Best Practice for Adoption of Electronic Care Management Systems

1.    Introduction

Adopting digital care management brings a wave of positive change for a care team. Taking advantage of digital transformation delivers better management of care, more secure data handling, better coordination and improved responsiveness. Given the importance of such system, and the importance of managing change in teams that are already extremely busy, selecting a supplier of digital care management services and solutions is critical.

This document provides guidelines derived from best practice compiled by suppliers of over 2000 registered services, including what works best, what risks to consider and how to avoid them, as well as what to look for in a supplier so that you get the product and service that is best for you and your care teams. Other industry bodies, such as the United Kingdom Home Care Association (UKHCA), have also published similar guidance.

2.    The Opportunity of Digital

Digital transformation of care practices is at present the greatest opportunity for positive change in the context of care provision. Successful implementation is known to result in:

  • Positive change in culture resulting from freed up time and transparency;
  • Improved health and wellbeing of care staff;
  • Safer, more transparent care;
  • Time and money savings;
  • Improved data security;
  • Data driven decision making;
  • More timely decision making based on real-time information;

Your care teams will be able to identify, monitor and control risks with added transparency, leading to overall better risk control. In the medium term, digital care recording will enable single sharable records, easing transition between care settings, including in and out of hospitals;

3.    Selecting, Buying and Adopting Digital

The Process

The selection of a product starts with the internal definition of what the care provider wants to achieve. This can be reactive (due to external factors such as a negative inspection rating) or proactive (to gain a competitive advantage over other providers).

In parallel to this, the provider, the owner, the board or a budget holder, will task a team with consulting software providers, learning about their solutions and their services. Define clearly who will lead on this effort and make sure your teams are given time to be involved in the selection process. The team in charge must have an open mind about what technology can achieve for care teams, providers, people receiving support and their families.

When care managers, senior care workers, nurses and care workers are involved in the selection process the adoption tends to be easier.

The team tasked with consulting suppliers will create a shortlist of suppliers, and from this shortlist, key stakeholders and budget holders will then select the preferred supplier.

Commercial Vetting Before Buying

Ensure that terms and conditions are aligned with your requirements. Areas to consider include:

  • Term of contract: contracts that lock you in for long periods may be disadvantageous for you as a business;
  • Is the supplier contractually bound to act as a Data Processor and is responsible for fulfilling their responsibilities under GDPR, and help you perform your obligations as a Data Controller;
  • Get clear understanding of data ownership, as well as retention periods the supplier is committed to providing – do check your insurance contracts as these usually demand longer retention periods than those set by NICE guidelines;
  • Understand the processes for offboarding – should you wish to change supplier in the future you should know what the terms and processes are;
  • The system may be bundled with a physical service, paid for by a third party: understand who will be training and supporting the system now and in the long term;

Technology Vetting Before Buying

Get a clear understanding of how the product is designed, basic building blocks, security and resilience:

  • Does the product rely on a well-established cloud infrastructure (as this is likely to maximise availability and security assurance)?
  • Can the supplier give you assurances of where the data is hosted, and how secure is the data within handheld devices, in transit and when stored in servers?
  • How does the product deal with loss of connectivity? Internet connections and WiFi networks are not perfect – loss of connection may lead to loss of records if the product is not well designed;
  • Is the supplier able to demonstrate their security credentials through certification or other form of independent testing or vetting, e.g. ISO 27001, Cyber Essentials or equivalent?
  • Are the devices provided suitable for use in real care environment? you should look for devices that are water resistant and able to withstand regular drops and falls – it must be easy to clean and it should be apparent they are work devices to avoid perceptions of staff using their own phones in the care environment;
  • Is the product future proof? Does the provider publish regular releases of the product, how often? Does the product integrate with other solutions, e.g. eMAR, nurse call systems?

Rolling Out and Adopting Digital

Working with the preferred supplier you will then agree:

  • Preparation: ensure you communicate with families, care teams in a way that is clear, reassuring and conveys the reasons for adopting digital
  • Training plan: you need to agree whether the supplier trains all your staff, or trains your internal training team which then delivers training
  • Roll-out plan: you will need to agree how devices are prepared and deployed, how user accounts are created, how records are created for people you support.

