Save time, money! Ease nurses’ paperwork burden!
Sounds too good to be true? Going paperless works!
Technology has gotten a bad rap this year. With everyone focused on year 2000 computer problems (see story p. 104), many agencies might view making some systems improvements as a bad bet for now. But at Partners Home Care in Chicago, nurses have seen a drop in paperwork, managers have found chart reviews easier, and paper consumption is likely to drop — all as a result of a paperless chart program, says Donna Escallier, RN, director of continuous quality improvement and education at the 70-clinician agency.
The program started eight months ago, and has been a breeze to implement at the agency, which serves the Chicago metropolitan area and whose employees make some 80,000 visits per year. Escallier says the decision to move to electronic charting was pushed by her 50 nurses, who had been using laptop computers for two years. They objected to having to come in every other day to do paperwork. "And it was also a financial decision," she says. "We figured we could reduce paper and filing costs."
Last fall, Escallier and the vice president of clinical operations developed a program. Escallier was in charge of writing new policies (see sample policy on electronic medical records, p. 96), and the vice president researched the legal implications. "She checked with [the Health Care Financing Administration], the state of Illinois, and our legal counsel to see what the requirements were."
Escallier penned policies that focused on data security and password policies. As soon as legal counsel approved the policies, they set a date for conversion of Nov. 1, 1999. "At the start date, we told everyone we would stop printing anything but 485s, verbal orders, physician orders, and paperwork that required patient signatures," says Escallier. "Before then, we had printed every piece of paper for the chart."
Staff were instructed on the new policies and told to change passwords. Prior to the conversion, the system administrator had a list of everyone’s password. Now, only the nurse knows the passwords, thus preventing data from being altered.
Happily, Partners didn’t have to add any hardware or software to make the project fly. "We use the Delta system, and when they made their upgrade to prevent note changes, that’s when we knew we would have data security that would enable us to go to electronic medical records. We didn’t have to spend anything." Indeed, the only cost was the staff time spent in the confidentiality and security seminar.
"And even that wasn’t new information for everyone," she says. "We stressed the password security and went over signs that it might have been breached." Key among those signs: an unsuccessful log-in notation in the system at a time or on a day when the nurse or clinician wasn’t working. The staff is encouraged to check the log-in attempt file regularly.
A positive experience
While the eight months of operation have probably saved on paper and filing costs, that data haven’t been compiled yet, says Escallier. However, there is ample evidence that nurse satisfaction is much higher. "They are much more efficient and feel they aren’t wasting time to come in and sign pieces of paper. We get information from them in a more timely manner, and they spend more time with patients." That means that existing patients get better quality time, Escallier adds, and that nurses have more time available to see new patients.
In addition, management finds it easier to do chart audits, which can be done electronically, and nurses, clinicians, and management all have immediate, up-to-date information on patients at their fingertips. Where they previously had two days to get notes in a patient file, says Escallier, now staff have to do it within 24 hours.
That immediate access has an indirect impact on patients, Escallier says. "I expect a note to be in right away, not in 48 hours," she says. "I think that means we can provide a better quality of care. But we haven’t quantified that yet."
Further evidence that what Partners did came with a fraud and abuse survey and a visit from the Office of the Inspector General (OIG). In both instances, the system worked, was approved of and, in the case of the OIG, was remarked upon as being a great idea. A state survey is due later in the year, and Escallier thinks that will also go smoothly. "We will assign the surveyor a view function on a terminal, or print-off files — whatever they prefer."
The only real problem, Escallier says, has been that outside vendors who have contracts to do some of the therapy are not yet up on the system. "Our original plan was to set up remote sites at their offices and have them enter the data directly. But there has been trouble getting phone lines and terminals for them." Originally scheduled for April, that aspect of the electronic medical records program won’t now be up and running until sometime this fall.
Escallier is a true technology convert and doesn’t see any reason why an agency would try this. "It’s a great idea," she says. "Most people I talk to fear the federal agency audits will turn up problems. But ours went well. And the nurses are so much happier. They wanted this faster than we could implement it. They see more patients and don’t feel that time crunch. And everyone likes doing less paperwork."
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