aged Care Industry Information Technology Council (ACl lTC) has been established since 2007 to provide the Aged and Community Care Industry with a vehicle to consider and debate Innovation and Technology related opportunities and to disseminate the lessons learned to the wider Aged and Community Care Industry.
This report contains complete copies of research activities completed from 2016 - 2019 which includes The Technology Roadmap for Aged and Community Care in Austra lia, Developing A Technology Roadmap for the Australian Aged Care Sector: Literature Review and Aged and Community Sector Technology and Innovative Practice - A Report on what the Research and Evidence is indicating.
The Technology Roadmap for Aged and Community Care in Australia (the Technology Roadmap) lays the foundation for these research activities and provides and critical guidance for the Aged and Community Care Sector at a time when little attention has been focused on the importance of innovation and technology enhancement for the industry. The Technology Roadmap explores three complex and intersecting issues for the Aged and Community Care Sector including:
1. Population ageing that has never been experienced to the same level; 2. the rapid development of new technologies; and 3. Reform in the sector that fundamentally changes the way in which older Australians are
supported and their expectations about the del ivery of their care.
The Technology Roadmap provides strategies to manage interdependence and a v1s1on for technology-enabled Aged and Community Care Industry which was informed by a comprehensive literature review of research and grey literature between the period 2011 - 2016.
The Developing A Technology Roadmap for the Australian Aged Care Sector: Literature Review talks about the new, emerging and disruptive technologies.
The technologies identified in the research literature were categorised as:
• Ambient Assisted Living; • Telemedicine and Telehealth'
• Assistive Robots and Social Assistive Robots;
• Smart Homes; and
• Geotechnology.
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The research literature provides a growing evidence base for the effectiveness of certain technologies in relation to several service types by also in targeting specific needs including:
• Promoting independent living (mainly through monitoring technology);
• Reducing social isolation and increasing social connection;
• Reducing the risk of falling;
• Managing chronic disease;
• Supporting people with cognitive issues, including dementia;
• Reducing or managing depression;
• Enhancing well-being; and
• Improving medication management• Supporting family and other informal carers.
Due to the rapid speed of technology, the ACllTC commissioned an updated literature review looking at major research databases and grey literature focusing on the period 2016 - 2019. The Aged and Community Sector Technology and Innovative Practice - A Report on what the Research and Evidence is indicating talks about technologies that support positive ageing and the technologies that support the care of older people. The report also discusses the barriers and chal lenges to the adoption of technology-enhanced Ageing and Aged Care are considered in the report including individual read iness, ethical issues and organisational and system readiness.
Finally, the ACllTC submission to the Royal Commission into Aged Care Quality and Safety recognises the need for future research to enhance understanding of the role that technologica l disruption and innovation are playing now and can play in the future of a quality and safe Aged and Community Care industry.
1.0 Introduction to The Aged Care Industry Information Technology Council (ACllTC) .... ....... ....... . 6
2.0 Research Projects Commissioned by ACllTC ......................... ....... ....... ............. ... .. .... .... ... .. .. .. . 9 2.1 Technology Roadmap for Aged Care in Australia ................................... ........ .. ........ ............ . 9 2.2 Developing A Technology Roadmap for the Austral ian Aged Care Sector: Literature Review ........ .. .. .................................. ................ ...................................... ....... .. ..... .. ... ... .... .................. . 12
2.3 Aged and Community Sector Technology and Innovative Practice - A Report on what the Research and Evidence is indicating .. ..... .......... ........................ ....... ....... ................... ............... 14
1.0 Introduction to The Aged Care Industry Information Technology Council
(ACllTC)
The history of the Aged Care Industry Information Technology Council
In 2003, a technology interest group was formed which morphed into the Aged Care Industry Technology Council (ACllTC) in 2007 as an unincorporated association.
The specific intent of the ACllTC is to provide the Aged and Community Care Industry with a vehicle to consider and debate Innovation and Technology related opportunities and to dissem inate the lessons learned to the wider Aged and Community Care Industry.
The ACllTC defines the Aged and Community Care industry as including all services funding under the Aged Care Act 1997 (Cwth) being residential, home care and flexible care, the Commonwealth Home Support Program, the various state-funded community care program targeted at older people and the unfunded service delivered to older people.
The primary objective of the ACl lTC is to improve the qual ity of care provided through supporting and educating Aged and Community Care service provider about the efficiencies and service improvement capabilities that well managed Innovation and Technology system deployments can achieve.
The AC llTC has two key roles (1) raise technology issues with policy and decision-makers, and (2) improve technology uptake and innovation in the Aged and Community Care Sector.
During its existence, the ACllTC has received some funds to undertake a variety of activities and manage several projects. Some of the more noticeable activities are:
• Ran a national technology roadshow with support from Department of Health (DoH).
