The interRAI Acute Care instrument incorporated in an eHealth system for standardized and web-based geriatric assessment: strengths, weaknesses, opportunities and threats in the acute hospital setting

Abstract

BackgroundThe interRAI Acute Care instrument is a multidimensional geriatric assessment system intended to determine a hospitalized older persons’ medical, psychosocial and functional capacity and needs. Its objective is to develop an overall plan for treatment and long-term follow-up based on a common set of standardized items that can be used in various care settings. A Belgian web-based software system (BelRAI-software) was developed to enable clinicians to interpret the output and to communicate the patients’ data across wards and care organizations. The purpose of the study is to evaluate the (dis)advantages of the implementation of the interRAI Acute Care instrument as a comprehensive geriatric assessment instrument in an acute hospital context.MethodsIn a cross-sectional multicenter study on four geriatric wards in three acute hospitals, trained clinical staff (nurses, occupational therapists, social workers, and geriatricians) assessed 410 inpatients in routine clinical practice. The BelRAI-system was evaluated by focus groups, observations, and questionnaires. The Strengths, Weaknesses, Opportunities and Threats were mapped (SWOT-analysis) and validated by the participants.ResultsThe primary strengths of the BelRAI-system were a structured overview of the patients’ condition early after admission and the promotion of multidisciplinary assessment. Our study was a first attempt to transfer standardized data between home care organizations, nursing homes and hospitals and a way to centralize medical, allied health professionals and nursing data. With the BelRAI-software, privacy of data is guaranteed. Weaknesses are the time-consuming character of the process and the overlap with other assessment instruments or (electronic) registration forms. There is room for improving the user-friendliness and the efficiency of the software, which needs hospital-specific adaptations. Opportunities are a timely and systematic problem detection and continuity of care. An actual shortage of funding of personnel to coordinate the assessment process is the most important threat.ConclusionThe BelRAI-software allows standardized transmural information transfer and the centralization of medical, allied health professionals and nursing data. It is strictly secured and follows strict privacy regulations, allowing hospitals to optimize (transmural) communication and interaction. However, weaknesses and threats exist and must be tackled in order to promote large scale implementation.

A systematic review of reviews to identify key research opportunities within the field of eHealth implementation

“…There is a need for active involvement and collaboration from all those involved; therefore, requiring the need for common understanding between all those concerned as well as combined participation and familiarity with associated processes [5]. For eHealth to progress, key factors relating to the end-user such as their attitudes [6], [7], [8] and their education [9], [10], [11], [12] prior to implementing an eHealth service should be considered. However, additional factors such as the level of training provided to an end-user [7], [9], [13] after an eHealth service has been implemented should also be considered.…”

Key stakeholders' perspectives on the development of a national transfer document, for older persons, when transferring between the residential and acute care settings: A qualitative descriptive study

“…However, this may have financial implications in terms of putting EHealth systems in place in all healthcare settings and in the staff training of the system. However, in the long term it may be cost‐effective in reducing problems occurring (Devriendt et al, ; Murray & Laditka, ). At the time of the study, new General Data Protection Regulations (GDPR; European Commission, ) was being enacted nationally, and this posed some concerns for participants in relation to ownership of the document and security of data.…”

Use of standard risk screening and assessment forms to prevent harm to older people in Australian hospitals: a mixed methods study

“…There is a need to explore new integrated and streamlined standard assessment forms that bring information from multiple disciplines together31 with the patient's voice to address multiple risks of preventable harms32 and guide recommendations for the best mix of interventions to prevent harm in hospital settings. Currently, few comprehensive and streamlined assessment tools are available that are valid and reliable for use with older people in acute hospitals,33 but these are not widely available and tend to focus on assessments rather than interventions.…”

“…Current use of a high number of forms and wide variability in their presentation and content, despite claims of using ‘reliable and valid’ tools, highlights the problem of translating assessment tools, often developed by researchers examining unidimensional risks, into practice involving people with multiple risks. Future work on tool development must consider the processes used to adapt and translate tools for use in many local contexts 32 34…”