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How to start implementing the interRAI assessment system

How to start implementing the interRAI assessment system kathschach

This section is about the practical, workflow-related items that your organization will need to address as you begin to implement the interRAI assessment system.

Develop a plan

Recommendations for organizations to develop a project plan before submitting interRAI assessment data to CIHI.

Engage your teams

Suggested strategies for seeking input from various perspectives throughout the implementation process. 

Train your staff

Recommendations and guidance to jurisdictions in determining a training plan for staff.

How CIHI can help

  • CIHI can provide support as you determine any potential changes to your business practice.
  • CIHI can help assess your education needs and help identify the best learning pathway for your organization.
  • CIHI can connect you to helpful resources — job aids, manuals, toolkits and more.

Manage the change

Implementing or transitioning to a new interRAI assessment system for the first time requires careful planning — and can impact organizational business processes.

Having a change management strategy in place can help with the transition. Start planning early. To be effective and meaningful, the plan should address issues related to

  • Change in culture
    • Identify key individuals who can serve as positive change agents and promote the benefits of the transition to others.
  • Change in business processes 
  • Change in day-to-day operations
    • Consider the potential impact on current roles and how they may evolve with the adoption of the Integrated interRAI Reporting System (IRRS).
  • The impact on clinical documentation
    • Provide robust preparation for staff, including appropriate documentation and support throughout the process. 
  • Evaluation and process improvements

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Develop a plan for implementation of interRAI and IRRS

Develop a plan for implementation of interRAI and IRRS kathschach

Establish an implementation project team and engage support

Have a team dedicated to the implementation project, with adequate time allocated to complete tasks. To maintain project timelines, avoid conflicting priorities and budget time for unforeseen circumstances.

The implementation project team should include representatives from business, clinical, technical and decision-support areas to ensure a well-rounded perspective and to incorporate lessons learned along the way.
 

Develop a project plan for interRAI assessment data

Before you begin to submit interRAI assessment data to CIHI, it’s a good idea to develop a project plan that outlines activities, timelines and resources.

Your project plan can include

  • If applicable, a timeline for transitioning from legacy data collection methods to interRAI Long-Term Care Facilities (LTCF), interRAI Home Care (HC) and interRAI Contact Assessment (CA); establish dates for start of data collection using the interRAI suite and for submitting to the Integrated interRAI Reporting System (IRRS)
  • An outline of the reporting expected and who is responsible
  • A staffing plan that allows time for recruitment
  • A list of the contracts to be prepared and when they need to be ready
  • Scheduled training and education sessions on the interRAI assessments, vendor software and any business practice or workflow changes
  • Administrative and logistic supports required
  • Dates by which reports must be created and submitted to senior management
  • A sustainability plan for change management/staff turnover
  • Opportunities for sharing resources and expertise within your jurisdiction

Cut-off dates for transitioning jurisdictions/organizations

For jurisdictions/organizations submitting to legacy systems, consideration should be given to when the older assessment training will stop and the cut-off date for completing the older assessment. 

Consider how much time should be provided to allow for corrections of previously submitted assessments, which can be made after the cut-off date. Discuss with your vendor if there are limits to the period for error correction.

CIHI recommends that jurisdictions/organizations explicitly communicate 

  • A cut-off date for when the older version of assessments will be completed and submitted to the Home Care Reporting System (HCRS) and the Continuing Care Reporting System (CCRS) 
  • A date for when interRAI LTCF, interRAI HC or interRAI CA assessments will be completed and submitted to IRRS

Keep in mind the decommissioning dates for HCRS and CCRS. Explicitly expressing expectations will help staff in preparing, implementing and following through with new business practices. 

Defining a cut-off date will prevent duplication of data submission to both CCRS/HCRS and IRRS.

Long-term care facilities should check with their jurisdiction to determine whether there are further directions regarding cut-off dates.

