Case Study: How we built a Document Management System for a Nursing Home

Did you know that healthcare professionals spend up to 37% of their time on administrative tasks, leaving only 9-22% for direct patient care? This imbalance contributes to staff burnout and compromises the quality of care. Fortunately, advanced technology offers a solution. One such solution is the Document Management System (DMS), designed to streamline forms management and reduce administrative burdens, allowing healthcare providers to focus more on patient care.

In this case study, we'll explore a custom DMS designed for a nursing home in the United States. Developed from scratch, this software aims to streamline creating, filling, and managing forms, thereby improving time management for nursing home staff and ultimately improving services for residents. While initially designed for nursing homes, this customizable platform has the potential to be adapted across multiple industries. Let's dive into the specifics of the solutions we implemented for our client.

What Is a Document Management System (DMS) For a Nursing Home?

A nursing home document management system (DMS) is a digital tool designed to streamline paperwork. Its primary goal is to automate tasks such as creating, filling out, submitting, and organizing forms.

But what exactly is a form?

Forms serve as standardized tools for collecting information from various sources, such as customers, vendors, employees, patients (in healthcare), and business partners. They're essentially categorized as documents, but what sets them apart is the presence of fields that require input.

To maximize the value of forms, electronic forms management is necessary because specialized software makes the process of handling forms much more efficient.

It's important to note that our DMS is different from typical healthcare DMSs. Instead of dealing with patient records, it focuses solely on managing forms to simplify administrative tasks. Think of it more as an All Care Forms system.

Speaking of which, the All Care Forms system serves as a digital platform aimed at streamlining all forms involved in patient care and facility management. Its primary goal is to simplify the entire process, from creating and filling out forms to submitting and managing them digitally.

Essentially, this type of system should allow forms to be filled out digitally rather than on paper. To achieve this, the structure of a paper document must be converted to an electronic format and then distributed to different categories of users for completion.

About our system:

• It's not designed exclusively for nursing homes, so it doesn't include purely medical features like patient cards.
• It's highly flexible and adaptable, making it suitable for various needs beyond nursing homes.
• It can be tailored for use in e-learning or sales contexts.

At the heart of the system lies the Form Builder, a versatile tool empowering users to craft forms tailored to any content or workflow. These forms are made up of customizable elements like fields, text boxes, file upload options, multiple-choice selections, and more. The beauty of it is that the subject matter of the forms is completely flexible, allowing them to be tailored to the specific needs of any given situation or use case.

What Is the Idea Of the Document Management System Project?

Large organizations, especially in healthcare, often face a common problem: documents go missing, no one knows where they are, and there's a general need to get things organized. While there are existing systems on the market that address these issues by creating documents in the form of forms, they come with their own set of drawbacks:

• They tend to be cumbersome and outdated in both functionality and interface.
• They often include a lot of unnecessary features that organizations end up paying for.
• These systems don't always cover all the actual tasks that the organization needs.

So what's the solution? It's to create a system that:

• Doesn't have any of those problems.
• Addresses complex processes efficiently.
• Allows management to easily create, customize, and manage forms.
• Is easy to use and accessible to those who aren't tech-savvy.
• Can be used on the go.

The system we've developed meets these criteria, with a powerful form builder at its core. But what does that mean? This means that DMS users can efficiently perform a range of critical tasks, such as monitoring narcotic medications, logging room or food temperatures, verifying hand washing training with signatures, or alerting patient representatives about a coronavirus outbreak. It's all about streamlining data collection through customized forms.

Development Process of the Document Management System

The whole development process turned out to be structured and consistent. Let's take a look at the major milestones.

Team

To bring the all-care forms DMS to life for our U.S. client, our team included the following experts:

• 1 Project Manager (PM)
• 1 UI/UX Designer
• 1 Front-End Engineer
• 1 Backend Engineer
• 1 Quality Assurance Engineer (QA)
• 1 DevOps Engineer

Methodology

In developing the DMS, we followed the Agile methodology, as it proved to be the most flexible and suitable approach for this type of project.

