Background and Aims
The primary purpose of this project was to build on existing research and complete codesign activities to design a minimal viable product of a residential aged care clinical care capability and system architecture digital tool. The project commenced on 6 March 2023 and concluded on 4 March 2024.
What we did
The consortium adopted a phased approach to implement this project. The first phase, planning, was completed within the first month of commencement. The literature review (phase 2) informed the co-design consultations (phase 3). Findings from these two phases informed phase 4, minimal viable product design, which included the design and development plan of the clinical care capability and system architecture digital tool. Finally, phase 6 drew together the outcomes from all prior stages into a final report.
Outcomes
The project has successfully addressed all the proposed aims. A systematic literature review during the evidence review phase, detailed the current state of digital technology in aged care, and supported the need for enhancing clinical care capability. Codesign activities throughout the project engaged residential and community care service providers, ensuring the creation of a usable clinical care system tool. The project included various service providers, incorporating rural and remote areas. The minimal viable product created during this project provides an evidence-based clinical care tool. The tool will have the possibility of:
- contributing to improving outcomes for older people by enhancing the quality and consistency of clinical care systems in their care.
- assisting providers in striving for excellence through the quality use of clinical care systems, leading digital transformation with a human-centred design approach.
- aligning new compliance measures, foster collaboration within the sector, and provide opportunities for quality improvement.
For the purpose of the report, a minimal viable product is a product with enough features to attract early adopter customers and validate a product idea.
The project was delivered on time, scope, and budget. The main deliverables of the project included a systematic evidence review, an iterative codesign process (six workshops), and development of a minimal viable product.
Evidence review
An evidence review investigated the existing and publicly accessible sources related to clinical technology and digital maturity tools. The evidence review provided insights into the current state and the implementation of the roles and digital technology in facilitating clinical care in aged care. Key findings included:
- The study included 45 relevant studies over the past 10 years that discussed the development, implementation, evaluation, and impact of digital technology to provide services and treatment for older adults.
- The review discussed five themes that evolved from the current studies reviewed (1) the capability and efficiency enhancement of aged care treatment, (2) digital transformation, (3) health monitoring and assessments, (4) interaction improvement between older people and caregivers, and (5) digital technology utilisation to facilitate self-care management.
- The study identified seven roles of digital technology in supporting clinical care in aged care. These included (1) health monitoring and assessment, (2) remote health services, (3) assistive technology to support treatment, (4) self-care management, (5) social technology to facilitate interaction, (6) clinical decision support, and (7) aged care quality measurement.
- Optimising the clinical decision support system is also essential to improve the capability and efficiency of clinicians or caregivers in making important decisions related to older adults.
- Collaboration is the key consideration for developing future digital technology and a codesign approach is appropriate in developing future digital technology for aged care.
Codesign consultations
Swinburne University of Technology conducted codesign activities, using international approaches to create a pathway to allow stakeholders to make constructive contributions. A total of six (6) codesign workshops were held during the project to meet the goals of the digital tool. There was a diverse set of participants from a variety of residential care, community care, and technology backgrounds.
Participants ranged from a multi-state to a single state, a range of clinical care systems, and across all areas of the care model.
Codesign workshops 1 & 2 outcomes outlined:
- Clinical systems in use by residential aged care providers
- Clinical care systems challenges faced by residential aged care providers. These were:
- No one system can do everything
- Data and applications are isolated from each other
- Effectively communicating/disseminating a clinical change is difficult in current systems
- Current clinical systems are old and redundant resulting in them not being responsive to reform changes
- Meeting requirements introduced in response to Royal Commission into Aged Care Quality and Safety have challenges in existing systems
- Data analytics integration
- Lack of standardisation
- Responsiveness to a culturally and linguistically diverse workforce
- Integration of AI capability.
- Clinical care successes
- Consistency and interoperability across systems
- Managing risk regarding legislative updates
- Medication management system working well.
- The key design requirements were that the minimal viable product should be or include the following elements:
- Widely available
- Culturally sensitive
- Tailored
- Automated
- Aligns with standards
- Auditable
- Predictive analysis
- Pool data that triggers activities or prompts
- Timely
- Free up care time
- Have mobility
- Supports point of care delivery
- Support data entry.
Codesign workshops 3 & 4 outcomes:
- Design requirements
- Qualitative rating and feedback on individual systems is important
- Benchmarking against other systems
- Include context such as the experience of the rater of the system
- Allow for benchmarking
- Shows the level of customisation required versus integration
- System should be simple to use and user-friendly
- Allow for multiple usage, e.g. annually or more frequent population by the same raters.
- Toolkit that matches industry needs with systems
- Independent of vested interests
- Match to requirement
- Checklist of minimum requirements.
Codesign workshop 5 outcomes:
- Overview of minimal viable product functionality:
- Rating system against requirements
- System produces an overview of raters against the system
- Apply a filter to select the system or requirements you want to see
- In the discussion board users can view ratings against requirements
- User can post commentary or ask questions about someone else’s rating of a system.