Initial assessment considerations

When a jurisdiction implements or transitions to the interRAI LTCF or interRAI HC assessment, assessors will need to conduct a First A_ssessment (Reason for Assessment A8/iA8 = 1) for every person. 

This will need to happen even if a person has previously been assessed using the Resident Assessment Instrument–Minimum Data Set 2.0 (RAI-MDS 2.0) or the Resident Assessment Instrument–Home Care (RAI-HC). 

This includes completing items in Section B (Intake and Initial History). Information captured in Section B of the interRAI assessment is used at a health system level to inform access to and delivery of care services. Every effort should be made to complete this section as accurately as possible. 

Once an initial assessment is completed, it is recommended that a routine reassessment (Reason for Assessment A8/iA8 = 2) be completed at regular intervals. For the interRAI HC, it is recommended to be completed within 6 months (and no longer than 12 months). For the interRAI LTCF, it is recommended to be completed every 3 months.

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Choose your assessors

Choose your assessors kathschach
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Selecting the right assessor depends on the type of organization.

In long-term care, most interRAI assessments are completed by registered clinicians such as nurses and sometimes by occupational therapists, physiotherapists, dietitians and/or social workers. Some organizations have super users whose sole responsibility is to conduct interRAI assessments, while other sites have an interdisciplinary team complete assessments.

In home care, the assessor is usually a registered clinician such as a case manager or care coordinator. These people are typically nurses by background, but assessors can also be occupational therapists, physiotherapists or social workers.

Multidisciplinary responsibility means that nurses complete specific sections of the assessment, and other allied health professionals (e.g., occupational therapists, physiotherapists, dietitians, social workers) may complete others. This approach recognizes the inherent expertise that each team member brings to the assessment. With this approach, 1 person usually takes the lead and assumes overall responsibility for making sure the assessment is completed on time.

  • Ability to establish a therapeutic relationship with clients, as well as strong communication skills to work with them
  • Strong interpersonal skills to communicate and collaborate with the interdisciplinary team
  • Technical skills/computer skills to complete the assessment using the organization’s software
  • Receptiveness to change and willingness to take part in the change process (attending training, influencing others, supporting other members of the health care team, supporting initiatives)
  • Capacity for informal leadership and/or being a champion for initiatives

In general, people in the role of interRAI assessor can go by different titles that may depend on the sector. Examples include

  • RAI coordinator
  • RAI assessor
  • Case manager
  • Community nurse
  • Home care nurse
  • Nurse educator
  • Geriatric emergency management nurse
  • Activation nurse
     

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How to integrate the interRAI assessment process

How to integrate the interRAI assessment process kathschach

The overall process for completing interRAI assessments is comprehensive. It includes many responsibilities and tasks, including gathering information from different sources, interviewing people and their families, completing reports and submitting data.

But while the process is comprehensive, it doesn’t have to be complicated. With strong leadership and careful planning, implementing interRAI assessments won’t overwhelm your organization.

It’s important to remember that completing an interRAI assessment isn’t an additional piece of work, but one that builds on a clinician’s intuitive assessment skills and experience. The assessment itself is simply an extension of what is already part of a clinician’s skill set.

An advantage of using the interRAI assessment system is that it structures the clinical assessment in a standard format using standard language. This helps to ensure accuracy and consistency, and it results in improved outcomes.

Successful organizations lead by example. This starts at the top by setting the stage for implementing interRAI, endorsing it and using the outputs.

