The days when care staff wrote important data for documentation on their forearm to transfer it to the PC during their break or at the end of their shift are over at carpe diem. At least soon, when all care facilities are equipped with the new "voize" app. The company, which is based in Wermelskirchen in the Berg region, offers 2,400 care places at 35 locations. The first home only started using the app, which uses artificial intelligence, in January. Feedback was received shortly afterwards. For example: "I've been working for you for six years and this is the best thing that has happened to me in my career here."

Love at second sight

Marc Urban is Head of Strategic IT at the carpe diem Group, responsible for all locations. He has been following the start-up voize for some time. "I was a bit critical of it at first," he says. "Additional software from a third-party provider, new end devices, costs for licenses and interfaces, scepticism among care staff about new things." carpe diem uses the standard module for the sector, Vivendi, for documentation. "It has all the tools we need," says Urban. "But data entry takes a lot of time, and more and more time every year. Time that is lost for resident care."

The carpe diem Gesellschaft für den Betrieb von Sozialeinrichtungen mbH

The carpe diem company was founded in 1998 and is now based in Wermelskirchen. Today, carpe diem operates 35 facilities throughout Germany and has around 2,400 inpatient care places, around 1,100 assisted living apartments, day care facilities with around 500 places and 2,500 outpatient clients. In addition, there are solitary short-term care, mobile meal and laundry services and its own catering facilities as café-restaurants with the associated canteen kitchens, laundry and cleaning operations. The carpe diem companies employ around 3,500 people - including over 200 trainees.

Last year at the geriatric care trade fair in Nuremberg, the IT manager also visited the voize stand to ask about the status quo. "There was a classic start-up atmosphere there," he says. But more importantly: "They were able to convince me in ten minutes." An initial project in Velbert and an extensive pilot phase followed.

User-friendly and extremely helpful - a real innovation

Since then, neither pen nor notes have been in the hands of the care staff, but a cell phone. They document everything they need to when they visit the residents - and voize automatically transfers all the data to Vivendi.

Vivendi meets voize

‍Vivendi has a different approach, is more complex and therefore much more time-consuming to enter data - lots of switching between screens and pressing buttons. This takes time, and nursing staff are not always IT-savvy. However, Vivendi is still needed. voize can only work because Vivendi provides the data in the background. Without Vivendi, voize would not exist. The two systems complement each other and ultimately make a perfect team. Not everything can be done on a small cell phone screen. Planning activities, for example, tend to require a large display. However, what can be done on a cell phone is much faster. voize regularly updates Vivendi's software. What has changed and improved is clearly displayed to users immediately after the update.

Staff comment on the way the software guides them through their working day: "At last, software that fits into the care and not the staff into the software." The key function for this is language comprehension," says Marc Urban. "You can speak in natural language, the app interprets the data directly and assigns it to the care documentation. That's the kind of innovation I wanted for the digitalization of care!"

He demonstrates it in training mode for the start of a shift. After logging in, he immediately sees a list with residents, room number, upcoming tasks and additional information from the previous shifts. "Fall at 5:24 a.m." or "Wound care required" are highlighted in color. But also "Was too excited for breakfast" and "The family was there for a birthday party." At the start of the shift, the nurses have an immediate overview of what is urgent, what is important and what is routine.

25 seconds - the app does the rest

Daily medication, for example, is routine. It is already listed for the resident and can be ticked off with a quick click on the checkbox. For more complex tasks, such as positioning, the app displays a selection. "Even without speech, it's very quick and easy for routine tasks," comments Urban and proceeds to voice input. The app receives the following information: "Mrs. Heise has been cared for in the bathroom and her dry skin has been creamed. She needed more support today. Drank 100 milliliters of water. Positioned 30° to the right in bed. Temperature 36.5, blood pressure 150 over 70, weight 55 kg."

The app turns 25 seconds of speech into the following: It creates a care report (acute incidents, successes/failures, deviations). It checks off planned measures (for positioning with drawing) and suggests categories for unplanned measures (here, for example, "skin check"). She keeps a continuous drinking log - instead of milliliters, she also understands glass or cup. It records the vital signs and displays them in a graph over the course of the past few days. She also checks for validity: since Ms. Heise logged 65 kilos the day before, she classifies today's 55 as an error or an oversight.