Sprint-Based Work

Our work was organized into 2-3 week sprints. This consistency allowed us to tackle tasks systematically and deliver results on time without having to backtrack or make significant changes.

Discovery Phase

Let's take a look back at how the system development journey began.

Step 1: The client approached us with a clear vision of the system he needed and extensive experience with similar software solutions. His deep understanding of nursing home operations and experience with off-the-shelf systems for solving industry-specific problems allowed him to precisely formulate the requirements for the upcoming DMS. This made it much easier for our team to achieve the desired outcome.

Step 2: Our team carefully analyzed the customer's requirements and prepared questions to clarify any uncertainties. We stayed in regular contact with the client, discussing our ideas and proposals while aligning them with their vision.

Step 3: Our discussion led us to the Discovery phase. This phase involved diving deep into the subject matter, thoroughly describing the project, preparing detailed documentation, and consistently communicating with the client about our progress.

The Discovery phase took us about 1.5 months.

DMS Development Phase 1

The next phase was the actual development of the DMS, which took over 9 months. This phase included:

• Planning
• Design
• Initial phase architecture creation.

Throughout the development process, a key component we created was the Form Builder, which serves as the core of the DMS. Notably, this was a completely bespoke solution, avoiding the use of any pre-existing libraries to ensure maximum system flexibility.

The adaptability and flexibility of the system can be seen in the way the forms are processed. Instead of creating a rigid, one-size-fits-all system, we opted for flexibility. Our approach allows form creators to establish the structure of forms, which can then be customized by initiators to meet their specific needs.

Throughout the DMS development process, we kept regular communication with the client, ensuring he was fully informed and aware of the issues and challenges we faced.

It took us about 11 months to complete the entire project, which we still call the first stage of development.

Release

After the initial development phase, users can do everything from adding a company to the system to creating, filling, and managing forms. It all wraps up with the ability to generate full reports on completed forms.

DMS Development Phase 2

After the system is released, we've moved on to Phase 2, which includes:

• System testing
• Bug fixing
• User training and familiarization with the system
• Gathering and processing ideas and suggestions from users on what they'd like to see in the system to simplify their workflow.

What Comes Next?

Currently, we've covered the basic functionality without which the DMS wouldn't work. In the next stages, we plan to extend the system with additional features and optional modules, such as a scheduling option, based on user preferences. Also, the client is thinking about integrating other healthcare-related systems into the DMS. This would allow users to address not only internal document management issues but also broader healthcare needs.

All in all, the development process can be summarized in the following way:

Challenges We Faced During a DMS Development

Our team faced several challenges during the development process.

Challenge 1

Create an extremely user-friendly system that non-tech-savvy users could easily understand, ensuring a smooth transition from paperwork to handling all document-related operations on a smartphone.

Solution

To tackle this challenge, we needed to understand how our users think, considering their profession, mentality, age, attitude toward technology, and other factors. Even a single unnecessary button or action in the interface could lead to confusion or resistance, especially since these users were accustomed to paper-based processes and now had to adapt to digital ones. Therefore, our goal was to develop the simplest possible system to minimize resistance from the users, primarily nursing home staff.

Challenge 2

Develop a mobile version of the system. Since most of the main users of the DMS, the form fillers, aren't tied to desktops, it became crucial to create a mobile version of the system that was incredibly user-friendly and intuitive. In particular, this version would need to focus on meeting the users' primary requirement: easy form filling from their phones or tablets.

Solution

To achieve this, our team had to meticulously map out the essential features required for this version of the DMS and figure out the best way to implement them in a way that users could easily grasp. Equally important was the need to eliminate any unnecessary elements that could potentially confuse or distract users from the primary goal: seamless form filling.

Challenge 3

Create a flexible access system for users in companies with different organizational structures. Creating a universal structure for all companies was impractical and time-consuming, so we needed a more feasible solution.

