Year

2006

Degree Name

Doctor of Philosophy

Department

School of Information Technology and Computer Science - Faculty of Informatics

Abstract

Australia and other western nations are actively formulating strategies that will increase the adoption of information and communication technology (ICT) amongst privatesector providers of aged care. The drivers for this technological change involve population ageing reforms, concerns about the quality and safety of healthcare, and global strategies encouraging governments to transform the way they do business. This research set out to examine these drivers and to inform development of a national aged care ICT strategy in Australia. The research questions prompted an examination of how national health information systems and e-health reforms in Australia and overseas address aged care, with a view to describing a hierarchical structure of standards for interoperability using the Health Level Seven (HL7) Reference Information Model (RIM).

HL7 refers to the international organisation involved in developing and supporting healthcare standards.

A review of the implementation of national health and technology reforms revealed there are gaps in most western nation’s approaches to e-health reform when it comes to identifying the information management and communication requirements of privatesector aged care providers. Through the participation of aged care provides in Australia, detailed requirements were gathered using a Delphi approach and analysed using healthcare information modelling methods to inform the development of a hierarchy of Australian aged care messaging and communication standards.

The methodology chosen for ocumenting these requirements was the HL7 Development Framework (HDF), the methodology which all HL7 Technical Committees are required to follow in the development of Version 3 (V3) standards. The first three of the seven formal phases to the HDF were employed to document a consensus business vision for nteroperability in aged care and some 82 storyboards. This provided detailed understanding of the likely system-to-system interactions and the associated application roles and receiver responsibilities of some 121 discrete interactions. Ten of these storyboards were subjected to international review as part of the published requirements for the HL7 V3 Care Provision standard in 2005. This comprehensive set of requirements informed development of an aged care Domain Analysis Model (DAM) whose elements were mapped to the HL7 RIM. This enabled the development of some early examples of how the aged care domain might be modelled using RIM conformant design models and how these might in turn be represented in an aged care Domain Information Model (DIM).

Modelling the requirements of aged care providers using the HDF revealed four areas of communication complexity: Accessing an aged care service; Contractual documentation associated with securing and funding an aged care service; Effective coordination of service delivery; and Consistent documentation of services delivered. A number of solutions for addressing these complexities are proposed including migration of the current aged care referral process to an electronic application process; adoption of a new aged care case-management structure by collaborating healthcare and aged care providers; and adoption of a suite of national forms-based specifications using the HL7 Clinical Document Architecture (CDA) standard. These proposals offer possible solutions for achieving the interoperability vision described in this research and they are supported by the proposed aged care DIM. They will, however, rely upon the adoption of uniform messaging standards by aged care providers and by healthcare providers interfacing with them such as hospitals, General Practitioners and Aged Care Assessment Teams. To engender adoption of such standards, a role delineation model for implementation of the proposed hierarchy of aged care messaging standards is described. Together, these finding offer practical contributions towards the development of a national strategy for the adoption of ICT in aged care which is capable of supporting the objectives of population ageing and quality and safety reforms.

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