• Advised on the initiative of the Australian Government in the 2004 - 2005 Budget for a $152 million one-off payment to residential aged care providers for improved information technology infrastructure, financial report and training ;
• Worked with Government to ensure that the new funding tool , the Aged Care Funding Instrument (ACFI), would be enabled for electronic lodgement from its release driving a large uptake in electronic care plans, assessment reviews and enhanced efficiency in ACFI processes especially accuracy;
• Developed and released in 2014 the report "Digital Care Services - Harnessing (ICT) to create sustainable Aged and Community Care services;"
• Auspiced the creation of the Aged Care Industry Vendors Association (ACIVA);
• Received funding to undertake a detailed assessment of medication supply chain in residential Aged and Community Care the possibilities of electronic enablement;
• Received funding to undertake the Personally Controlled Electronic Health Record (PCeHR) Pathfinder project aimed at analysing vendor enablement for PCeHR and provider questions in a PCeHR setting;
• Conducting the annual Innovation and Technology in Aged Care conference, (ITAC);
• Receiving funding to demonstrate the benefit of telehealth and telemonitoring in homebased care using National Broadband Network (NBN) enabled households;
• Undertaking a national program of Awards of Excel lence and an Industry Hall of Fame. Both programs aim to showcase and recognise organisations, projects and individuals who have demonstrated and promoted innovative and technology-enabled Aged and Community Care as well as making an impact in delivering more consumer-centric, higher-level qual ity services and added to the research and evidence available to the sector in respect to the uptake of innovation and technology; and
• Raised the profile of Innovation and Technology related issues through information dissem ination, publication and industry conference presentations.
The Board and Committee Chairs
In 2017, the ACl lTC was formed by the two industry Peak bodies, Aged and Community Services Australia (ACSA) and Leading Aged Services Australia (LASA).
The ACllTC Board has equal member representation from industry peak bodies ACSA and LASA and an Independent Chair:
• Mr George Andreola - LASA Representative • Mr Brandan Moore - LASA Representative
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The AC llTC has three subcommittees to action the board's strategic plan. The three subcommittees' roles are to engage specific sectors of the industry and to promote collaboration and activities focused on the uptake of technology and innovation in the sector.
The current Committee structure and Chairs are: • Ms Anne Livingstone - National Home Care Group Chair
• Mr Gavin Tomlins - Chief Information Officer (CIO) Forum Chair • Mr Rod Young - ITAC Committee Chair
Following the release of the Aged and Community Care Sector Comm ittees' Aged and Community Care Roadmap in 2016, the ACllTC identified there was no mention of innovation and technology in this roadmap and was concerned about this lack of focus on these critical areas of considerations for the Aged and Community sector then and in the near future.
The ACllTC recognised the need for future research to enhance understanding of the role that technological disruption and innovation are playing now, and in the future, for the Aged and Community Care industry.
After a national tender process, the ACl lTC contracted Flinders University Medical Device Research Centre to assist in the research and consultations undertaken to develop the Technology Roadmap for Aged and Community Care in Australia.
Launched by Minister Wyatt on 13 June 2017, the Technology Roadmap for Aged and Community Care in Australia (the Technology Roadmap) was informed by a review of the academ ic and grey literature as well as consultations with key stakeholders in Aged and Community Care and technology sectors.
The review acknowledges that the Aged and Community Care Sector is facing three complex and intersecting issues:
• Population ageing that has never been experienced to the same level; and
• the Rapid development of new technologies; and
• Reform in the sector that fundamentally changes the way in which older Australians are supported and their expectations about the delivery of their care.
These three meta-influences bring both challenges and opportunities, and while each is often treated separately, the Technology Roadmap provides strategies to manage their interdependence and a vision for technology-enabled Aged and Community Care industry.
Destination 1- Technology-enabled operational, business & communication systems; Destination 2 - Technology-enhanced care & support for older people; Destination 3 - Technology-enhanced information & access to care; Destination 4- Technology-enhanced assessment of eligibility & changing needs; and Destination 5 - A technology-literature and enabled workforce
The Technology Roadmap for Aged and Community Care identifies a range of barriers to the effective integration of technology into our Aged and Community Care Systems. The identified barriers include:
1. A failure to embed technology as a core feature of Aged and Community Care, rather than being an after-thought;
2. Separation of key sectors into service silos, particularly Aged and Community Care and Health, and lack of interoperability;
3. Under-developed and variable technology readiness at sector level; 4. Under-developed workforce technology readiness; 5. Under-developed capabilities for assessment of initial and changing needs; and 6. An aged care funding model that fails to acknowledge the investment that aged care
services need to make in technology, innovation, research and development.