Practical tips for success

  • Understand how the interRAI assessments differ from their predecessors (i.e., Home Care Reporting System — Contact Assessment [HCRS-CA], Resident Assessment Instrument–Home Care [RAI-HC] and Resident Assessment Instrument–Minimum Data Set 2.0 [RAI-MDS 2.0]).
  • Take the approach that any interaction with the person is an opportunity for assessment.
    • Make the interRAI assessment part of team rounds and shift changes.
  • Try to ensure that the assessor is familiar with the person being assessed and their family.
  • Set up strategies for good communication within the organization.
    • Add assessments to white boards/flow sheets, identifying what needs to be completed.
    • Include discussions about the assessments in care conferences, team meetings and family meetings.
    • Encourage interdisciplinary teams to use the interRAI language in their day-to-day work.
  • Use the information from the interRAI assessment as the structure for admissions, history notes and discharge planning.
  • Encourage clinicians to use Clinical Assessment Protocols (CAPs) in care planning and to use outcomes in evaluating interventions, monitoring treatment and getting a sense of baseline clinical and functional status.
  • Include interRAI assessments as part of new-hire orientations, yearly clinical competency reviews and even staff performance appraisals.

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Build a communication strategy for interRAI and IRRS

Build a communication strategy for interRAI and IRRS kathschach

It is important to develop a strategy for effectively communicating pertinent information about the project of transitioning to interRAI and the Integrated interRAI Reporting System (IRRS).

The strategy should address the following:

  • Methods of communication that will be used to convey information to stakeholders
  • Reasons for the transition, what stakeholders can expect during the transition and what a successful transition will look like
  • Roles and responsibilities of each project team member and a clear plan for addressing queries and resolving issues
  • Engaging with organization contacts (including clinical, technical and leadership) to promote buy-in and support change management
  • Plans for managing and communicating with contracted or affiliated sites or agencies (particularly those that are part of a corporation with locations in multiple provinces or territories) and keeping track of their progress

If an organization prefers to have a designated contact who will direct questions to CIHI, this process should be communicated clearly to staff, including circumstances for reaching out to that designated contact versus reaching out to the software vendor or CIHI.

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Engage your teams for interRAI system implementation

Engage your teams for interRAI system implementation kathschach

How is your organization doing when it comes to implementing the interRAI assessment system? 

As you move through your implementation plan, it’s important to seek input from various perspectives throughout the implementation process, particularly involving front-line clinicians in all interRAI processes, whether at the point of care or through a feedback loop.

While there may be challenges along the way, regularly soliciting feedback and applying what has been learned can help make the implementation process smoother.

Here are some suggested strategies:

  • Hold a series of lunch and learns where you provide part of a report (such as the outcome scale) and, at the same time, review the items and coding for that particular scale.
  • Consider forming clinical and/or technical advisory groups to address any issues that arise. CIHI is always available to provide support.
  • Post reports at the program level.
  • Ask staff what they want to know about interRAI assessments.
  • When discharging clients, provide a report and pass along key information from the interRAI assessment system (e.g., Clinical Assessment Protocols) to the caregivers/organizations they’re being referred to.
  • Engage with families and the community by communicating how interRAI assessments are used to evaluate and adjust care plans.
  • Ask your staff for suggestions on how you might measure things like record completion, timeliness of assessments, error rates on submissions and submission volume.

It is also important to define markers of success and celebrate them with your team and staff. Success is more than the finish line — there are plenty of milestones to be celebrated along the way! 

Ensure that all contributors are included in these celebrations and that their efforts are recognized.

Examples of success milestones include migrating to a new software platform, completing education courses and successfully submitting your organization’s first test data.

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Train your staff as part of interRAI implementation

Train your staff as part of interRAI implementation kathschach

Having informed and well-trained staff is vital to the success of your interRAI implementation strategy. Developing a training plan with timelines will help keep your organization on track.

Jurisdictions may wish to standardize their approach to education and review the suggested learning pathways available in CIHI’s Learning Centre. CIHI has education sessions on the interRAI Long-Term Care Facilities (LTCF), interRAI Home Care (HC) and interRAI Contact Assessment (CA), job aids on what is different between older and newer assessments, and educator resources.

CIHI’s role in training

If your organization or jurisdiction wants to adopt and implement the interRAI assessment system, CIHI can provide resources and deliver training programs based on your assessed needs. 

