Help With Software

Archerlpvn, LPN, LVN · Sep 13, 2020

The companies I have worked for, have provided us with tablets or phones capable of using the EMR. I’ll get about 75-90% of the charting done in the home. I’m an LPN, so I’m talking about routine visits of course. Most of the time, I’ve had to call and reach patients, doctors offices etc on my own, though sometimes patients and physicians will call the office and the office will call/email me with their message. I do all my own clinical notes. Hope this helps at least a little ?

VegGal, BSN, RN · Sep 19, 2020

On 9/4/2020 at 7:06 AM, Frank Wisniewski said:

Hi,

I am a software developer tasked to update our home health care product (www.cradlemrx.com). It is older and somewhat complex so I am trying to redo large portions to make it easier. Right now I am working on the patient documentation and scheduling parts. In an effort to better understand the process I would like to get any input from real nurses like yourselves about the pain points you face daily when filling your assessments and notes on software. At my job I have been directed to speak with "business experts" who are not nurses and have never worked in home health or any medical profession for that matter. Here are some of the question I have been struggling with:

1) Is it realistic to actually fill out paperwork on software at the patients home? Do you use laptop's or tablets while you are talking to them and do you normally have internet access while you are there?

2) Whats the balance of work between you as a nurse and the office staff? Does the office staff assist you by making calls to patient and inputting notes or is that all left up to you?

3) More specifically on frequencies and plan of care. I am being told that an RN will decide the frequency when they fill out the OASIS. They will choose stuff like 1W9 or 3D10 which represents 1 time a week for 9 weeks and 3 times a day for 10 days. I have to convert this to visits on calendar. I proposed making the input form simpler by using dropdowns with spelled out words instead of D's and W's but was told no because this was industry standard. In my mind good software should make everything easier and I understand why on paper 1W9 is easier to write but would anyone prefer being more descriptive and using full words on software?

4) When you are creating frequencies is it possible to have a frequency where you visit the patient 2 times a week for 9 weeks and on each day of those days you see the patient more than once, say 2 times? So the total visits would be (2x9)x2 equaling 36 visits. If so how would you represent that using the shorthand, 2D1W9 possibly?

I appreciate in advance any answers you can give to the questions above or any feed back on pain points you have with other software right now. I have been arguing with the "business experts" for a while and in an effort to not get fired I thought would try reaching out to real experts so that I have something solid to argue with.

Thanks,

Frank

I'll try my best to respond to your questions. I work in HH but I'm mostly in the office doing QA there days, although I do work in the field at times, and I also have a lot of interaction with the nurses in the field on a daily basis.

1. Most of the nurses are our agency do not fill out the paperwork at the patient's home although as the QA person who's also an RN, I try my best to get them to do that. The reason why they don't fill it in at the patient's home is because most of them over-schedule themselves for the day, and they then have to rush on to the next patient, often not with our agency (they work for multiple agencies, seeing various patients daily). Some other reasons are because the patient population we work with generally don't want people hanging around. I've suggested that they stay in their vehicle outside patient's home once the appointment is over, as a second option (the first one being in the patient's home) but that's rarely done either. The main reason though is that most just want to be able to get in more appointments in a short amount of time, and they think that they can get the documentation done at the end of the day, in the comfort of their home

2. Each agency is different. Some have support staff who make calls to remind patients to expect the nurse, others don't. Our agency doesn't because it's more efficient for the nurse to be in touch with the patient, and schedule their own appointments based on theirs and the patient's schedule. Not too such what you mean by "balance of work" but we do the QA when the nurses turn in their docs, that can sometimes take some time depending on how responsive the nurse is to requests sent through QA, then we receive the corrected doc, and we either approve or ask for further changes or clarifications (which is extremely rare). As for inputting notes, our office staff does not do that. We do however help with wound care consults and we follow-up with all wound and medication orders for the nurse (apart from the basic monthly med order refills). We also provide phone support, answer all MD and their office calls, take all patient family calls, we also help our nurses report issues to MDs, VA, etc as required in order to help our nurses. Also we write communication notes so that the nurse and other staff are all on the same page, and the communication notes are in the patient's chart (online)

3. RNs decide the frequency only for Medicaid, not for VA patients, and I'm unsure about Medicare patients. As for the abbreviated terms, I think nurses may find it easier to just click on the number of times a week, or a month, or whether it's bi-weekly, or weekly, etc but it would be great if were easily converted to industry standard short form so that others who also look at the documentation can use it in the form they've been used to having it in. Not sure if that makes sense.