The Technology Roadmap for Aged and Community Care proposed multiple strategies designed to address the above and other barriers - all of which reflect the need for intervention at the
systems level:
1. Embed technology as a core feature of Aged and Community Care, reflected in policy, industry standards, the delivery of care and the operation of business systems supporting care provision;
2. Breaking down sector silos and supporting interoperability; 3. Building technology read iness at sector level; 4. Under-developed workforce technology readiness; 5. Develop a technology-aware assessment workforce and support the adoption of
6. A funding model that acknowledges the costs involved in technology-enabled qual ity care, research and service transformation.
In 2018, the ACl lTC Board reviewed the Technology Roadmap for Aged Care and developed ten Priority Projects for the next three years 2019 - 2021 . These Projects are key to translating the Technology Roadmap into action: (These priority projects are contingent on available funding resources) .
1. Technology Infrastructure Project; 2. Digital Investment Strategies and Return on Investment on Technology; 3. Digita l Maturity at Governance Level; 4. Digita l Maturity at Operational Level; 5. Digital Maturity at Sector & System Level ; 6. Technology-specific Aged and Community Care Workforce Planning; 7. The Development of strategic partnership and collaborations; 8. Digita l Literacy in the Aged and Community Care Workforce; 9. Overarching report on Digital Maturity in the Aged and Community Care Sector; and 10. Overarching report on Aged Care Workforce & Assessment into Aged and Community Care
Sector.
The "Technology Roadmap for Aged Care in Austral ia" Research project as a sector first and a critical undertaking at the time of release in June 2017. This Technology Roadmap has provided essential and critical guidance for the Aged and Community Care sector at a time when little attention was being focused on the importance of innovation and technology enhancement for the industry. This was the face of many other sectors, such as health, smart cities, mining and agriculture, investing and focusing efforts to ensure their industries are well-positioned, innovative and utilising available technologies to improve the quality and safety of service delivery as well as harnessing the various data collection sources to improve and evidence-based practice and qual ity improvement activities.
As of 21 January 2020, there has been a total of 1, 134 downloads. The Technology Roadmap is downloaded by:
Australian Care Provider International Care Provider
Public Sector Education Technology Vendor Other Business Individual
7.03% 8.83% 19.82% 20.81% 10.99%
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Work has progressed benchmarking the ACl lTC Technology Roadmap against similar roadmaps in other countries. This has formed the basis of an ongoing development of a Technology Roadmap for Aged and Community Care which might be applied internationally.
The ACl lTC trust the work of The Technology Roadmap for the Australian Aged Care Sector will enhance the position of the Australian Aged and Community Care industry for a vibrant and sustainable future. Further, it is hoped that this work will stimulate continued research, evidence gathering, and the deployment of practical demonstration projects designed to explore how greater innovation and technological uptake will help to improve the quality of the aged care industry in Australia.
Attachment A - A Technology Roadmap for the Australian Aged Care Sector
2.2 Developing A Technology Roadmap for the Australian Aged Care Sector: Literature Review
The Technology Roadmap for the Australian Aged Care Sector was informed by a comprehensive literature review encompasses recent research and grey literature concerted on the period 2011 -2016 inclusive. The literature search explores international as well as Australian studies and initiatives in both the academic and 'grey' literature.
The focus on the five-year period addresses the rapidly changing nature of grey literature associated with new, emerging and disruptive technologies.
The technologies identified in the research literature as able to play a role in improving the quality of life of older people can be categorised as:
• Telemedicine and Telehealth; • Assistive Robots and Social Assistive Robots;
• Smart Homes; and
• Geotechnology.
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Unfortunately, this review has identified that while numerous studies report positive outcomes for older people as a result of technological interventions, most are based on poor quality evaluation methodologies, involving small samples, questionable modelling decisions and/or problematic va lidations, limiting the generalisability of their findings, therefore, their usefulness.
Where the relationship is explored between technology and its application in aged care, the focus is on community-based care and only a handful of studies have involved residential aged care. That said, much of the research evidence associated with telehealth and telemedicine, including monitoring through the use of different types of sensors, which has been undertaken in the health sector is transferable to the residential aged care sector.
The research literature provides a growing evidence base for the effectiveness of certain technologies in relation to a number of service types but also in targeting specific needs -Developing a Technology Roadmap for the Aged Care Sector in Australia Literature Review highlighting its relevance for enhancing independent living - with or without aged care services. In particular, technology has been found to play a role in the following:
• Promoting independent living (mainly through monitoring technology);
• Reducing social isolation and increasing social connection;
• Reducing the risk of falling;
• Managing chronic disease;
• Supporting people with cognitive issues, including dementia;
• Reducing or managing depression;
• Enhancing well-being; and
• Improving medication management • Supporting family and other informal carers.