- Feedback on functionality:
- Overall, participants valued the system
- The ability to rate and provide comments was appreciated
- The ability to provide an anonymous rating, if preferred, was appreciated
- The comments display was well-received
- The participants liked the display cascading from most recent to older feedback
- The participant valued the thumbs up/date and smile responses
- The participants reported they are happy to be approached to further discuss their comments with other people seeking systems
- Role of vendors: vendors should have separate access and only be able to see aggravated overall scores. Vendors should not view individual comments/scores to protect the identity of raters
- Systems that are phased out, or phasing out, should not be included in the system
- Systems that are not commercially available e.g. are start-ups, or undergoing beta testing, should not be included OR at a minimum should be flagged. Participants do not want to test immature systems.
- Design requirements
- Value for money
- Security
- Customer service response
- Anonymity
- Wider use of systems
- Risk identification
- Scoping Rules
- Number of raters
- Company size
- Customisation versus interoperability
- Offline/online use.
Codesign workshop 6 outcomes:
- Codesign participants indicated the minimal viable product was easy to use, clear, relevant, appropriate, and coherent but they would not pay for the use of the tool.
- The timing of the use of the tool would be when required, typically when providers are considering a change in their clinical systems. Systems are not regularly changed due to significant investment in terms of time, money, and human resources.
- The tool is regarded as support for the aged care providers (comparable with a community of practice) and hence creates benefits through detailed ratings and rich discussion.
- Currently, for making clinical care system decisions the biggest challenges are to get a realistic understanding of how the software will fit into the organisation’s daily routines, operations, fulfil the need for legally required updates and customer service by vendors. The providers reported that they appreciate the tool as an independent source of information.
The scope for the minimal viable product is still within the overall scope to improve clinical care capability but has been narrowed down and informed by the codesign process. There was reported to be great diversity across systems used within the sector, and these systems had diverse focus, capabilities, and challenges in different aged care settings. The participants (service providers) asked for support to better understand the capability of existing systems to support their care operations. This was important as it was apparent that there was not only diversity in the systems themselves, but in user profiles, roles, and contexts. In other words, there was no single system that matched with participants' wants and needs.
Therefore, what system will be most suitable for their organisations can differ between organisations. Hence, the system considers the specific needs of provider organisations and supports them with understanding how systems address these needs (or not). However, it would only be a small addition based on the prioritised requirements and the matching function to establish how well the currently used system matches the needs of the organisation (this could be reported as an individual capability score – not an objective score across the sector). Providers wanted to understand how well the existing software would support their needs – the system they are currently using (if any) might even be listed as a top match – or could be added in comparison and alongside the best matches. Further, participants were concerned to recognise that systems can be modified, withdrawn and new ones developed at any time, leading to further complexity and challenges for the sector; and the necessity of potentially developing a living prototype that can be adjusted to reflect real-time changes in the sector.
Minimal viable product
A minimal viable product is a product with enough features to attract early adopter customers and validate a product idea.
The provided outcome is a concept prototype of a tool to support aged care providers in making informed choices based on the ratings of other users (aged care providers) and their requirements for suitable clinical care software. The tool constitutes a platform to discuss different clinical care products used by the aged care provider community of practice thus increasing clinical capability over time in the sector. This is partly achieved by giving the sector more independence to recognise and understand available products in the sector, and how they match with their requirements, as a counterweight to vendor information.
The three main functions are (1) rate different clinical care systems, (2) find the best match according to an aged care provider’s requirements (3) discuss how well different software products perform on different levels (overall, for different care operations, on single requirements).
- Rating: The experienced user of the system can give overall ratings on important aspects such as customer service and safety (5-point scale) and rate the requirements according to different operations/care activities the system needs to fulfil (5-point scale and open feedback).
- Find a match: A care provider can select important requirements and find which software will best suit their needs for providing clinical care to their clients. The top three matches are provided.
- Discussion: The ratings are displayed, and other users can add their feedback or questions. The tool provides filters for overall ratings, care operation level and requirements level.
Impact on Aged Care and Workforce
There is a significant issue and risk for the aged care industry due to the poor implementation and lack of quality applications of clinical systems. Beyond this risk, confusion exists concerning approaches applied to the deployment and use of various clinical technologies. The lack of digital maturity in the aged care sector is also a significant roadblock to the delivery of effective and quality digital care management systems. Currently, the aged care sector is losing time and money due to inadequate implementation of technology, but most importantly, older Australians are receiving sub-optimum care and support as a result. Implementing suitable and targeted clinical systems has the potential to assist with workforce pressures and could augment or substitute the workforce in some incidents, along with having great potential for improving care delivery.
This project has delivered outcomes for the aged care workforce and organisational improvement through the development of a minimal viable product digital tool. The tool, informed through a process of codesign activities with aged care providers, aims to enhance the clinical care capability and system architecture in aged care settings. By providing the sector with a user-friendly and evidenced-based tool, the sector is empowered to increase its digital maturity and streamline care processes.
Resources Developed
The project outcomes will be disseminated through journal articles and industry media.
