One of the most exciting developments in the Irish health system has been the initiation of an integrated care programme bridging hospital and community services for older people with complex medical, rehabilitation and support needs.
Although elements of the team required may have been present in a more dispersed form, what had been missing was the focus, training, leadership and coordination. Working as a team requires formal multi-disciplinary team meetings, training and ongoing development above and beyond the remit of solo practitioners.
When explaining this to my trainees and students, I use the analogy of a successful football team or orchestra, each of which needs to invest time away from games or performances for training and familiarisation with the other players.
Referral is through the family doctor, and the team has been incredibly busy and a pleasure to work with
In addition, the older people involved often also may require various sophisticated elements of hospital care, such as diagnostics and specialist services such as falls assessment or day hospital.
Tallaght Hospital and the surrounding area has been one of the initial sites chosen. Spearheaded by Dr Sean Kennelly, the team consists of two case workers, a geriatrician, physiotherapist, occupational therapist and social worker. Referral is through the family doctor, and the team has been incredibly busy and a pleasure to work with.
At a recent meeting of the International Association of Gerontology and Geriatrics in San Francisco, I was fascinated to learn of the innovations of other countries in this area. Prof Karen Andersen-Ranberg, a friend and colleague in Odense, Denmark, presented on the GERI-briefcase which she has developed for a similar team.
This includes a miniaturised blood-testing system, ECG, and sophisticated blood pressure monitor which upload to the information technology system supporting patient care. There are few things more dispiriting in the Irish healthcare system than to see patients from primary care queuing for blood tests in hospital corridors.
This theme of uploading to an integrated information technology platform formed the basis of an important session on telemedicine to support sophisticated care of older people in remote areas in Canada and Australia.
At the heart of these presentations was the priority of ensuring that the system upskilled the practitioners in the remote area, and the necessity that all shared a common language of needs and interventions. Each of these was more important than the technology, which is almost the easiest part of the equation.
These are particularly relevant to Ireland, as we are in the process of developing an electronic patient record which would provide the platform for a common language in conjunction with the increasing trend to electronic care records in nursing homes.
Common language
The HSE and the Department of Health and Children have also chosen the leading common language for assessing needs of older people, known as interRAI internationally, and the Single Assessment Tool in Ireland.
This has been implemented effectively across hospital, community and nursing home sectors in Belgium: as older people move between these settings, as they often do, the healthcare workers are able to see, and adjust the record appropriately and in real time so that all relevant care workers can see the changes.
This is an enticing prospect for Ireland, and in particular for healthcare in rural settings which have higher numbers of older people. A public health nurse or community therapist could assess using the interRAI, and then discuss the findings and suggested actions with a specialist (or team) via telemedicine, an interactive process which upskills and empowers the professional at the remote location.
Many Irish nursing homes are investing currently in electronic case records
For this to happen, we need a significant training programme and investment in interRAI-compatible healthcare electronic records in hospital, community and nursing home settings. As many Irish nursing homes are investing currently in electronic case records, it is essential that these are interRAI compatible, and vital that the HSE and HIQA should clearly communicate this to nursing homes.
If not, we are faced with a daunting prospect of the sector dealing with the most vulnerable of older Irish people being unable to engage with a major advance which accurately assesses needs, proposes care plans, and facilitates information transfer between nursing homes and hospitals.
We are standing on an exciting threshold of integration of community and hospital services in Ireland. For a country priding itself on prioritising the information technology industry, it would be a terrible own goal not to align this leadership with the necessary state-of-the-art systems and technology to improve care for us as we age.