Electronic Documentation Systems

CampNurse1 · May 22, 2014

Going to EMR for camps is really tough. I have been crawling towards it for years. It is not surprising, when you think about it. Hospitals have thrown millions of dollars at this issue for the last 20 years or so. Not many are happy with the results so far. EMR software is often not intuitive, involves too much repetition, and does not "play nice" with other systems. Add that to the constant wear and tear on hardware. I remember rushing my COW (computer on wheels) from room to room to get to an outlet before the battery died again. I still would not trade EMR for the old way. We granny nurses remember trying to decipher handwritten orders, etc.

I have played around with different camp software suites, such as CampBrain. Most of the software for camps are centered on the business end of camping, and focus on accounts receivable, cabin assignments, logistics, staffing, applications, etc. Camp

software does, in general, have a section on health care and will include things like history, meds, allergies, etc. They even have a way of creating MARs. Each camp has different needs and a one-size-fits-all approach is not always useful. I sometimes think it is possible that nurses did not have much to do with creating some of the software suites. My camp does use camp software, and it works well for everyone except me, lol.

Another problem with camp software is that it is take-your-breath-away expensive. Don't even consider piracy. I'll turn you in.

I got around this problem by creating my own software. I have all my needs, except MARs, on spreadsheets. Microsoft Office is the gold standard, but I really do not like how they only lease the software now. Yep, you have to pay a fee every year to use the software, you can no longer buy it outright. I use one of the free office suites. It is just about identical to Office. I made a mistake in originally creating my MARs in document format. I now have some 2,000 of them on file, and am kind of stuck with it. I am going to convert them to spreadsheet next off-season. The reason for the spreadsheet preference is how you can use them to count things and find trends. How many of my campers have Down's Syndrome, Spina Bifida, etc. How many meds were given last summer? It helps me justify staffing levels. If we see more of this or that diagnoses, we can adjust our programming to fit. Obviously, I manage the nursing care at a special needs camp.

Another reason for electronic document preference is filing. Keeping track of the dozens of camper documents is daunting, and absolutely necessary, especially for risk management and ACA accreditation. With documents on my hard drive, I just pull them up.

For MARs, I include the camper's name, DOB (identifiers), age/sex, allergies, and hx. During the off-season, as we receive applications, I transcribe the medications, doses, times, etc. If I see something wacky, I call mom. This saves much angst at the check-in table. My medications include their generic names, drug class, and use for the particular client. Obviously, this helps the nurse, since we cannot easily look up meds at check-in. Each of my nurses has a laptop at their check-in station, so changes to camper documentation can be made electronically, not by hand. We print of the new document, have the parent sign it, and complete the check-in process. My documents all have a footer with the camper's name and page number ("page one of three") to keep the lawyers happy. There is a section for nurse's notes, and another section for information about unusual history, e. g., Syndrome of Alternating Hemiplegia. Again, to help the nurse.

Another difficulty is spotty wifi, which makes it impossible to set up a useful network. You have to have this so changes will go to and be stored on a server, if you have one. Without a network, the changes are only on your local hard drive. I get around this by using an old trick from the eighties called "sneaker net." I put all documents on a jump drive, put on my sneakers, and import or merge documents as needed. I then take the jump drive to the next laptop. Not great, but good enough, and, for now, the best we can do.

So, now to get to your specific questions. What exactly do you want to do with your software on wilderness trips? MARs? Nurses notes? What kind of hardware will you use? Do you have a data device, such as a Mifi, for a Virtual Private Network (VPN) or local access only? What about backup? Cloud storage? Will your hardware tolerate the outdoors? What about battery life? Tablets are sexy, but hard to type on. I like a netbook better. What about security? Password protection is a must, and encryption should be considered. How much budget do you have?

Most importantly, is your Camp Director behind you on this? Without that support, things are a lot tougher. This project is going to be very time-consuming, so good thing you will tackle it during the off season. It is well worth it, in the end. Since about 85% of our campers return, it is a great time saver to have them in my database. I have really enjoyed that during the last couple of seasons. Can you imagine checking in a group home with ten clients and a hundred meds, all to be written in by hand? Our check-in time now averages about 5 minutes a camper. I am also thinking about a way to dictate nurses notes to our smartphones and emailing them in, to be hand signed later. I wish you luck! Contact me if I can help.

Alex Egan, LPN, EMT-B · May 23, 2014

My camp uses a newer software . We were involved in the beta testing and continue to be well connected to request things in updates. The nursing management has been extremely hesitant to go fully online for a lot of the reasons listed above. We do track health visits, but they are double charted. The health assistant pulls the information from the chart and puts it in the system. The parents can input what meds the kids are on. This hurts as much as it helps, but it did pull us out of the fire when the pharmacy was screwing up hard last year. We get our mars printed from the pharmacy, and then match them to the computer system. It's a hodgepodge but it seems to be working. We had a sister camp that tried to go fully on the system hand they said it was a disaster because it slowed them to a crawl as far as documentation. I think a big issue is that it's internet based and the fat internet pipes don't run out as far as camp.

I use my phone, to type, I work at night, and I'm a bad speller. Pick any reason you want for my misspellings

kaufer01 · Jun 3, 2014

Thanks for the replies. It's a lot to think about and I've really only just started the process of trying to figure out what exactly we want/need with all of the different programs and how the database we have works and what exactly it is capable of.

My supervisor (another nurse that has been with the organization for about 5 years) is really on board with the idea, but wants a system that can be rolled out all at once rather than done in pieces (I'm still trying to convince her that this isn't the best idea). There has been some discussion among the higher-ups regarding paper reduction in the health center, but really it's up to us to figure out what is going to work for us and what we need. As long as we're able to keep track of what we need to and our documentation is accurate and all that stuff, they don't seem opposed to anything.

You definitely have a good point that software seems to be created for the business end of things by business minded people and is not the most intuitive or user friendly in health center world. That being said, I'd really like to find out what the system can do before giving up on it and trying to recreate my own system.

With CampMinder, parents are able to upload or electronically fax in their documents directly to the software which is great because it keeps everything organized, but we still end up printing everything out in duplicates for a paper chart we keep in the health center and a paper packet that gets sent with the participant whenever they leave campus to go on a trip etc. Eventually we'd like to see smart phones (or something similar) for our wilderness trippers to use for MARs, notes, and to be able to access all the camper paperwork.

Initially, what I think I'd like to see if movement towards utilizing CampMinder to house our health center files while keeping a paper copy for trips, as well as using the electronic system for documenting conversations with parents and visits to the health center, which I think is all do-able with the system we have.

Because of the other programs we have running, we actually have a pretty reliable internet connection for being in the middle of nowhere and have multiple computers in the health center for nurses and health center staff to use.

Alex Egan, LPN, EMT-B · Jun 3, 2014

We thought we had a good connection to until we tried to run more than 3 terminals at once. Be prepared to move back to paper at a moments notice just in case, but if your program is workable and your logistics are in order all you can do is try. Let is know how it goes!

I use my phone, to type, I work at night, and I'm a bad speller. Pick any reason you want for my misspellings