The med-tech revolution

Medication management continues to be one of the most complained about issues in aged care. Time and again it charts high in the regulator’s industry performance reports.

Which is why med-tech companies such as Australian-based BESTMED have been working hard to come up with innovative solutions to improve the medication administration process in aged care homes.

A common complaint is that families are often kept in the dark as to what their loved one is being prescribed and why.

“A lot of those complaints occur because an event happened previously that the family weren’t fully informed of,” Phil Offer – BESTMED chief executive officer – tells Australian Ageing Agenda. “Improving that communication and transparency is key to what BESTMED Connect is all about.”

As Offer explains: “BESTMED Connect is an add-on module to the BESTMED medication management service and its principle is to improve communication with families when it comes to those key changes to medications and to understand what their loved ones are on.”

The standard BESTMED platform allows three parties access to an individual’s medication record – the doctor, the pharmacy and the aged care home.

“With BESTMED Connect, we’re adding a fourth pillar so the family – or the substitute decision-maker – has got access to what medications their loved one is on, and the reasons why,” says Offer.

BESTMED Connect has been piloted across a number of homes operated by Southern Cross NSW,ACT.

“The feedback was heartwarming, because it meets the needs of the product … it helps build communication,” says Offer. “It helps as a safety net and reassures. And for family members, they’re not having to chase information up – they’re getting that as it happens.”

Offer tells AAA, the app’s feature to confirm consent is proving especially useful in a live setting.

“Previously, if a change to medication occurred, the [aged care] home is having to confirm manually, on paper, that yes, consent was confirmed by the family. So it’s a big time-saver for homes [because] they’re not having to try and reach out to those families. And also the families have the information themselves. So that confirm-consent process has gone very smoothly.”

The recent rapid uptake of digital systems in aged care provides huge opportunities to improve care delivery

Associate Professor Magda Raban

The BESTMED medication management platform is currently being used in more than 1,100 aged homes across the country.

“We’re now rolling out the new connect module for those homes that want to take it up,” says Offer. “You will also see BESTMED Connect expand out into the home care environment to the families and users as well,” he adds.

BESTMED Connect was codesigned with researchers from Sydney’s Macquarie University. Offer says such collaboration is vital.

“It’s a key priority for us that we build those connections to the universities – to help make it easier for them to do their research, so we can do it at more scale,” he tells AAA.” And when we’ve found something that works, we can roll it out to get that holy grail of impact. That’s a win/win for us.” 

Associate Professor Magda Raban is a research fellow at Macquarie University’s Australian Institute of Health Innovation.

As she notes: “The recent rapid uptake of digital systems in aged care provides huge opportunities to improve care delivery. Macquarie University is exploring ways in which we can leverage this technology to improve medication management and safety.”

A key component of the research conducted at the AIHI is understanding the information needs of consumers and exploring digital solutions to meet those needs.

“With a panel of consumers, we are designing requirements for a digital platform for medication management reviews,” says Raban.

We are working closely with consumers, aged care providers, GPs, IT vendors and government partners to design, implement and evaluate solutions to tackle them

Associate Professor Magda Raban

As she explains, currently, medication reviews are a disconnected process – patients, their families and carers, pharmacists, clinical and aged care teams rarely have access to the same information at the same time.

“This technology-based solution will bring together all stakeholders to improve engagement in medication reviews, and hence, lead to improved medication management outcomes. We are working with BESTMED to embed this within their IT system to ensure the solution has reach,” says Raban.

“Ultimately, this means aged care residents, their families and carers will have simultaneous access to their live medication list for the very first time.”

As well as ongoing communication issues around medication management, Raban tells AAA there are also problems with over-prescribing. “For example, antipsychotics are used for prolonged periods in people with dementia as a form of chemical restraint; and antibiotics are overused and used for longer than guidelines advise in many cases. Our evidence synthesis estimated only 28 per cent of antibiotic courses were appropriately initiated.” 

Technology has the potential to address many of these issues, says Raban. “We are working closely with consumers, aged care providers, GPs, IT vendors and government partners to design, implement and evaluate solutions to tackle them.”

By harnessing the vast amounts of data already being collected – making it accessible, actionable and timely – there is no doubt digital solutions such as BESTMED Connect will revolutionise clinical care in aged care settings.

As Raban tells AAA: “This transformation is already underway, enabling more personalised, efficient, and responsive care for older adults.”

Detecting deterioration

In November last year, Australia’s first electronic screening tool designed to detect risk of deterioration in aged care residents won another national prize – the Digital and Data Health Innovation Award 2024.

Developed by RMIT University and Telstra Health – in collaboration with the Digital Health Cooperative Research Centre – the AI software can rapidly screen electronic records for 36 evidence-based indicators of deterioration.

“It automatically scans the electronic record in residential aged care facilities and assigns a score and categorises a resident’s degree of frailty. And it tracks changes over time,” Vickie Irving, Telstra Health’s deputy chief health officer tells AAA.

As Irving explains: “One of the key value propositions of the innovation is that aged care workers and nurses are extremely busy – they’ve got very high caseloads. One of the key focuses of our project was to decrease the burden of data collection because those staff are already too over-worked.”

The starting point was to identify evidence-based markers of deterioration using data collected routinely at the point of everyday care in aged care facilities.

“We scan everything from the daily notes that the nurses and care workers input into the care records – the observational data like [residents’] vital signs. We also scan the records of visiting specialists,” says Irving.

The AI tool is powered by an algorithm that has a massive data dictionary alert to key words associated with evidence-based markers of deterioration.

“It has additional smarts around being able to identify the context around those evidence-based markers,” says Irving. “It doesn’t just look for the word falls, it will look for the context around it so we can identify if an event has occurred.”

The tool differs from those used in hospital settings, explains Irving. “They are very much based on things like your heart rate, blood and oxygen levels, blood pressure and so on. Those sorts of markers don’t predict deterioration very well in an aged care population because the changes are much more subtle … until something catastrophic happens.”

Such as falls or injuries that require emergency transfers and hospitalisations. 

Last year’s trial of a prototype tool – which scanned 66,000 records across 44 aged care homes – was, says Irving, “incredibly successful”.

The next step is for the prototype to enter the production phase, then regulatory assessments hopefully sometime later this year, she says.

“So we can release it – not only to our own customer base – but looking at being able to release it more broadly.”

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