A paperless workflow in post-acute care may soon become a reality thanks to the advent of innovative software technology. New clinical solutions including electronic medication/treatment administration records (eMAR/ eTAR) are pivotal in shifting the current paper-intensive care paradigm toward an electronic medical record model of care.

With the federal government's steady push toward a national electronic health record, early adopters of electronic technology are benefiting in advance from automated health information. Numerous software, networking and hardware vendors have already set the paperless revolution in motion, with products that improve efficiency and care delivery while helping to build a computer-based health record.

The emergence of clinical tools such as eMAR and eTAR do more than just replace cumbersome and error-prone binders on the medication chart: They provide a point-of-care system that improves documentation, risk management and information for collaborative care delivery.

IMPROVED DOCUMENTATION

Unlike paper forms, paperless systems are interactive. An eMAR/eTAR can be set up to require charting for certain conditions, such as late, missed, PRN or held orders. The system prompts the caregiver to enter additional information during these occurrences, improving both the quantity and quality of documentation. The eMAR/eTAR can also handle individualized correlations, such as requiring an FBS before insulin is administered.

It goes without saying that paperless systems eliminate handwriting, filing and pulling charts. Taking paper out of the process eliminates tasks that are time-consuming, repetitive and prone to errors. Lost or destroyed paper records cannot easily be replaced, but online records can be readily retrieved.

RISK MANAGEMENT

With eMAR/eTAR staff can see at a glance irregularities in order administration. Late or missed medications/treatments are easily recognized. No time is lost before identifying whether an order was actually missed or just not charted. Correction notes keep the EMR accurate and legible.

Because the eMAR/eTAR is connected to the provider's computer network, medication nurses and other caregivers have immediate access to the latest information, such as a physician discontinuing or changing an order.

QUALITY ASSURANCE

Paper MARs and TARs contain a wealth of data, but until now it has been too unmanageable to extract. With the eMAR/eTAR, there is no limit to the information yield. Reports can show how many PRN acetaminophen were delivered in a day, or how many and which medications were delivered late and by whom. More complex reporting needs can effortlessly be accommodated by combining multiple criteria, such as a list of residents receiving PRN acetaminophen and wound care.

Data gathered in the eMAR/eTAR also can be accessed by executive dashboard systems, providing a high level look at overall performance.

POINT-OF-SERVICE CHARTING

While the benefits of eMAR/eTAR are far-reaching, it is important to realize upfront that implementation involves changes to hardware, workflow and policies. From a hardware perspective, organizations will need to step into the wireless age for the most effective point-of-care charting. Wireless networks are widely available in today's marketplace and provide the mobile platform needed to collect and share information. Tablet PCs are recommended to connect to the facility's wireless network in real time.

The move to electronic charting will also impact staff workflow and current policies used in a manual system. As part of the conversion to point-of-service charting, shadow paper systems that rely on yellow stickies, handwriting on the back of forms and clipboards need to be identified and replaced with real-time data entry.

With electronic MARs and TARs, session lists are automatically generated, relieving nursing staff of having to scrutinize numerous paper documents for orders, doses and times. The system helps improve efficiency by presenting all pertinent information online.

In states that require paper documents, electronic systems comply through the printing of reports. In fact, this method is likely to produce more current and accurate information, as the data is available in real time. Think of the benefits on-demand reporting can provide when trying to complete the complicated and time-sensitive CMS-672/802 form for a surveyor. It becomes as easy as a mouse-click away.

MOVING TOWARD THE EMR

The availability of eMAR/eTAR software is a breakthrough for paperless systems in post-acute care, bringing the EMR closer to reality. Moving toward electronic records keeps the industry in step with the national initiative for electronic health records.

Jeff Jordan is the managing director of Keane Care, Redmond, Wash. For more information, visit www.keanecare.com or call (800) 426-2675.