4. Can't help with number 4, sorry.

Frank Wisniewski · Sep 23, 2020

Thank you both so much! This is very valuable information and I appreciate it very much.

@VegGal I do have one follow up question if you have time. The QA process, what does that entail? Do you just look at the one note you are QAing or do you look at the entire episode and other patient info like medication and orders and such. I guess what I am trying to figure out is what do you need to see when you QA a note, is it just the single note detail you are looking at or do you need to see the whole episode details plus previous notes?

Frank Wisniewski · Sep 23, 2020

Hi @VegGal

I was thinking more about your answer to #1 and that led me to another question: If nurses don't fill out the paperwork after seeing the patient and they see lots of patients each day, how do they remember what they did at each patient? I would think they must write something down somewhere for each patient and then maybe use that as a guide when filling out the EMR or do they just do it from memory?

amoLucia · Sep 24, 2020

Frank - we here make the recommendation to new members to change screen names to remain anonymous.

Everybody and anybody under the sun can join the site, so responses may reflect variations.

Frank Wisniewski · Sep 24, 2020

@amoLucia Thanks for the warning. I don't mind keeping my name there since I am not a medical professional. The nature of my questions are about process so that I can help build better software. I wanted to be completely up front about that in case anybody has any questions about my motivation. I don't mind if anybody googles me to verify my identity. I appreciate that you inform people about guarding their identity here, it is a very smart thing to do in this day and age. My employers already know my issues with them and anything I say here I would have no problem saying directly to them. Not everybody is that lucky and can voice their true opinion so it is very smart to warn people and guard your identity.

amoLucia · Sep 24, 2020

Just very recently, we had a hosp HR rep post here reach out to contact a member who had posted re some unresolved issue (unexpectedly out of the blue). So just goes to show, who all accesses this site and NOTHING is private, and pretty much traceable.

And then there's no way to track all the silent 'lurkers'. So it's poss someone might recognize you thru your services.

Just some cautionary advice.

Frank Wisniewski · Oct 23, 2020

Hi @VegGal

As a QA person do you also QA the oasis submissions? I have been working on a tool to allow you to take the standard oasis xml that is submitted to the state and build your own validation rules. I am not sure if that is something that is useful to anyone but if you are interested I would be happy to show you more and give you a quick demo.

Thanks,

Frank

VegGal, BSN, RN · Nov 6, 2020

Hi Frank,

The nurses are all given 24 hours to get their documentation submitted, and it then shows up in QA. Some follow the rules, and others don't. We say that we submit everything within 72 hours, but t's been more and more difficult lately as we are short of nurses and most of our nurses have a full load of clients. So all that to say we give them a little more time, but of course there are some who will still not abide by the rules, even with the additional time. So the only other option is to have HR call them the week their paycheck is due, and tell them that they have to submit all the paperwork before they pick up their paycheck, which has worked so far. As for your question on how they remember everything when they see so many patients over several days, well that's why we request that they document right there on the software using their tablets, but we're noticing that most don't do that as they want to rush on to see the next client. I did ask one nurse how she kept everything in order, and how she'd know if the client was in pain on Monday, but fine on Wed, and remember that a week later, and she assured me that she takes very good notes. I can only hope that it's true.

As for QA itself, when it's a new client I do look through the whole plan of care (I'm required to do that as part of QA anyway as I have to make sure that the POCs are valid, and suitable for the client's meds and diagnosis, etc) but apart from the initial intake SOC I generally take notes myself from what I learn from the referral docs, or from the nurses' docs. But for the most part everything is accessible very quickly from the portal. So if I need to verify if the patient is on a certain med, or if he's a diabetic, or if he / she has a wound, etc. then I can click on the care plan or the med section through links from the QA section while I go through the visit notes, or the SOC or Recerts, basically whatever I'm doing in QA.

I hope my responses make sense.