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Punctuation, dialects and "intelligence"

"I can also pause, and then even the punctuation is adjusted," says Marc Urban, after he has quickly recorded a 200 over the erroneous 100 milliliters. "And the spelling is always correct." The app also doesn't care whether it is fed in Kölsch, Bavarian or with a Polish accent - it understands numerous deviations from standard German. Voize benefits from the fact that many users speak or type into it every day. This is one of the characteristics of artificial intelligence: it learns with every entry.
If the software doesn't understand something, it asks. If it corrects a suggested value, it works in the background. It will be (even) smarter the next time and will, for example, display the most likely action as a suggestion. "The exciting thing is how few mistakes it makes," says Marc Urban.

Artificial intelligence

Artificial intelligence (AI) refers to software and robotic systems that exhibit behavior that is generally assumed to be human intelligence. This means that they are capable of solving abstractly described tasks - without every step having been programmed by humans in advance. There is no generally accepted definition of AI. Not least because it is difficult to determine what is considered "intelligent" in the first place, and the terms AI and algorithms are often mistakenly equated. An algorithm is a finite sequence of instructions that leads to a specific goal. If the input is the same, the result always remains the same - similar to a recipe. It is true that artificial intelligence is also based on algorithms. In contrast to classic algorithms, however, these algorithms are constantly learning - whether through human-led training or independently. The basis for this learning process is a large amount of data that serves as a knowledge base for the AI system.

Quantity brings quality

At 25 seconds or even less for individual values, care staff have been shown to document more frequently. "The more values I have for a resident, the better I can plan and react and recognize deviations," says Urban. The doctors who come to the home also appreciate the app because it immediately shows them graphically how the vital signs or blood sugar levels have been over the past few days, for example, or because wound care has been documented with photos.Marc Urban, on the other hand, needs little quantity for staff training. "We provide training and it starts immediately afterwards," he says "There's nothing bureaucratic. There's no months of rippling along, the benefits are there the next day." The management team attends a one-day face-to-face event in the morning, followed by staff training in the afternoon. By the end of the day, the first shift is already working mobile. No long preamble. Right from the start, people try it out - and are amazed. "We don't have to do any convincing," says Urban. "The colleagues are in a good mood and we don't need any follow-up training. Instead, there are feedback meetings and voize coaches on site for new employees.

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Application figures speak for themselves

The IT manager can monitor how the app is used using a statistics function. It shows the week of a new introduction: a very small spike in the statistics - that was the training. The very next day, over 1,700 entries from the working day are documented. voize has now been introduced at 12 locations. The plan is to equip one or two buildings per month. The high number of users not only shows how user-friendly the app is, but also that it has clear benefits for employees. From one day to the next, they have almost half an hour more time. Suddenly they have a lunch break at their disposal, and after the shift is actually over. In the homes already connected, there is already a higher level of job satisfaction.

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Conscious decision with high investment

The innovative project in collaboration with a start-up is the largest IT project at carpe diem in ten years. It is an investment to improve the framework conditions in everyday life - with a high investment. It's not just the company smartphones for all employees and the licenses for the software. The mobile application requires a significant upgrade of the Wi-Fi infrastructure "This alone requires a considerable investment," says the IT manager.

Safe technology‍‍

The cell phones are powerful devices with security features, as they contain personal health data that is worth protecting. The AI is located on a server in Germany. The data is calculated locally on the cell phone and not in the cloud. By storing the data on the cell phone, the residents' data is not only secure, but the work can continue even if the internet connection is unavailable.

The decision had to be carefully considered. "It was clear to everyone that something had to be done," says Marc Urban. "Care documentation is consistently going up. Reducing bureaucracy has never worked." There are no refinancing offers from the care insurance companies, although the time saved benefits the residents and the quality of care. The situation is different in Carinthia in Austria, for example. The federal state has announced that it will refinance 60 to 80 percent of the costs for all retirement homes as a flat rate, unbureaucratically and on a monthly basis. The nursing staff quota is prescribed, the staff must be retained and cannot be reduced - if that would be considered sensible at all. "The measure is purely for the employees and the residents," says Urban. "There are no economic benefits for us."

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Setting an example

It is therefore a courageous step by the management to opt for innovation and introduce it consistently. The employees are already thanking us every day. And so do the residents. The quality of the documentation has increased significantly and benefits everyone involved. Urban is delighted to have finally made the bureaucratic documentation process, which is not much loved by care staff, much more attractive. This is an aspect that should not be underestimated in the care sector, which is plagued by a shortage of skilled workers. In the medium and long term, the effects on the working atmosphere, staff turnover, sickness rates and occupancy figures could also be considered. At the end of the day, however, it is also about something that often only plays a secondary role: an investment for people and for society.

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The article was published on 02.05.2024 in the newsroom of Rheinisch-Bergische Wirtschaftsförderungsgesellschaft mbH

Author: Karin Grunewald

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