Where the heck is the EMR?!

[Madras]

Ahhh ok. So I've been told I'm very "spoiled" by the hospital since entering into the realm of LTC/Rehab.

I absolutely love it, so much so that my per diem position has me now working close to full time hours and I'll be taking the proverbial plunge in the near future. The hospital shall see my Madras shaped hole in the wall soon as I speed outta there like the Road Runner!

But but there's just one thing that I never paid much mind to that now has my panties in a bunch!

There is no EMR system in my facility! We are totally Stone Age, rock and pebbles, paper charting. I used to not mind so much on my few shifts a month; figured I was getting some extra practice with my penmanship; but now that I'm their daily, on day shift, Medicare notes, A&I's, report sheets, MAR/TAR updates, narc counts, consult notes, rehab/PT/OT etc notes I'm starting to realize the MOUNTAIN of paperwork here and how much easier it would be for most of this to be electronic! I can't count how many times I've reviewed the MARs to see that acetaminophen is spelled wrong or can't read vitals because they're squished into those teeeeeeny tiny boxes in the date column.

A lot of the redundancy and "doin' it twice" would go away if we were paperless. And most people wouldn't have to spend their time running back and forth asking "what is this that you wrote here?".

So makes me wonder. Everyone is going electronic by next year, no? Suppose to be by law, or some kind of fine. Is LTC not included in this initiative? Or is it just my facility?

How do you guys deal with all of this paper?!?

[CapeCodMermaid, RN]

We are about 99% electronic. The hospitals are reimbursed for switching to EMR. SNFs and LTCs are not. It a huge investment for companies, especially small ones. I can't imagine having to go back to paper.

[ktwlpn, LPN]

I believe all LTC's over a certain size must go electronic ,the date had been pushed back so I'm not sure when this has to be accomplished. We have had TWO systems and each had their pro's and cons. We now have TWO operating systems, MAR is a different platform then the system we do our documentation in (which is also used by other depts. but not all of them)

Don't count on the redundancy going away any time soon.We have had a number of glitches-the CNA's are still using paper.We STILL keep a vital signs ledge,we have to print each new doctor's order for them to sign (that should be resolved soon) Our rehab dept has it's own system-we can not see their progress notes and I don't think they bother to look at ours.THey still hand write orders.Someday it will be PERFECT....

[jeriksmoen]

I'm in my third LTC job and all three buildings have been "stone-age" paper. My current building is the most technologically-advanced of the three -- the CNAs chart on a special computer program that allows them to use a touchscreen to record things like how much assistance someone needed with feeding and what percentage they ate. Therapy is a separate department and they do all their charting electronically on iPhones, but then their notes are printed and placed in the chart. Our census is also on the computer, but that's it. Everything else -- report sheets, vital sheets, diet slips, MARs, TARs, appointment requests, therapy screens, telephone orders, etc. are written out by hand. When I take a telephone order from a physician like "start 100mg Colace PO q day for constipation," I write it on a telephone order sheet (which makes a triplicate), write it on the pharmacy order sheet and fax it to the pharmacy, write a chart note, write it on the MAR, write it on the 24-hour report, and write it in the alert book. You can imagine when I get orders on four or five people at once...

On the other hand, I find that people tend to read my charting because at least it's legible.