Elderly care is one area where information technology (IT) is rapidly gaining ground. An increase in the number of elderly, and a demand for more advanced help and support, together with a desire to make it possible for the elderly to live in their own homes for as long as possible, force decision makers and healthcare professionals to develop better and more efficient elderly care. Many advocate the use of IT for management and administration of elderly care as a solution for coming to terms with many of the problems facing elderly care. An instrumental perspective is dominant in studies on IT such as the electronic health record (EHR), and values for stakeholders are often discussed in financial terms. However, in order to achieve successful implementation of IT, it is also important to study the values of IT in a broader sense.
Using four IT-projects as a basis, this article discusses the value of IT in elderly care, ending with a conclusion on the influence of values on IT in elderly care.
Sofia Omfale is an organisation-wide, offthe- shelf IT-system for administration of elderly care, and consists of optional modules. The case-site organisation has chosen to use Sofia Omfale for 'assignments', 'living', 'clients', 'staff', 'debiting', 'population record', and 'miscellaneous'. The users are mainly section managers, nurse aids, LPNs (licensed practicing nurses), and administrative staff. The section managers use Sofia Omfale for accessing information about clients, accessing or reporting statistics and information on fees and charges. Nurse aids, LPNs, and administrative staff use Sofia Omfale mainly for registering and accessing client information. The IT-project started in 1996, and was going to meet the following objective: 'A modern IT support tailored for the organisation, together with appropriate technology for registration of time that electronically create basic data for debiting and invoicing, will result in savings from a more efficient administration'. Sofia Omfale was implemented and in use by 1998. Sofia Omfale has improved registered data, making information more accurate and up-to-date.
Mini-pAKT was developed in-house by a section manager, nurse aids and LPNs in collaboration with the municipality's IT department. The section manager saw the need for an IT-system as a support for the nurse aids' and LPNs' communication and documentation. Mini-pAKT supports documentation of elderly care carried out, as well as planning elderly care. Mini-pAKT consists of the following documents: 'client information', 'notes', and 'work plan'. 'Client information' gives details on the clients, were they live, and what type of help they are entitled to. 'Notes' is equivalent to a health record containing day-to-day record entries. The 'work plan' is a detailed account on how the client wants to be treated, and how to carry out the help needed. Every nurse aid, LPN, and section manager used mini-pAKT on a daily basis. Mini-pAKT was introduced 1998-2000, and created a mutual organisational memory accessible for all authorised personnel. This contributed to improved client documentation, which resulted in better knowledge about clients and their needs, developing staffs' competences, and an increased awareness of their organisational roles. 'You are a representative for the local government and cannot, therefore, write the documentation anyway you want. You have to be objective [...] and the information has to concern the contact between the nurse aids and the client'.
DocIT is an off-the-shelf organisational wide IT-system for administration and management of elderly care. One important objective with the new IT-system was to create 'a mutual entrance for all' meaning that all authoris ed staff would access the same information. This would hopefully increase cooperation between staff, improve the quality of elderly care, and contribute to a more efficient administration. The system consists of a basic module that supports administration of clients and assignments according to the Swedish Social Services Act. The optional modules include 'debiting', 'living', 'social record', 'transportation service', etc. DocIT is used on a daily basis by all staff working with elderly care. The system was gradually implemented 2002- 2003, and has contributed to 'Increased understanding for different professional groups as the users can see what various professional groups do vis-à-vis a client'. The users also state that DocIT has made administration more efficient, as DocIT makes information available irrespective of time and place, decreasing the need for phone-calls as well as eliminate double-work in terms of recording information: 'Only one person records information, making it available for all'.
SAVA is an IT-system, developed in-house, by IS- (information systems) researchers in collaboration with nurse aids, and section managers. SAVA supports communication between care professionals about the clients, their needs, and events and actions related to their lives. The objective with SAVA was to improve knowledge transfer between care employees in order to ensure safe and adequate care, with the possibility for evaluation. SAVA supports documentation (social record and registering events), client information, planning, and follow up, and is used by nurse aids, LPNs, and section managers. SAVA is mainly used for documentation and client information. 'We use SAVA for documentation and client information, when you register a new client, search for family. We use SAVA several times every day. It is the first thing you do in the morning, so you know what has happened since you worked last.' The IT-project started in 1999 and the system was gradually implemented in 2002. Using SAVA has resulted in a more efficient communication, as the information is accessible by all authorized personnel, irrespective of time and place. One major result of this IT-project was the staff's relation to computers. This was an organisation with users with none or little computer experience. Many were initially very hesitant about using IT-systems for elderly care, but this changed completely. At the end of the project there was a dramatic increase in computer skills, and a very positive attitude towards using IT for the administration of elderly care.
IT Values in Elderly Care
The values embraced by the new IT-system depend on the initial goals, driving actors, and experienced problems, as illustrated by the case studies above. Sofia Omfale mainly relates to administrative values as administration and efficiency are the main problems addressed by the new IT-system. Mini-pAKT on the other hand, has had most impact on communication routines, and the nurse aids' knowledge about clients and their view on their professional role. This means that minipAKT is seen as an IT-project that supports values related to administration, communication, care and the elderly care profession. The purpose of DocIT was to support cooperation, and information transfer, which would contribute to more correct care, cost savings, as well as a safer care. DocIT therefore supports values related to efficiency, administration, cooperation, and care. SAVA, with its focus on quality assurance and knowledge transfer, embraces values related to communication, documentation, competence, as well as administration.
An IT-system includes social as well as technical aspects that need to be considered. Implementation of IT invariably involves making decision about communication patterns and routines – elements that are by their very nature social. A successful IT-system for elderly care needs to encompass not only values related to administration, efficiency, and cooperation, but also values such as improved care and correct care, as well as values related to the elderly care profession. Different actors are carriers of different values, depending on their organisational position. If we want to promote and support certain actors' interests and values by an IT-system, it is necessary to include these early in the process. Otherwise they will be more difficult to embrace and incorporate in the design.