The Literature Review provides part of the evidence base to inform the design of the Technology Roadmap.
Attachment B - Developing a Technology Roadmap for the Aged Care Sector in Australia: Literature Review.
2.3 Aged and Community Sector Technology and Innovative Practice - A Report on what the Research and Evidence is indicating
Since the release of Australia's first Technology Roadmap for Aged Care was published in 2017, the speed of technology has changed. Given this rapid change, the Aged Care Industry Information Technology Council commissioned an update literature review in 2019.
The Aged and Community Sector Technology and Innovation Practice - A Report on what the Research and Evidence is indicating is based on a search of major research databases and of the grey literature, focusing on the period 2016 - 2019, updating the first literature review identifying research studies published 2011 - 2016.
The lag between gathering and publishing research evidence and the speed with which new technologies are developed means many innovations have not yet been assessed by researchers or had findings of their effectiveness published in the academic literature. However, the grey literature does provide information about those innovations and indicates their likely use and application.
The 2019 literature review report overviews some of the most disruptive technologies and is presented in two main categories (1) technologies that support positive ageing and (2) technologies that support the care of older people.
The report explores key recent technology changes including:
• Advances in artificial intelligence and automation; • Advance in blockchain and data analytics;
• The continued evolution of sensor technologies; • Ongoing development of virtual reality and augmented reality; and
The barriers and challenges to the adoption of technology-enhanced Ageing and Aged Care are considered in the report including individual readiness, ethical issues and organisational and system readiness.
Individual readiness The literature review explores the extent of which technological innovation is fit for purpose, is well designed or is likely to significantly enhance health, wellbeing or independence, its adoption requires its end-user to be reasonably 'tech-savvy' with technological literacy and confidence in using technology. The review found a failure by technology developers to not include older people as co-designers of technology intended for them also effects update rates.
Ethical Issues The inclusion of technology in the provision of services to older people requires an assessment of ethical issues. Unfortunately, these tend to be identified once the product has become available, again because much of the research is focused on technology feasibility studies and far less on its impact on people. The 2019 literature review discusses a number of studies based on feedback from end-users identifying concerns about loss of privacy from monitoring technologies, with videobased monitoring repeatedly perceived as invasive and undesirable.
It is also evident from the literature review that the end-user who are able to do so, make trade-off decisions about the potentially intrusive nature of monitoring technologies - preferring a loss of some privacy to losing the ability to live independently at home. However, for those who are unable to make such a decision, and to provide informed consent, the ethical issues are more challenging.
Organisation and Svstem Readiness The report looks at the significant role Technology has to play in the provision of care as well as in the underpinning operational and business systems that support care provider organisations. However, there is very little research on technology maturity at the organisation level in Australia or aged care system in which those organisations are located.
The Technology Roadmap for Aged Care recommended that the Technology Maturity Assessment survey be repeated every three years, building on the 2014 benchmark established by the above and extending the survey beyond community care to the sector as a whole. This recommendation
focus' on technology-enabled care service and on technology-enabled business and operational systems - quantifying structural arrangements, underpinning systems and capacity for interoperability.
This important research work detai ls the evidence of the impact of new technologies on the delivery of care as well as service and business structures.
The AC llTC hopes the industry will find this report impactful when considering the future strategic direction for Aged and Community Care.
A summary of the report has been created in the form of a discussion paper.
Attachment C - Aged and Community Sector Technology and Innovative Practice - A Report on what the Research and Evidence is indicating
Attachment D - Discussion Paper: Aged and Community Sector Technology and Innovative Practice - A Report on what the Research and Evidence is indicating
In conclusion, this submission outlines the opportunities that innovation and greater use of technology can have in enhancing the quality and safety aspects in aged and community care, as well as to underpin greater consumer choice and self directed care options.
The Aged Care Industry Information Technology Council has proposed several suggestions which will enhance future aged care service design including:
• Evidence-based technology-enabled service design; • Incentives for technology adoption; • Building technology read iness; • Acknowledgment of the cost to organisations in meeting quality standards, research and
service transformation and digital technology adoption; • Standards to support technology-enabled quality aged care; • Development of agreed Standards and Protocols; • Adaptation of existing digital standards for the aged care sector; and • Nat ional data exchange and reporting hub.
To ensure that the aged care program redesign is fit for purpose it must focus on the opportunities that innovation and technology can play in providing more user-centred, safer and quality care and support.
The Aged Care Industry Information Technology Council will continue to work to provide the industry with a vehicle to consider and debate Innovation and Technology related opportunities and to disseminate the lessons learned to the wider Aged and Community Care industry.
