Vol. 10 •Issue 6
• Page 88
Case Study
Going Paperless
The Keane NetSolutions browser system and eCharting module helped this organization enter the digital age.
By Judy Hellmers
Nye Senior Services of Fremont, Neb., had all the essentials for moving to a paperless medical record. Our four facilities are fortunate to have a forward-thinking owner, a progressive administrator and DON, and staff members who are willing to learn.
When we initially viewed Keane NetSolutions and eCharting module at the 2005 Keane Client Conference, we knew we wanted to be on board. A browser-based system meant no workstation installs and easier updates. We were big fans of the snapshots that gave us full information on one page. The system was also user-friendly to make training easier down the road. We also recognized that Keane NetSolutions would help us reach our goal of an electronic medical record.
TEST SITE
We agreed to be a beta-test site for Keane NetSolutions eCharting with eMAR/eTAR at Nye Pointe, a 66-bed skilled nursing facility in Fremont, Neb. that has used Keane Care's windows-based financial and clinical system for many years. They have CareTracker installed with an interface to Keane Care's MDS software. We decided to use Nye Pointe as an ongoing training site for three additional facilities under the Nye Senior Services' umbrella in Fremont, South Sioux City, and Lincoln, Neb.
DECISIONS, DECISIONS
To prepare for electronic medication and treatment charting, we researched options and made these hardware decisions:
planned and installed a wireless network
chose laptops instead of tablet PCs for point-of-care charting
determined our server was adequate
addressed security issues
planned battery backup and charging systems
retained current medication carts.
We reviewed our workflow and made these preparations:
decided to use parallel paper charting to ensure all medications were given
chose training methods and developed a preliminary schedule
reviewed policies and procedures for changes related to eMAR/eTAR
mapped out a conversion and implementation schedule.
TRAINING
A Keane Care consultant set up a classroom with 10 laptop computers for training medication aides and charge nurses. We held multiple sessions to accommodate schedules and ensure each participant had a computer for hands-on practice. A positive environment helped ease the frustration of any staff members who had never used computers, lacked basic computer skills or were not comfortable typing.
The consultant demonstrated multiple eMAR/eTAR scenarios, including meds given, meds held, meds not given and PRN meds. We set a go-live date for several weeks away to allow ample practice time. Before going live we had to change some existing data to make it compatible with eMAR/eTAR. We reviewed the setup of shifts and made some specific changes to orders. For example, time codes needed to be shown in all numbers, such as 08:00 not 8:00 a.m.
OVERCOMING CHALLENGES
After going live, our first challenge was the lack of room on the medication cart for both the new notebook computer and the old paper notebooks. To rectify this problem, we added an extension to the carts to hold the laptop until the paper notebooks were removed.
For hardware-related issues, Nye's IT manager and Keane Care technical consultants worked closely to analyze problems and provide solutions. To solve the problem of needing to reboot several times a day, we purchased a new server with Windows Server 2003. To boost the wireless signal we added more hubs. We extended the time between battery charges to up to six hours by replacing the laptops' CD drives with extra batteries.
We relied on our aides and nurses to verify that orders displayed online as intended. We experienced instances of data entry changes making unexpected changes to the eMAR/eTAR. But with Keane Care's support and attention to our suggested changes, we had taken another step closer to a paperless system.
I served as a point person for our staff members' problems, wants and needs. I communicated our input to Keane Care's clinical product manager who worked with Keane Care staff to resolve our issues and determine how our input translated into software changes. Keane Care made and released those changes for further testing, with more software updates scheduled.
SURVEYORS ARRIVE
The system was up and running for about two months when the surveyors arrived. The surveyors had questions about our eMAR/eTAR system but accepted our parallel system even though pass times exceeded the 60-minutes-after guideline. Surveyors requested records from our Keane Care and CareTracker systems and were pleased with how quickly we could print reports with the information requested.
Our new system is running well and we're glad we did it. Even staff members who were resistant at first now love it. The transition to Keane NetSolutions and eMAR/eTAR presented us with hurdles but we have jumped each one, thanks to our outstanding staff and the great support and cooperation of Keane Care.
For more information on Keane Care, visit www.keanecare.com or call (800) 426-2675.
Judy Hellmers is director of administrative services for Nye Senior Services in Fremont, Neb.
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