Data were labeled according to two criteria: failing to meet one or more aged care accreditation outcomes, and using some form of EHR. First we identified the RAC homes that failed to meet one or more aged care accreditation outcomes by searching the content such as that presented in Table 1busing the keyword ‘not met’.
To identify the RAC homes that used an EHR system and those used paper records, first we read through 50 copies of the accreditation reports and found that different terms were used to describe an electronic record system. Based on the terms we identified, we developed a list of keywords that was used to identify whether an RAC home used an EHR system or paper records. They included electronic clinical plan, electronic clinical documentation, electronic clinical in-formation, electronic documentation, electronic care plan, electronic care documentation, electronic care information and electronic health record.
We scanned section 1.8 Information Systems france area code number in the reports (see Fig. 2b), and a list of documents that a RAC home submitted to the accreditation agency for desk audit. Based on this, we used a program to automatically structure the name of an RAC home (from document name), frequency of matching the keywords and details of matching (e.g. 30 characters before and after each keyword) into an Excel spreadsheet (Table 1). The reliability of the labels in Table 1 was further validated by manual checking against the original documents.
Afterwards, we aggregated all RAC homes into four groups:
Group 1 – meeting all accreditation standards and using EHR,
Group 2 – meeting all accreditation standards and using paper records,
Group 3 – not meeting one or more accreditation standards and using EHR, and
Group 4 – not meeting one or more accreditation standards and using paper records.