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How can care infrastructures benefit from digitization?

The pilot project NeCTra (Networking - Care - Transparency) investigates how care processes within an urban social environment can be improved by using digital technologies. The goal is to bring together all partners and institutions in real time so that people in need of care and those seeking advice receive appropriate support more quickly.

With a population of around 20,000, the city of Weil der Stadt is just the right "object of investigation" for testing modern, digitally networked structures for improving the care of patients. The city is big enough to have a sufficiently high number of different care providers and partners, and its manageable social environment means that it is not too big for a pilot project. Since December 2017, five project partners from the fields of nursing and geriatric care have been exploring ways of using digital solutions to bring more transparency to the local care system. Digital solutions are expected to enable people in need of care and those seeking advice to find the right contacts more quickly who, in turn, will be able to find a suitable solution faster than they previously could. Ultimately, this will benefit the entire social system as reduced waiting times and connections with the right specialists can reduce costs.

The concept convinced the selection committee of the "Digitization in Medicine and Care" funding programme at the Baden-Württemberg Ministry of Social Affairs and Integration and was granted around 200,000 euros for a period of three years. The remaining costs are being borne by the cooperation partners themselves. The Sindelfingen-based “Gut altwerden GmbH” develpment centre is in charge of project management, and Martin Weweler is one of the project managers. In his role as managing director of the city’s welfare centre, Weweler also accompanies the project on an operational level.

"The welfare centre provides outpatient care services, and looks after around 250 people from all over the city and occasionally also in the small neighbouring municipality of Grafenau," says Weweler. Grafenau is well connected with Weil der Stadt and is also home to the Adrienne von Bülow senior citizens’ centre. It is one of three senior citizens’ centres run by the Keppler Foundation, which, like the welfare centre, is involved in the implementation of the project. The other two Keppler Foundation senior citizens’ centres are the Bürgerheim senior citizens’ centre in Weil der Stadt and the Haus Michael senior citizens’ centre in Weil der Stadt - Merklingen. "All three senior citizens’ centres offer full-time care and also run supervised residential complexes, private apartments with care contracts," explains Weweler. The Bürgerheim senior citizens’ centre also provides care for around 25 people per week on a day-care basis.

Transparency and rapid help increase security of care

Martin Weweler © Sabine Schreiber

The entire spectrum of care concepts is therefore represented in the project at several locations. In addition, there is the Weil der Stadt counselling centre, which is part of the welfare centre and is funded by the city authorities and a development association. The counselling centre provides low-threshold advice on the issues of care and ageing. "In 2018, we had around 320 consultations and the number is rising continuously," says Weweler. Clients that come to us are given initial information and then referred to the appropriate care providers depending on their individual requirements. Thus, the counselling centre also plays an important role in the project and the plan is to expand it further, inter alia, as an intermediary.

Ideally, i.e. if the digital switches are set correctly, clients will be put in contact with the appropriate care provider or the right offer without delay or the need for any further queries. Moreover, care providers will be able to inform one another and the welfare centre of their availability and services at any time - ideally in real time, as Weweler emphasizes - via digital care coordination.

"The basic idea behind the project is to offer a fast, customized solution to a client who logs on to the system to find help for a specific problem. Digital care coordination is also expected to help overcome a certain degree of operational blindness, which usually means that only the follow-up care services of the institution to which a patient is being referred to are being offered rather than the whole range available in a community," says Weweler who also mentions hospital discharge management as an extra service. He believes that communication and transparency that can be improved with digital solutions can in the medium term become another building block of NeCTra. "We hope that digital communication will help us to put patients faster in contact with suitable aftercare providers that have the capacity to deal with all the patient’s needs at the requested discharge date.”

Technically, the project team largely relies on existing hardware that is already used by partner organisations. However, finding and developing the right software turned out to be a bigger problem than originally expected. "The platform solution that was initially planned proved to be ineffective. Above all, the requirements on the interfaces could not be solved within the time and budget we had available. We eventually found the right software partner in the form of a company called SWING from Freiburg. This company has already developed solutions for the care sector and offers most of what we need," says Weweler. Meanwhile, the first software applications are already up and running. "As a first step, we installed FAQs at the counselling centre. We developed them based on statistical surveys of the most common questions. What is a care level? What is the difference between non-cash benefit and cost allowance? These are the types of questions we have included in the FAQs. The feedback we received for this low-threshold measure from patients’ relatives, in particular, was very positive,” said Weweler.

Digitization has the potential to provide relief for relatives, customers and care staff

The counselling centre at the welfare centre in Weil der Stadt provides advice on care and ageing. The project partners hope that digital tools will help them put patients faster than is currently possible in contact with suitable aftercare providers that have the capacity to deal with all patient needs. © Doro Treut-Amar

There is a reason why relatives are a particular focus for the team. The team knows from experience that those who need care usually have little digital knowledge due to their high average age. “We accept that many old people do not like venturing into the digital world, and are often also unable to do so. That's why we decided to go for mechanisms that do not (yet) directly affect our clients. What we want our clients to realize is that they can get the help that they want and need quickly,” says Weweler. Weweler also reports that the interest and understanding of care providers in what is happening technically behind the scenes varies considerably. It was therefore quite time-consuming to formulate requirements that were common to all involved. IT4Change AG, based in Herisau, Switzerland, participated as an advisory project partner. "All the project partners have learned a lot, they meet regularly and develop new, common perspectives," says Weweler.

The Catholic University of Freiburg, which is another project partner, assesses how well the whole system actually works. "We included the university in our considerations very early on. It advised us, for example, on how the counselling centre can be statistically evaluated," says Weweler. In addition, the university conducts focus group interviews so that parameters can be changed during the course of the project, based on feedback from relatives, decision-makers and care providers. The university also deals with expectations that have already been met and where improvements are needed, and will also conduct the final evaluation at the end of 2019. Weweler finds that a very positive effect has already been generated through the mere existence of the project: "The project has inevitably meant looking at what the other partners are doing and finding points in common. As a result, a holistic approach is taken regarding the needs of the social environment in Weil der Stadt, and those looking for advice are assisted more purposefully, and looked after according to their individual requirements."

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