Aged Care Data Compare

We aim to resolve technical challenges around the standardisation and sharing of valuable data that is recorded as part of every-day practice in residential aged care. To this end, will work with interested aged care service providers, software vendors and government. We will:

• Survey types of information currently recorded in software solutions to judge suitability for standardisation.
• Create an agreed standardised data inventory that software solutions can draw on.
• Configure data items and develop protocols that allow sharing between organisations and software platforms.
• Construct a prototype ‘data hub’ to support a quality benchmarking platform.
• Identify a suite of quality indicators that can be calculated from the standardised data.
• Ultimately enable residential aged care providers to understand, compare and improve their quality of care.

This technical ‘ground-work’ will allow assessment data that is routinely collected in residential aged care to be used to greater potential; for every-day efficiency, for care improvement, for transparency, and for ease of reporting to government.

We envisage that, in the future, our proposed data standard and prototype ‘data hub’ will facilitate the calculation of quality indicators and preparations of reports from standardised data. Such infrastructure will enable organisations to compare their performance – within their own operations, or with facilities operated by other, anonymous, providers.

Beyond this two-year project, we plan to make our solutions available to all interested aged care providers and software vendors, and will work toward the creation of an extensive benchmarking capability for the industry. The availability of standardised data will create opportunities for data exchange with health care systems outside of the aged care program, including hospitals, primary care and mental health services.

A gap analysis of the interRAI LTCF data elements and SNOMED CT AU will be conducted. This will involve mapping the interRAI LTCF data element values to SNOMED CT AU and identifying interRAI LTCF elements with no matching SNOMED CT AU content. Requests for new content to represent unmatched elements will be made to SNOMED CT using the organisation’s standard process.

The project will define resources to represent assessment and clinical data for aged care in the FHIR® (Fast Health Interoperability Resources) paradigm and deliver a FHIR implementation guide (FHIR IG) initially using the data definitions and data elements within the interRAI LTCF dataset. The team will align this work with that being conducted using the interRAI LTCF in other jurisdictions (notably Belgium, Canada, Finland, New Zealand, Switzerland).

It is hoped that these (FHIR) resources will represent an industry interoperability standard for Australia, and potentially internationally. Integration of these resources into software solutions will pave the way for data exchange among software platforms within and beyond the aged care industry.

The Australian Department of Health is currently trialling 7 quality indicators and is likely to resolve a final set later in 2020. The Aged Care Data Compare project will ensure that the raw data elements that enable calculation of these indicators are incorporated into the proposed standardised data set.

In addition, the team will create an inventory of quality indicators that have been created for institution-based long term care settings.  These indicators will reflect both the processes and outcomes of care. The team will identify which of these indicators can be calculated from the Australian data set.

In collaboration with industry advisors, a test set of indicators will be created for trialling in the proposed data hub and benchmarking model. The indicator set will include those indicators developed and confirmed by the Department of Health.

In collaboration with other University of Queensland entities, the team will design and construct a prototype data hub that will take into account the recommendations from the privacy impact assessment (PIA) process, and relevant state and Commonwealth laws and regulations governing the handling of de-identified health data and quality registries.

An analytics application will be constructed to enable ingestion and interpretation of provider supplied data, to create report formats that will enable benchmarking of selected quality indicators.

Upon completing the development and initial tests, the entire system will be tested using production data (simulated data) from at least three different vendors. The purpose of this testing will be to ensure that all the individually tested units of the system work as required as a unit. This will include the ability of the FHIR IG to effectively facilitate data exchange and the prototype data hub’s benchmarking capability.

The project is scheduled over a 2 year period, and commenced in June 2020.  The major project outputs include the data and quality indicator inventories, a FHIR implementation guide, a prototype data hub, and a benchmarking toolset, along with protocols for mapping, data retrieval and analysis. The inventories and FHIR guide are expected to be compiled in year 1, with the prototype data hub and benchmarking toolset constructed and tested in year 2.

No. To our knowledge no other research teams are pursuing this work. There are other national and international teams conducting related work in data standardisation, and we are in communication with them to share knowledge and for technical efficiencies.

This project will not collect or use residents’ personal information or data. We will develop data standardisation models (based on FHIR resources, applicable SNOMED CT terms, the LTCF proxy care assessment) and a prototype data hub. We will do this with input from technical, clinical and aged care experts. We will use “dummy” data to test the use of these FHIR resources with the software vendors of RACFs. We will also test the prototype data hub with dummy data for its ability to collate, present and analyse such standardised data.

