A tablet in your future

October 11, 2011
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It's ironic that the first mode of writing has been revived … and just in time. The ancient Sumarians used tablets (of soft clay) to record their numbers and words. Those fell out of favor when the Egyptians invented a type of paper. The papyrus was much easier to work with and carry. The computer revolution promised a paperless world-and instead has greatly increased the demand for paper!

Few industries demand more paper than healthcare, and especially in the nursing home sector, which stands to be a big winner in the move to electronic records. MDS 1.0 was five pages, MDS 2.0 was nine pages, and now the MDS 3.0 is nearly 38 pages. And they have to be completed on every resident, often several times.

The greater length of the MDS 3.0 is not due entirely to content; the Centers for Medicare & Medicaid Services (CMS) was required to comply with a requirement of the Americans with Disabilities Act to make all government material accessible by blind users; the reformatting was according to 508 standards that allow the document to be read on a computer by a text-to-voice interface.

It is common practice in nursing homes to manually complete the MDS at the resident's bedside (essential with the MDS 3.0 to accurately capture the resident interaction), and then transcribe it to the computer program for analysis and transmission-using twice the amount of paper and staff time. Current technology now makes it possible to capture the data on laptops or tablet devices anywhere. Adequately designed systems that comply with CMS's electronic signature and record requirements never need to print to paper. And the complex instructions can be available to the staff at the bedside.

Administrators are advised to work with their software vendor to identify the best devices and interfaces to go paperless. All vendors are aware of the need to move in that direction, but many have to modify their systems to meet the security and usability requirements.

Some vendor systems provide a browser-based access that uses Internet Explorer or other Internet browser to access their systems. Some require software to be loaded to the client (nursing home computer) system to facilitate communications and security. Don't buy devices without conferring with your vendor.

This would be a good time to review your assessment processes. Develop and implement a plan to ensure smooth transition, eliminate redundant processes, improve quality control and maintain security. Have a plan to harvest the benefits of the investment.

Review the privacy and security issues raised in our May 2011 Tech Notes article (“Mobile Devices Contribute to PHI Breaches,” page 20), and plan to make the move to paperless. The infrastructure costs and device costs will be small compared to the savings in staff time-and the trees left standing.

David M. Oatway, RN, MPH, is a long-term care IT consultant based in Key West, Fla. He has been the Chair of the HIMSS Post-Acute Care Special Interest Group, Vice Chair of the American Association of Nurse Assessment Coordination (AANAC), and a member of the American Health Information Management Association. He developed one of the first clinical MDS systems (CHAMP). He is the database manager of the STRIVE national nursing home time study which developed the RUG-IV Medicare PPS. He can be reached at

daveo17@bellsouth.net. Long-Term Living 2011 October;60(10):24

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