NOTE-[this is from a LTC perspective] I did the end of month recaps for a 59 bed facility on paper for the past 8-9 yrs,noting every order,d/c,edits(time changes,preferences,etc),carry-overs,dx/med.on a 59 bed unit with and average of 7-9 med sheets per pt. I'd go in @ 0300 just to get my hands on the med books,had 9 printing runs (meds/notes/prns/notes/tmt/notes-you get the picture) for about 600 pieces of heavy vellum paper,then print monthly MD orders. With eMARS,all of the important content of those orders comes down to ORDER ENTRY,whether it is done by unit sec. then noted&verified by nurse,or entered by nurse herself. In our program,what the med nurse sees to administer is driven by the times entered for administration,whether by hour,shift or day of wk. If an order is obtained during the time frame the med would be administered ie"lasix 40 mg.po daily in AM",an overide to start time has to be entered(0800) so it can be started the day the order is obtained,otherwise the nurse has no idea she has a med to be give. As we continue to shift from paper to EMRs, the challenge will be to remember-THE MACHINES ONLY DO WHAT WE TELL THEM TO DO! We've been doing computerized charting for 2 yrs. now,added the eMARs recently and I"ve come to realize how much of our day to day communication regarding our care has been verbal,conversational and anecdotal. The shift from one form to another is time intensive(short-term)but the intention is to keep all pt. info in one place(EMR),and once you learn how to navigate it,it's A LOT easier to find out why Mrs.X was ordered Pamelor q HS in June 2005[migrane management],rather than digging out folder #6/12 in the med records room.