Community care needs client management platforms

FEATURE - Industry Innovation Article - Noted

Noted founder and chief strategy officer Scott Pearson makes the case for client management platforms to meet the unique needs of community-based care provision.

We have heard a lot about the state of health IT systems lately. Descriptors have included: ‘ugly baby’, ‘fragmented’, ‘out of support’, and ‘not fit for purpose’. The resulting negative impact on recipients of care, time wasted, frustrated and burnt out staff, compromised security, siloed data and lack of evidence of outcomes and other key data is also on record.

While these comments have been referencing systems in Health New Zealand | Te Whatu Ora, community-based care health and social care providers face all these challenges too. Possibly even more so.  

This matters because over half of the health and disability workforce in Aotearoa works outside of secondary care. Most contacts actually take place in communities. 

At a time when evidence of work undertaken and outcomes achieved can be the difference between retaining a contract, or not, the lack of appropriate systems can lead to an entire service being discontinued. This is a tragedy for both the people who have dedicated so much of their lives to supporting vulnerable people, and the people who depend on that support. Meanwhile, it is not a new idea that interventions in the community are more likely to improve the overall quality of life of New Zealanders, as well as reducing the load on secondary care. 

While some community work is undertaken by hospital-based teams, much of the load is carried by NGOs who deliver on contracts for a range of government and non-governmental organisations, such as Health New Zealand, Ministry of Social Development, Department of Corrections, Ministry of Justice, Kāinga Ora, Ministry of Education, New Zealand Police, ACC and Whānau Ora commissioning agencies.

Some providers focus on one or two contracts, but many deliver numerous services and have large numbers of teams with a diversity of types of worker and sensitivity of information, as well as an enormous amount of data capture and handling required to meet operational and funder reporting requirements. Despite this, the majority of community-based health and social care providers work on systems that are not designed for this level of complexity.  

There would seem to be two main reasons for this. The first is funding, the second is the limitations of systems available. 

Client management systems

Most providers are funded by contracts from commissioning agencies that fund the staffing requirements of services, but not for ancillary requirements. This means that there is little to no money left over for the systems they desperately need. This is a false economy as the inefficiencies and other flow on effects cost more money than investing in client management systems. But even when there is money to hand, most existing client management systems are poorly suited to the task at hand. 

Client management systems are typically designed for a particular profession/contract, or subset of contracts, which means that they are less able to meet the needs of other types of services, such as using medical PMS for case noting of social services. This leads to teams working on systems that do not suit their needs, or that are cut off from the wider organisation. A single provider may have many client management systems with paper notes and Excel filling in the gaps.

This leads to negative impacts on recipients of care, staff, and data accessibility, quantity and quality.

An attempt to solve the issues described has been to build new systems from scratch using CRMs. Based on feedback from the market, my impression is that these solutions allow systems to be put together faster and more easily than building from scratch with proprietary code, but run into challenges when attempting to meet the extremely complex needs of health and social care provision. 

The result can often be a poor user experience for staff that fails to solve for many of the issues described above. Even when the resulting system is fit for purpose, these solutions can also be very expensive.

Client management platforms

I propose that the answer lies in client management platforms: products designed from the ground up to meet the needs of health and social service providers that can be easily configured to suit the needs of all workers, contracts and sizes of organisation.

It has been over ten years since the core ideas of Noted were originally conceived.  Over that time, working closely with an expanding range of customers, the concepts and implementation have been continuously challenged, revised, and extended. The result is a proven platform that has demonstrated its value across the community care sector.

Noted’s customers include Health New Zealand; Pegasus Health; 19 Māori health providers, including Te Rūnanga O Toa Rangatira, He Waka Tapu, and Te Puawaitanga ki Ōtautahi Trust; mental health services, such as CARE Waitakere;  various social service providers; 21 percent of New Zealand secondary schools; and a diversity of small private clinics.

Noted’s ability to serve such a wide range of customers in a scalable way is a combination of its well-rounded, standardised, easy to understand foundation and easily configurable content, tailored to each type of user. To my mind, this configurability is what separates a ‘client management system’ from a ‘client management platform’. 

From our experience, every organisation needs to be configured at a global level, and then every team needs to be configured so that their needs are met. This configuration needs to be achievable without teams of developers to be scalable.

The addition of data domains, created with our customers specifically for the context of community care, has greatly increased our ability to capture useful information that can be aggregated from many providers to offer a deep view into an entire service or population.

Key components of a platform would ideally also include: ease of use, note taking with fine-grained data capture, note taking for people, groups and whānau, workflow support, sophisticated access controls, interoperability with NZ health systems, scheduling, a client app, and data discovery. They should also address the requirements of data sovereignty for providers and whānau.

Health and social care providers undertake critical work in communities, improving the lives of New Zealanders and reducing the load on secondary care. 

Their ability to deliver effectively is curtailed by a lack of funding for systems and a scarcity of systems that are able to meet the requirements of their diverse teams.

I propose that the solution is client management platforms: products tailored to the needs of community-based care provision that can be easily configured to meet the needs of care providers and their teams. Data domains for community-based health and social care are also a necessity.

Image - Scott Pearson, founder and chief strategy officer, Noted  

If you would like to provide feedback on the above feature article, please contact the editor Rebecca McBeth.

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