eACCR

1. eACCR THEBLACKTOWN ACAT EXPERIENCE

2. WHO ARE WE? • We are part of the Rehabilitation and Aged Care Service at Blacktown Hospital • Blacktown and Mt Druitt Hospitals form the Central Cluster of Sydney West Area Health Service • We are approx. 35 kilometres west of Sydney CBD • The Blacktown LGA has a population of approx. 272,000 (2006 Census) with 8.2% over the age of 65 years (22,235). 2.6% of this population is ATSI (7,055) and 40.9% were born overseas

3. NSW AREA HEALTH SERVICES

4. SYDNEY WEST AREA HEALTH SERVICE

5. In August 2007 we had a staff of : 3 x RNs 3.6 x Social Workers 0.7 x Physio 2 x OTs 1 x Secretary • This meant 6 computers shared between 11 staff • The majority of data entry was done by the Secretary • We sent our completed ACCR forms to DoHA once per week via courier

6. WHY US? • Proximity to the NSW Evaluation Unit and small number of computers • Already using the ACE program • History of assisting the EU with new programmes • A very computer literate Secretary who wanted us to volunteer when she heard Westmead was going to be involved (a point of pride that we did much better ACCRs than them) • The Proof of Concept (POC) component was a surprise that I found out about at the Workshop in August 2007.

7. OUR JOURNEY BEGINS • 2/8/07 - Workshop in Canberra with representatives from all participating ACATs , Medicare and DoHA • 29/8/07 – Training for Team from Chris Benson, Manager of the NSW Evaluation Unit • 30/8/07 – I participated in my first weekly Teleconference • 11/9/07 – Proof of Concept phase begins • 13/9/07 – Urgent request to Medicare to replace my iKey (instructions did not include a warning that entering the incorrect password 3 times would lock the iKey) • 13/9/07 – We transmitted a record to Medicare but it was rejected

8. 20/9/07 – We transmitted successfully but records were rejected by Aged Care Payments systems • 26/9/07 – First eACCR successfully processed by Medicare Australia • October 07 – everything going well until transition to Daylight Savings which resulted in events not being received properly at Medicare. The problem was identified and resolved. • 29/10/07 – 12 week Demonstration Phase begins • 9/11/07 – Our first request to correct Part 6 (good learning curve for all parties on processing this request) • 25/1/08 – Demonstration Phase concludes • April 08 – attended my last Teleconference

9. WHAT CHANGED FOR US? • Secretary * Less data entry * More photocopying (copy for client and copy stored in ACAT office to fax to ACFs and Carer Respite). Increased our paper usage * Less control over quality of data being entered * No more using Couriers to send forms to Medicare and entering the details in a Postage Book • Assessors * More data entry which increased workload until they became more proficient with computer skills * Needed to work out how much of the paper ACCR they filled out with clients before entering it into the computer or giving it to the Secretary to enter

10. * By the end of the Project all assessors were entering their own data – less duplication, easier and quicker to enter it on the computer than on the paper form * The number of characters allowed in free text was limiting and staff needed to think carefully what they would write * Access to computers was becoming an issue • Delegates * Electronic Forms were much easier to read compared to handwriting. Necessary corrections could be made without the form looking messy or becoming illegible

11. * Some Delegates struggled with viewing the form on the computer and scrolling through it so initially it took longer to read through it * Business code violations and omissions of mandatory fields were picked up before the forms were submitted to Delegation which saved the Delegate’s time * There was some anxiety initially about Delegation happening so fast - at the push of a button the form was sent. This anxiety eased as staff became more familiar with the process and more safeguards were built in as the software was upgraded. • By June 2008, thanks to assistance from the NSW Aged Care Integration Unit we had one computer per staff member

12. WHERE ARE WE NOW? • All Assessors are confident about inputting their own ACCR data • Delegates are more proficient at using the Delegation software and therefore take less time per form. The ACE-generated electronic Template letter was time-consuming initially but this has improved dramatically since issues around evidence were resolved by DoHA. • ACFs are reminded to check on the Medicare website to obtain copies of ACCRs (some are still resistant and some have internal issues about who has access to the website). Now that there is a PDF version of the Form that looks like the paper version it is more appealing to them • Still waiting for CACP providers to apply for access which will be a great help

13. We are no longer dependent on DoHA sending out ACCR forms. We are able to print copies of the Signature page from ACE • We no longer keep copies of ACCRs in ACAT office which has freed up 2 x 4 drawer filing cabinets • We can check on the Medicare website for ACCR approvals for clients that have come from out of area. This benefit has gradually increased as more Teams have become electronic

14. SUMMARY • Despite some initial trepidation, the transition to eACCR went smoothly and painlessly • There were IT glitches with ACE and Medicare payments in the early months but these were resolved and now we rarely need to contact the Evaluation Unit for assistance • Our suggestions for changes to the software were taken on board and subsequent versions have incorporated them along with suggestions from other ACATS (more free text space , removing lines, prompts to check that you are Delegating the correct form, etc)

15. The support we had from the NSW EU, Medicare and the eACCR Working Group was excellent. The whole process was well organised and well co-ordinated by Arthur Gidis and the Working Group • eDelegation is easy and efficient. An Assessor knows where in the process their form is up to and we receive confirmation of approval outcome within 48 hours. It is faster and more reliable than sending forms to Medicare via post or courier. • Filling out the paper-based 21-day respite extension form feels quite archaic now!

16. Good luck to those ACATs who are still to embark on their own eACCR journey • We are looking forward to further developments in the use of technology in our work (some with more enthusiasm than others!)