Piloting Products

Most providers will be able to facilitate low risk evaluations – this is usually done through easy contract cancellations in the first few months. For large providers with multiple registered services, a pilot may be used to evaluate more than one product – although costly, this may be a sound approach when your procurement process fails to identify a clear preferred solution.

Deploying a Digital Product

For creating a roll out plan, always consider:

  • How you create excitement and openness to change – communicate with teams on the run up to adoption;
  • Early engagement of relevant stakeholders to surface any issues that may hinder the roll out – work with registered managers to ensure they take ownership and lead change;
  • A care team must adopt digital in one go – avoid parallel running of digital with paper recording, or phased roll-outs within a single team – these tend to create slower change, resistance and risks regarding which information is recorded where; a fast launch with an iterative mindset works better than a slow launch;
  • Have an experienced user or trainer on site to answer questions during the first shift of the launch, their enthusiasm will overcome a lot of resistance, and seemingly huge issues can be removed immediately;
  • Identify key members of staff who will become catalysts of transformation: people who are enthusiastic about the change and who communicate well and are supporting towards their colleagues;

4.    The Risks, and How to Manage Them

Digital systems for care management have proven to reduce risks and increase transparency. However, there are risks, predominantly related to change which must be acknowledged and managed during the procurement process. These include:

Risk Risk Avoidance Actions and Mitigation
Staff resistance to change and loss of key staff Involving key staff in the selection process is likely to decrease the likelihood of staffing dissatisfaction; ensure staff is briefed in advance of training and roll-out, listen to concerns and address them – some providers may have brochures or other items to help with raising awareness and internal communication; internal workshops pre- and post-deployment can be used to ensure good communication and engagement;
Data loss or data breach Seek reassurance with the supplier as part of the technical evaluation. How long have they been registered with the ICO? How do they report issues of data breaches to you? Which continuous improvement and monitoring processes do they have in place? Ensure your supplier allows you to control which devices have access to records – authorising or revoking access (e.g. registered manager’s home computer);
Devices being lost Introduce charging stations, ensure devices are tracked, either with a device count on handover or digitally if suppliers allow for this. Some suppliers will be able to track devices remotely and wipe them remotely in case they are lost;
Poor adoption, worsening of quality of records In the same way your team performs record audits on a paper-based system, it’s important that these continue when on a digital system. Some suppliers may offer functionality regarding audits;
Risk of CQC seeing the use of technology in a negative light Managers can keep a crib sheet, mapping compliance to how they use their systems. Suppliers will be able to provide evidence of how CQC endorses the use of digital tools;
Poor governance around password management Integrate basic IT security into your internal training plans – as a minimum explain people in your teams, they must not share passwords, and passwords must remain confidential. You must also ensure accounts for care workers are deactivated when they cease working for you;
Perception of tech as a barrier to engagement with person receiving support Record the care notes at the point of care and let the person you support know what is being recorded. This can even be extended, when there is capacity, to people receiving support contributing or creating their own records;
Access to information for external stakeholders Ensure this is understood by your teams – most systems offer proxy access to personal data – either for family access, GPs or other providers – this must be controlled. Ensure suppliers provide specific training on these areas of functionality and how to manage them;
Scope of tech supplier responsibility vs. provider duty of care responsibility Ensure that the terms and conditions are clear regarding scope of responsibility regarding data governance and security, as well as your responsibilities as data controller and the supplier’s responsibilities as a data processor.