In the future, capabilities based on outcomes from this project may use de-identified data related to residents’ needs and outcomes. Such use would be the subject of relevant data privacy, consent and security laws and standards; and data privacy, consent and security agreements between project participants. With this in mind, a privacy impact assessment (PIA) process has been initiated as part of this project, and relevant state and Commonwealth laws and regulations governing the handling of de-identified health data and quality registries will be followed. This process will inform the design and development of outcomes from this project so that they are ready and compliant for future use with de-identified data.

LTCF stands for the Long-Term Care Facilities assessment, and interRAI is an international collaborative that develops comprehensive assessment systems. interRAI Australia is supported by a Coordinating Centre based at the University of Queensland. The LTCF assessment enables carers to make a comprehensive, standardized evaluation of the needs, strengths, and preferences of persons in residential aged care settings. This assessment covers much more than medical issues and includes items to assess a person’s wellbeing (physical and mental), their needs for daily living, and to plan for their care. The interRAI LTCF (or previous versions) is used extensively across Europe and North America. It is mandated by governments in many nations, including Canada, Finland, New Zealand and the USA.

We chose the LTCF dataset as the basis to standardise data elements and definitions in this project. Aged care providers will be collecting similar or overlapping information as part of their ongoing assessments of resident’s needs. The naming, definitions and recorded responses will, however, vary between organisations and IT software.  We selected the LTCF assessment as a proxy reference because it provides comprehensive coverage of relevant issues, has clearly articulated specifications, has good reliability and validity, and it is the most widely-used, long-term care assessment system. This approach also ensures that this project will have international relevance; it opens the door for Australian software vendors to position themselves in markets where the interRAI standard is mandated (e.g., New Zealand, Canada) or emerging (e.g., China, Hong Kong, Singapore).

AN-ACC stands for Australian National Aged Care Classification and was released in early 2019. The AN-ACC assessment captures clinical information that is directly related to the cost of care delivery.  As part of this project, we will assess the ability of the proposed AN-ACC data set to be mapped to the interRAI LTCF.

FHIR® stands for Fast Health Interoperability Resources. It is a standard for describing health data and exchange of this data. FHIR is published by Health Level Seven International (HL7), a not-for-profit standards developing organization. FHIR allows for the development of an implementation guide (IG) for healthcare data exchange in a specific setting. We will use FHIR-based data description for our standardisation agenda, and this will allow sharing of data from aged care organisations that use different aged care information technology (IT) systems.

FHIR IG stands for a FHIR Implementation Guide. An IG describes how standards and interoperability problems are dealt with for a particular care setting, via the FHIR standardisation method and model. The IG gathers all the parts into a logical whole and is published to assist care providers, software vendors and other interested parties. Development of an IG for the residential aged care is an aim of this project.

SNOMED CT stands for Systematized Nomenclature of Medicine - Clinical Terms. SNOMED CT is a standard for medical terminology and is employed to solve interoperability and exchange issues in the electronic recording of health care information. SNOMED CT aims to capture information accurately, promote data sharing, and facilitate analysis and research among other goals. This terminology standard is owned and maintained by SNOMED International, a not-for-profit association. As part of this project, we aim to make our proposed data standard SNOMED compliant.

Quality indicators (QIs) in aged care are measures developed and validated to help aged care providers understand and improve the care and services they provide.  QIs enable providers to identify and watch trends in care performance over time, plan their improvement initiatives, and compare themselves with other services. QIs can also be useful for people looking to judge the quality of care provided by an aged care service. All Australian residential aged care homes must provide QI data to Department of Health as a condition of Government subsidy of aged care. There are currently three mandated QIs for Australian residential aged-care facilities concerning pressure injury, restraint use and unplanned weight loss. Other quality indicator concepts exist; either in development, or in use internationally.

No, not directly. This project aims to produce a standard for aged care assessment data and build a prototype data hub that could collate such de-identified data. Our project team will, however, examine how current mandated QIs (and additional QIs; such as medication management, and falls and fractures) could be calculated from current assessment data collected by vendor software offerings, and from a proxy standardised assessment (the interRAI LTCF). We will also explore QIs in use in other nations (e.g. New Zealand, Canada, and USA) and assess their relevance to, and ability to be calculated from, the standardised data elements produced by this project.

This project is designed to create and test mechanisms that will enable sharing of information collected by aged care providers. In the future, it will enable provider organisations to indicate how they measure quality and show how they are currently performing. Such indicators will be of interest to current and future residents, and their families and carers.