Co-founder and director Jonathan Papworth explains how Person Centred Software is leading the sector in the adoption of electronic evidence-based care systems.
I caught up with Jonathan at Person Centred Software’s Guildford office shortly after the software provider celebrated its 1,000th care home coming on board with its electronic care planning system, Mobile Care Monitoring.
Jonathan has come a long way since starting his career as a junior programmer in the late 70s.
His career in care began in the early 90s when he was commissioned to develop a service user billing system for Court Cavendish. The billing system went on to become the electronic care planning system Caresys, which Jonathan sold to Advanced in 2010.
It was shortly after this that Jonathan and his brother Simon set up Person Centred Software.
“Simon and I said ‘why don’t we create the product that we always wanted Caresys to be?’”, Jonathan told us.
“We knew that there was no-one delivering something that works for the carers. There’s loads of electronic care planning products out there but nothing works for carers. If you wanted to use an electronic evidence of care system you had to walk back to the computer. People don’t do that.”
It was on this basis that the brothers developed their Mobile Care Monitoring system.
“We created the first, and in many respects, still the only fully mobile, easy to use, fit for purpose, evidence of care system,” Jonathan said.
“Everyone was thinking that to go digital, a computer was the answer. But we take people from using paper to evidencing care using a digital system that is mobile. Remember, carers don’t sit at a desk using a desktop computer.
“If you’re not evidencing care on the go, how can you remember everything you did at the end of the shift? You only remember the big things. You don’t remember the little things like the cup of tea, the sit down for a chat, reading a prayer when they’re feeling anxious. But it’s the little things that make a life. If you are elderly, the most important thing is quality of life, which means enjoyment and to be happy.”
The icon interface is combined with a slider scale of measurements where carers can log, for example, levels of happiness, fluid intake and severity of falls.
“We had happiness as a core measure from day one,” Jonathan said. “Happiness levels are measured with a range of five smiley faces in different colours.
“We have had people say to us – ‘how can you measure happiness it’s not objective?’ But subjective is good enough.
“If you ask a carer to evidence happiness, they have to think about how happy they believe that person is. In doing that they are trying to make them happier.”
The easy-to-use, icon-based interface of the system developed in 2012 was born out of Jonathan’s aim to create a system that was universal, which anyone could use.
“It’s no good if you have a system that 20% of carers use,” Jonathan said.
“You don’t have holistic care until it works for 100% of people, including all ages and those who don’t speak English as a first language.”
In a radical move that dispensed with the need to write lengthy care notes, the system is designed so that 95% of care can be evidenced simply by pressing picture icons.
As a result, Jonathan is proud that Mobile Care Monitoring saves every carer an hour per shift that was previously spent on paperwork.
“The first set of pictures on the interface shows service users with their names,” Jonathan explained.
“The carer can see who they are caring for, so they can tap their photo, then tap ‘cup of tea’ and tap ‘happy’ and they have not used a single word in any language to evidence care. This is particularly important for agency staff or new members of staff who don’t know the residents well. Because it’s used by everybody, we have holistic insight into care and can measure outcomes that no other system can.”
Another innovation from day one was the Relatives Gateway – a secure portal for friends and family of residents in care homes to share messages and photos electronically, and if appropriate, to view care and electronically sign the care plan.
“The system not only dispels families’ fears about care homes but keeps them much more connected to their family member’s new stage of life during the transition to living in care,” Jonathan said.
“The Relatives Gateway also gives value back to carers too, since it shows and recognises everything that they do, from major activities to the smallest acts of kindness.”
Jonathan admitted that getting providers to adopt the system remained a challenge, however.
“Transparency and openness in social care in 2013 was unheard of,” Jonathan said.
“You could ask a care home manager to lay open the care to the people who came into the home and they wouldn’t.”
Fast forward to today, and while significant progress has been made with nearly 300 care homes using the Relatives Gateway, Jonathan concedes there remains a reluctance to share care notes.
“They talk about it but the ‘doing it’ is a step beyond most care homes,” he said.
“It’s an education process we have to go through and we are working on that. They have got to have a better understanding of the benefits of it. For those that are using it, the benefits are clear.”
Providers are given maximum control over the level of data sharing with options ranging from simple picture sharing to sharing daily care plans.
While electronic care planning systems have seen significant take up amongst small and medium sized providers, Jonathan noted there remained a notable reluctance amongst the large providers to ditch their paper.