5.    What to Look for in a Supplier of Electronic Care Management Products

When choosing a supplier for digital care management, you may want to consider the following aspects of evaluation. Different care providers will take each aspect as more or less critical for the choice. Considering the complexity and risk of adopting a system, you may want to consider aspects of evaluation as well as aspects of culture fit. Here are some examples of aspects you may want to consider as part of your evaluation:

  • Supplier reputation: can you talk to providers who use the product and service? What do they say?
  • Ease of use for care workers: the larger number of users of any system for care recording and coordination will be care workers – your chosen produce needs to be intuitive, friendly and designed in such way that training needs are reduced – good products make care workers feel valued; ensure care workers are involved in choosing and evaluating this aspect of your procurement;
  • Length of time trading in care sector: how many years has the provider been operating in the care sector?
  • Business continuity: probe what mechanisms the supplier has in place to ensure your business will be able to operate in case of disruption of the supplier, such as escrow arrangements, human readable repositories of care records, data transfer agreements; also, ensure the supplier has plans in place for disaster recovery – if a catastrophic event brings their servers down, what mechanisms are in place for recovery, including how long will it take for the supplier to bring the service back up;
  • Size and robustness of company: connected to the above, and considering that you are likely to rely on this supplier for many years to come, you will want to assess how likely it is they will still be in business in 5 years; you can probe financial robustness as well as trading history;
  • Certifications and quality: check for reassurance that the supplier has been through checks regarding their processes and security e.g. ISO 27001, CyberEssentials or others;
  • Listing on nationally recognised procurement frameworks: these usually require the supplier to qualify, such as the UK Government Cloud (gCloud);
  • Level of customer support: if your care teams work around the clock, ask the provider for their customer support hours and response times, both in office hours and out of hours including weekends and bank holidays;
  • CQC reports: can the supplier point to CQC reports that highlight the use of their product and what difference if made in the various KLOEs?
  • Does it deliver what’s important to you? different products will be stronger is different aspects – some products are stronger on their handover, family engagement, audit tools, reporting, configurability, integration with other systems – define what’s important to you and ensure each supplier demonstrates functionality that is key for how you want to operate;

6.    What Else Must be Considered When Going Digital

Information Governance

Digital solutions help you streamline your data governance obligations. GDPR and the Data Protection Act 2018, define the responsibilities of the data controller, i.e. the legal entity, and the data protection officer (DPO), the person who determines the purposes for which and the manner in which any personal data is to be processed.

By contracting a digital care planning supplier, you need to consider how the supplier is going to fulfil their obligations as a data processor.

Information about your obligations and those of data processors can be obtained from the Information Commissioner’s Office or the National Care Forum.

You also need to be mindful of the scope for which the supplier is responsible. When the supplier is providing you with a locked down handheld device then the supplier will be responsible for information security end-to-end. However, if you choose to source your own devices, or if the supplier does not manage your devices, you are responsible for managing the data while in the device until it gets to the app – this includes how the data is handled by the phone’s keyboard, any speech to text software or other applications that may intercept data being typed before it gets to the supplier’s app.

Staff Training

Once the product is in use, you need to consider how your onboarding of new team members will have to include training modules to cater for the use of electronic care recording systems; when you choose a product that is easy to use, most carers are trained by their peers; but you need to consider how to address this training requirement – as well as information security guidelines for each user of the product.

Handheld Devices

Suppliers will give you a range of options, including:

  • Fully managed devices, where the supplier is managing the full security of the device, including the portfolio of applications on the device;
  • Open devices with the pre-installed app: where you will need to manage the security of information within the device, control which apps are installed, and be responsible for any data that may leak the device into the open internet;
  • Buy your own devices: as with open devices, but you are procuring your own, and installing the supplier’s application;
  • Bring your own device: in line with ICO’s guidance for Bring Your Own Device;

When choosing devices, it is important that you are mindful that:

  • Devices should be visibly marked as work devices to avoid perceptions of carers being on their phones;
  • Devices should have suitable battery capacity to last at least two shifts should carers not be able to recharge them;
  • Devices need to be shock and dust proof (ideally water resistant), and be easy to clean;

Communication with Families and Community

Introducing an electronic care system is a significant change with impact on the work routines of your teams; it is sensible to inform the people you support, their families, district nurses, GPs, commissioners and community care teams of your plans to adopt digital, as well as the advantages for the quality of care you provide, and how people you support, their families and other visitors will benefit from this initiative.