We offer

  • Facilitated web conferences and web-based self-study education and training
  • Resources for educators and/or trainers
  • Collaboration and expertise on building a train-the-trainer model that can be customized to your organization
  • Ongoing support, including
    • Additional training (e.g., in data use, care planning and data submission)
    • Answers to clinical coding questions
    • Client Support Sessions
    • Access to CIHI expertise

Note: CIHI does not offer training about your vendor’s software. If you would like software training, be sure to include this as part of your conversations when developing a contract with your vendor. Include considerations for post-implementation training for new users and considerations for regular annual training.
 

Things to consider when designing your education and training plan

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CIHI, as part of its partnership agreement with interRAI, provides training free of charge to Core Plan organizations that implement the following interRAI assessments:

  • interRAI Long-Term Care Facilities (interRAI LTCF)
  • interRAI Home Care (interRAI HC)
  • interRAI Contact Assessment (interRAI CA)

Costs for software-related training are generally part of an organization’s agreement with its software vendor.
 

CIHI’s education offerings consist of facilitated webinars led by members of its clinical team, as well as self-study modules. These can be accessed in CIHI’s Learning Centre. 

Estimated durations for completing self-study modules are available once you click into a chosen course. 

Facilitated sessions can also be provided to a specific jurisdiction to help it meet its learning requirements prior to implementation/transition.

CIHI recommends assessors complete training 6 to 8 weeks prior to implementing the interRAI assessment and submitting to IRRS. 

CIHI also recommends you connect with your vendor to understand how long software training will take.

You can use this information to gauge timelines needed for training. 
 

Clinical personnel will need to receive training on the use of interRAI assessments for the purposes of administering, documenting and coding assessments. 

Experienced assessors may need less training compared with inexperienced ones, but they will still need to familiarize themselves with changes and new coding practices. 

It is recommended that jurisdictions implement a train-the-trainer (PDF) model when establishing an education plan. 

The training model should include education on the assessment as well as on the software used when completing the assessment. 

Include considerations for post-implementation training for new users and for regular, ongoing training.

It’s important to note that an education plan will be dependent on a variety of factors such as size, number of resources and business processes. You will need to develop an education plan that fits your needs. 

CIHI offers a beginners course series for interRAI LTCF and interRAI HC. This series consists of courses designed to assist educators, new assessors and those requiring refresher training. It focuses on documenting assessment findings and using assessment information, outcome scales and Clinical Assessment Protocols (CAPs) to complete a person-centred care plan. 

The new interRAI CA training consists of an eLearning session designed to assist assessors with documenting findings in community and hospital settings.

For experienced assessors, What’s Different information sessions in CIHI’s Learning Centre assist with understanding similarities and differences between newer interRAI assessments (interRAI LTCF 9.1.4, interRAI HC 9.1.4, interRAI CA version 10) and their predecessors (RAI-MDS 2.0, RAI-HC, interRAI CA version 9.1). 

CIHI can also provide presentations on the differences between older and newer suites of instruments as required. 
 

Check out the courses in CIHI’s Learning Centre. You can review our home care (PDF) and long-term care curricula (PDF), which list courses for different roles. 

If you require additional training that’s not currently available in those formats, please contact CIHI. 

Yes, trainers can use CIHI educational resources to develop their own learning and training products. Trainers can do this for ongoing education and for regular onboarding of new staff. 

Depending on your facility or service delivery site, training plans may look very different. It is important to assess your own resources to determine how much and what type of training can be provided. 

Please reach out to CIHI if you have any questions.

Tip: Start early

  • Give learners time up front to apply learning — and to continue learning after formal training is complete. Expecting assessors to be perfect on day 1 may provoke anxiety. 
  • Ensure there is appropriate training on the vendor software solution. And ensure that this is aligned with the assessment training. 
  • Consider having super users support front-line staff through the initial adoption/transition and ensure they know who to contact if they have clinical coding questions. 

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