Societal,
Impact
Impact Summary
The impacts of this line of research are generating research evidence to promote use of electronic nursing records to improve residential aged care services at a local level with individual aged care providers, supporting product marketing for the medical software companies producing these products, and at a regulatory level advising peak bodies and government. The next generation researchers in health information management and nursing have also been developed in the process.
The next generation nursing and health informatics researchers were developed in this journey, including seven PhD graduates.
Related United Nations Sustainable Development Goals:
3. Good health and wellbeing
9. Industry, innovation and infrastructure
Details of the Impact
I gained full time employment as a lecturer in the School of Information Technology and Computer Science at the University of Wollongong in February 2002. Ever since I have established and consolidated research in health informatics by joining the research group Initiative for e-Health immediately and developing applied research that use multiple theories to solving problems in health information practice in a richly supportive research environment.
My research in electronic nursing records in residential aged care has developed in parallel with the process of transformation from the “cottage industry” to consumer directed care in Australian aged care in the past 15 years. With the belief that the value of digital technology can only be realised through its application to solving real world problems, I have taken a social technical approach to conduct applied research, unpacking the maze of technology adoption and usage to support aged care services. My research agenda has always been co-developed with industry partner organisations. The research was conducted in residential aged care homes with participants being frontline aged care workers, nurses and managers. Being grateful of the enormous contribution of my industry supporters and participants to the research endeavour, I have always delivered value for them. Our team have always communicated our research findings timely to the partner organisations, workforce and public for aged care practice improvement, to the medical software companies for better product development, and to the peak bodies and government for technology policy development.
Beneficiaries
- Aged care sector: Warrigal Care
- Aged care sector: RSL Care
- Aged care sector: UnitingCare Ageing South Eastern Region
- Aged care sector: IRT
- Aged care sector: Aged Care and Community Services Australia
- Aged care sector
- Australian e-health companies: Electronic nursing documentation system vendors
- Australian e-health company: Datanova
- Australian government Department of Ageing
- Australian government: Aged Care Quality Agency
- Older people receiving aged care and their families
- PhD graduates
Countries
Impacted Countries
- Australia
Approach to Impact
Summary of the approaches to impact
The pathway to impact started with a proactive approach to the local aged care organisations IRT and Warrigal Care to understand their needs for technology. With the management support, I led the third-year software engineering project students to develop prototype electronic nursing documentation systems for these organisations in 2002 – 2003. None of the organisations implemented our products due to a lack of resources and capacity to do so. This generated my interest in understanding and promoting adoption and usage of technology ever since.
With support of UOW Industry Linkage grant and industry matching fund, we produced a landmark report to then UnitingCare Ageing Southeast Region, NSW entitled 'Capacity and willingness of residential aged care workers to use IT to manage care information'. The report was publicly launched by then Minister of Ageing the Honorary Julie Bishop on July 28, 2005. In her media release, the minister appraised our research endorsed Australian government’s approach to encouraging the uptake of digital technology in aged care. The report attracted substantial media attention, including in The Australian and has had significant influence on the attitude of Australian aged-care towards introducing digital solutions into services.
I was twice engaged by RSL Care to evaluate the organisation’s pilot implementation of an electronic client care system in 2005 to 2007. Our research provided evidence for the decision makers in the organisation.
Approach to Impact
Encouraged by the acquired value of the above collaborative research, in 2007 the four beneficiaries, IRT, Warrigal Care, UnitingCare Ageing and RSL Care, in conjunction with the peak body Aged Care and Community Services Australia, provided cash contribution to support us to submit a proposal entitled ‘introducing computer based documentation to residential aged care: a multi-method evaluation of success’ to Australian Research Council Industry Linkage Grant scheme.
Funding support from the ARC Linkage Project LP0882430 in 2008 to 2012 has enabled me to establish a multi-disciplinary research team of three academics and three PhD candidates to systematically develop a body of knowledge about the impacts of electronic nursing documentation systems on aged care services.
Every effort was made to transfer the generated knowledge to the partner organisations and the aged-care sector. Three milestone newsletters were disseminated to benefit the four partner organisations and 24 participating residential aged care homes in 2010, 2011 and 2012. The newsletters were also disseminated to the aged care sector through the national conferences of the peak bodies Aged Care and Community Services Australia and Leading Age Services Australia. We gave more than 50 presentations in national and international academic and industry conferences including National Health Informatics Conference, Information Technology in Aged Care Conference and the national and regional Conferences of the two aged care peak bodies.
The social impacts have been achieved through dissemination via media reports. For example, the magazine Australian Ageing Agenda reported our findings in Sep/Oct 2010 volume entitled ‘Mixed results: electronic care software was supposed to make life easier but does the reality match the hype?’. Aged Care Insite wrote ‘Human connections’ on August 1, 2011. The Australian e-health magazine PULSE+IT reported ‘EHR in aged care: the good, the bad and the unintended' on July 2, 2013.
Our findings about the benefits of electronic documentation are disseminated to international audience by the Journal of Prosthetic Dentistry. Illawarra Health and Medical Research Institute reported our findings entitled 'Electronic health records make life easier for care staff' in December 2012. A paper we published in Journal of Advanced Nursing entitled 'Quality of nursing documentation and approaches to its evaluation: a mixed-method systematic review' has the record of 3,455 readership according to Research Gate. All these articles are still available online, benefiting the community with interest in applying digital technology in aged care and nursing documentation.
From 2013 onwards, we have conducted further study to collect “hard” evidence about the impact of electronic nursing documentation on risk management for client safety in residential aged care. We identified six risk factors for a residential aged care home to fail the information system accreditation standards, as well as the weakness of aged care accreditation in lacking objective measurement of care standards.
On May 27, 2015, we met and shared our findings with the General Manager, Accreditation and his team in Australian Government Aged Care Quality Agency. The agency staff fully acknowledged our findings and admitted the weakness in the regulatory framework. To my knowledge, currently the Agency is in the process of consultation to develop a Single Aged Care Quality Framework to replace the current aged care quality framework.
Our research have also benefited the Australian digital health companies that supply electronic documentation systems to aged care, such as iCare, Leecare Solutions and AutumnCare. These companies often quoted our findings in their marketing brochures. A cloud software solution provider Datanova publishes the key findings of our article about risk management impact of EHR in aged care on their website as evidence to support the use of their product by disability and aged care services in Australia.
In this journey, I have gradually developed capacity in higher degree research supervision. With support from the VC's award for highly commended HDR supervision, I successfully completed seven PhD graduates. Two of them were awarded ‘Highly Commended’ student scientific papers in 2009 National Health Informatics Conference. Candidate Dr Ning Wang graduated with highly commended PhD thesis.