In this edition we speak with Professor Len Gray, Professor in Geriatric Medicine and a Senior Researcher within the Centre for Health Services Research at the University of Queensland. Len brings a lifetime of experience in practice and research in the aged care sector. He is now lead researcher in the flagship DHCRC project Aged Care Data Compare. 

Why have you dedicated your career – as a clinician and a researcher – to the aged care sector? 

There are many older Australians who very much depend on the systems, the funding, and the policies that underpin the aged care system. As I moved from being a specialist geriatrician into health management and in the last two decades to academia, I realised the biggest impact I could have would be to help to improve the system.  

Over my career moved my research interest towards a focus on informatics – using data to support clinical decision making; using data to deliver patient care most effectively and efficiently; and using data for system planning, monitoring and evaluation. 

Individually, there is a community of health professionals providing aged care and that is critically important. But one thing I have learnt over the years is how critical it is to get policy implemented correctly to ensure that we have clinical care that is delivered consistently and accurately. No individual can deliver that. This is a system issue. That’s how we’ve arrived at the Aged Care Data Compare (ACDC) project with DHCRC – looking to make a bigger impact by examining and improving data systems.  

How has Australia’s aged care system evolved to where we are today? 

It is about 80 years ago that “nursing homes” first emerged in Australia, so there is a lot of history and a lot of change that has occurred. It wasn’t until the 1980s that we saw the introduction of the Aged Care Assessment Service as a more precise way of defining eligibility criteria and distributing funding. In the 90s we saw the private sector substantially entering aged care, bringing capital and competition and giving consumers greater choice. But it also led to greater fragmentation of the sector. Since then, there has been a great deal of incremental change up until the establishment of the Royal Commission into Aged Care Quality and Safety. This has resulted in accelerated improvements in a number of aspects of aged care – including the implementation of Star Ratings and the Mandatory Quality Indicator Program, which are particular interests of mine. While there is still work to be done to refine and improve them, these changes have the potential to drive significant system improvements.  

Throughout this time there’s also been a number of fundamental shifts driving change across the system: the increased focus on delivering care in the home, which makes perfect sense; the challenge to recruit, train and retain quality people in large enough numbers to deliver good care, especially post Covid-19; and of course, the demographic shift that has seen the number of older Australians relative to the rest of the population continue to grow. These are clearly fundamental and ongoing challenges for the industry and for government.  

As you mentioned, you’re currently the lead researcher on the flagship research project Aged Care Data Compare. Why is this project so important? 

This project really came about because of the DHCRC and its ability to bring the university sector and industry together. Established in the context of the evolving Royal Commission, and subsequently in supporting some of the recommendations, ACDC gets to the issues of data standardization and data exchange. A major problem in the industry is that there is no standard way of recording information among organisations nor software vendors. Without standardized data, it’s very hard to then work out a way to exchange it. That presents a huge problem in terms of data duplication which creates inefficiencies for aged care providers and friction for consumers 

In essence, ACDC is seeking to standardise the data that all relevant agencies collect, match it wherever possible and then create the machinery to exchange it. 

That’s where our interest in HL7 FHIR comes in. We’ve really set up ACDC as a demonstration of how data can be standardised and exchanged using these modern standards. 

Why do you think ACDC Plus could be successful at using these standards in practice if this hasn’t been done before? Is it because you’ve got the right parties together to do it? 

Yes, I believe so. We’ve got industry engagement through Regis, software provider Autumn Care, supported by affiliation with the CSIRO e-Health Research Centre which has deep expertise in terminology and FHIR infrastructure. Without the DHCRC, it would have been very difficult to have made those relationships work. I’ve tried to cultivate this type of collaboration all through my career, it’s awfully difficult and that’s where the DHCRC has been incredibly helpful, critical, really. So, at this time it feels like we have the evolution of suitable systems, the technology capability and the availability of the right partners to create this now. So yes, it hasn’t been done before. but that is because to some extent it couldn’t be done before.  

What is your hope if this is all successful, what is the outcome / impact?  

Obviously, this is a little piece of the whole system. But we expect the ACDC project will show that improving the use of information can lead to an improvement in the quality of care. Better quality data can help ensure the right decisions are made and reduce duplication, so the system becomes more efficient. By doing that we can ensure staff have more time to spend delivering quality care, we can better assess the impact of that care and we can allocate funding more efficiently.  

For more information on Aged Care Data Compare click here  

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