“The bigger the organisation the more layers of change there are to go through,” Jonathan noted. “The more conservative they are by nature.”
With logistical challenges often cited by the large providers for their reluctance to adopt electronic care systems, Jonathan highlighted the ease with which Mobile Care Monitoring can be implemented.
“We have an implementation process that is very efficient,” Jonathan said.
“With just one day’s implementation and training, 85% of care homes are live the next day.”
The director and founder pointed to the prevelance of CQC ‘outstandings’ amongst smaller and medium sized providers as evidence of their greater willingness to innovate.
Pointing to Warwickshire based WCS Care’s success, a satisfied customer of Person Centred Software, Jonathan added: “It wasn’t a care provider with 200 homes that was the first to get six outstanding it was one with 13.”
The digital provider has seen its own notable success with CQC ratings.
It has 46 homes that have achieved CQC outstanding, representing around 5% of its customers, which is ahead of the sector-wide level of 3% with the regulator’s top rating.
“We are not a magic wand,” Jonathan noted. “Mobile Care Monitoring is only one part of supporting a provider to achieve outstanding, but we can see that we are supporting providers well because our customers have a higher level of outstanding ratings.”
As one of our customers said: “The amount of outstanding rated care homes using MCM is validation that it will give us the tools and insight to help us reach outstanding as well.”
While the business has seen strong growth in take-up in recent years, Jonathan observed there was still much talk to do in gaining sector-wide implementation.
“We have 1,000 care homes of which we believe we have 50% of the market that has adopted an electronic evidence-based care system,” he explained.
“There’s 16,500 care homes in the UK. There’s a lot of mindsets to change.”
The director said the CQC had a crucial role to play in changing mindsets.
“They are encouraging transparency and openness and one of the easiest ways of doing that is electronically,” he noted.
The Person Centred Software founder called for a mandatory date to be set for sector wide adoption of electronic evidence of care systems.
Looking ahead, the provider is working with partners on the development of a care ecosystem composed of a complete suite of digital systems that can work together and feed into its system. Potential partnerships include a company that is creating facial recognition apps to detect the amount of pain being suffered by people who are unable to communicate.
“We are taking that to a couple of providers shortly and are working on the interface that will feed directly into our care plan and will provide better quantitative measurements of the pain people are in and then be able to evidence what we do and measure if that care improved the pain,” Jonathan said.
The business is also working with a number of different medication providers on the integration of eMar systems.
“One of our goals is to have meds all the way from the pharmaceutical company to medication being administered available within one process,” Jonathan said.
“We will be feeding in the impact so that people prescribing can see whether it is having a positive effect. We expect that to reduce overmedication.”
The software provider’s electronic care planning system is a comprehensive compliance product that helps providers meet most of the CQC’s Key Lines of Enquiries (KLOEs).
“Lots of our features within our mobile evidencing, monitoring and reporting system cover all five key questions,” Jonathan said.
Person Centred Software is also working on the possible addition of an artificial intelligence layer to its system, though Jonathan remains a committed advocate of person provided care.
“I still personally believe that people interact best with people,” he stressed.
“We are not trying to remove people from the equation, we are just trying to take the mind-numbing burden of paperwork away from carers. We know that data combined with artificial intelligence can come up with other solutions, but I am not yet convinced that they can be effective because people are more complex than computers realise. The last thing I would want to lose is those personal interactions.”
The software company stores over 50 million additional care notes a month, and is working with several universities on research projects using big data analysis of routinely collected information by carers to identify patterns that predict development of malnutrition and dehydration. This will lead to simple early interventions to prevent entirely avoidable causes of death in vulnerable care home residents.
Person Centred Software also continues to partner with WCS Care on its analytics projects.
WCS Care has improved hydration levels through data analysis and is monitoring associated benefits such as falls reduction.
Person Centred Software gives care providers the ability to analyse incidents, to trace what actions led up to them and prevent future incidents occurring.
“In our falls matrix we measure the location, where it happened, how many staff were on shift, etc,” Jonathan explained.
“One care home realised that the times when their residents were more likely to have falls were during their shift handover when less staff were on the floor. They were able to change their staff working patterns so that they were able to support the residents better.
“No-one else has this measurement of multiple pieces of data,” Jonathan said.
“We capture so much data that we can analytically add it up, correlate it and identify where care needs to improve. We are all about joined up, holistic care. We develop our software with carefully chosen partners to integrate Mobile Care Monitoring with the most effective systems for social care. Where it affects care, we will be there.”