Implementing an interRAI Assessment System
In response to many inquiries, we’ve outlined some of the key issues to be addressed if your organization is interested in adopting an interRAI assessment system.
Implementation of an interRAI System Will Be a Major Reform for Your Organization
The adoption of an interRAI assessment system is likely to represent a significant change in how the organization does business. It is not simply a matter of taking a new set of data collection forms and replacing the old ones. To realize their full potential, interRAI systems depend on competent, well-trained assessors, responsive software systems, and appropriate administrative support. A successful implementation will likely require new resources — at least at startup, and maybe indefinitely — and careful planning over a period of at least several months.
Licensing with interRAI
All end users need to obtain a (free) license from interRAI to use our assessment systems. There are two kinds of licenses:
The interRAI Web site gives a general overview of the two licensing agreements. We recommend that the licensing process begin immediately, as experience shows that this can be a time-consuming task in large organizations, where many parties must review and sign off. Licensure must be final before the implementation goes “live.”
Are Suitable Resources Available?
interRAI systems require personnel to conduct assessments, data entry personnel (ideally, the assessor), and software and administrative support staff. If your goal is simply replacing an existing software-based assessment system, then the resource requirements may not extend beyond the purchase of software. However, in many situations, implementation will represent a considerable investment in people, skills, software, and hardware that necessitates new financial resources. Implementation may also require some reconfiguration of workforce and staff skill sets. While interRAI systems often require investment in assessment personnel, this may be balanced by reductions in other staff due to efficiencies of the interRAI system and the move to an electronic environment. As a result, careful appraisal of resource needs is required. It is important to note that the use of a paper-based approach is generally inadequate, as a critical strength of interRAI systems is the extensive range of secondary clinical decision support tools that can be automatically calculated with software.
Will Potential Participants Be Screened?
Many entities screen potential participants to decide whether the person would benefit from a full assessment. The screen may be of your own design or may employ a screen developed by interRAI. In either case, it is essential to plan the rollout of the screen system. Some of the decisions that will need to be made include:
- Who will do the screen?
- Will the screen be done face-to-face or over the telephone?
- Will the screen be computerized or performed on a paper form? If the latter, who will design the physical form and scoring instructions?
- How will screeners be trained?
- What quality initiatives will the organization deploy to measure reliability of screeners’ activities?
- What is the plan when a later full assessment is performed and the person is found not eligible or appropriate?
What is the Implementation Plan for the Assessment Process?
Some of the decisions for the rollout of the full assessment system are similar to those needed in planning a screen implementation. The following is an initial list of considerations:
- Who will do assessments?
- How will Information flow?
- Who needs assessment data and in what format?
- What paperwork and duplicative processes can your organization eliminate by deploying the system?
- How will assessment data be linked to services costs or other internal records?
- How will raw data be transformed into information useful for policy or program administration purposes?
- How will assessors be trained?
- Who will provide training on three fundamental training topics: assessment tool basics, care planning, and the computer system?
- Does the timing of training enable assessors to begin to use the system immediately to prevent “de-training”?
- Does the training plan address assessor turnover?
- Will you develop or acquire any competency testing to establish/maintain reliable, high-quality assessment data?
- Will there be a pilot to “shake down” implementation procedures?
- Who will be available to answer assessment questions that arise? Computer questions?
Selecting a Software System
Software systems are integral to the effective implementation of any interRAI system. Your organization must make important choices early in the planning process. Some entities choose to develop their own solutions, but the majority purchase systems available commercially or use a system developed under the auspices of their government. Development of your own solution is challenging, but has the advantage of being customized to your own agency culture. The decision to “make or buy” is complex, and we do not offer specific advice. However, we do offer suggestions about what to look for in an interRAI software solution.
- Each software vendor must hold a license to distribute software in each nation. Check that your potential vendors hold a license for your country.
Look for the following core components in a software system:
- Is the data entry section customized to your nation, particularly the administrative sections?
- For clinicians:
- Does the software generate a full array of available scales and other decision support measures?
- Does the software generate a list of triggered clinical assessment protocols (CAPs)?
- Does the software generate a clinical profile (or snapshot) of the assessed person that brings together the key observations, scales, and CAPs in an easy-to-read format? Summaries may be useful for many audiences, including other clinicians, care providers, family members, as well as the person being assessed.
- For administrators:
- Does the software generate quality indicators and case-mix tools, if they are available for the system that you are planning to implement?
- Does it easily export data that may be required by government or other higher level bodies?
- Is it compatible with other software systems in use within your organization or network?
Please note that interRAI does not recommend particular software vendors. It is your responsibility to appraise alternatives carefully. Our vendor list indicates the nations and systems for which vendors are licensed. interRAI is able to add systems to vendor licenses fairly promptly if requested by the vendor.