Solution

We minimized the number of roles and instead implemented permission settings for user groups. Here's how it works. Every employee is assigned to at least one user group (department). However, not all employees have the same access to the system. System administrators can grant additional permissions to different user groups, making the system flexible enough to fit any company's organizational structure.

In essence, we replaced the cumbersome user role branching with a more efficient permission-based system.

This approach made the system flexible and able to handle different organizational structures and needs, simplifying settings and access levels for different companies.

How Does This Document Management System Work?

Here’s how the DMS we created for nursing homes works:

• A company is registered in the system by a Super Admin. This company can manage one or more nursing homes. There can be many such companies in the system.
• Each company has its own Company System Administrator (there can be more than one - it's up to the company) who is responsible for adding one or more facilities (such as nursing homes) and assigning employees and patients to them.
• When a company is added, user groups are created, permissions are assigned, and other company-related settings are configured.

User Roles

There are several types of users within the system:

• Super Admin (only one): This is the system owner (the client) who can add new companies and manage all processes and forms. The Super Admin has the authority to manage all companies within the system and has access to the General Library, which serves as a repository for various types of form templates. The Super Admin can share these templates with all companies.
• Company System Administrators: These administrators handle all user and form management tasks within their specific company.
• System Users or Employees: These are staff members of a nursing home or other organization using the system. They can log in, view documents, and see the history of form completions.
• Patients and Their Representatives: When a patient's representative needs to complete forms, they receive a link via email or SMS. Notifications are customized for each form. Patients and their representatives do not need to log in; they simply complete the forms using the link provided.
• Unregistered Users: These are individuals who interact with the system but cannot log in and are not listed as patients or representatives. Typically, they are third parties, such as vendors.

Desktop Version of the System: No Company Selected Option

After logging into the desktop version, users land on a page with a "No company selected" status. In the left sidebar, they have quick access to three main sections:

1. Company List (default landing page)

2. Form Builder

3. General Library

Company List

While on the Company List page, users can add a new company and view all existing companies using the system, along with the contact details of those who have signed contracts.

Clicking on a company leads to a detailed page with structured information, including:

• Full company name
• Contact person and details
• Users
• Default User Groups
• All User Groups
• Related Files
• Settings
• Facilities with options to edit, copy, delete, or deactivate each facility.

Noteworthy: The Copy Facility option saves time and makes it easier to create new facilities. You can simply duplicate the desired facility and make any necessary edits.

Form Builder

In the Form Builder section, users can create customized forms for various workflows. This section offers rich customization options:

• Create a new form
• Set form name properties
• Choose content, form, selection, and other components.

By default, the super admin and company system administrators can create forms. This permission can also be granted to user groups.

Settings in this section vary depending on the type of submission form:

• Special form (General)
• Public form
• Mixed forms

Forms are organized into folders or subfolders within the "Forms Available to Me" folder, visible to the current user based on access rights. Until a form is placed in this folder, it remains in drafts and is only visible to its creator. Users can move forms from Drafts to "Forms Available to Me" at any stage of form creation.

General Library

In this section, users access a space dedicated to storing form templates and files exclusively for the Super Administrator's use.

By default, the General Library consists of two sections:

1. Files: Contains files added by the Super Administrator for their use in forms.

2. Forms: A repository with forms added by the Super Administrator.

All forms in the General Library only have elements, files, and PDF template settings. Additional customizations can be made after the form is copied to the company's Corporate Library.

The Super Admin has the authority to create, edit, and delete folders in both the Files and Forms sections, including the option to create folders within other folders.

Desktop Version of the DMS: Company Selected Option

To access the settings for each company individually, users can use the drop-down menu in the top right corner under "Select a Company".

After selecting a specific company, users are directed to a page with detailed information about the chosen company.

On the left sidebar, you'll find a list of sections for quick navigation:

• Company
• User Groups
• Users
• Form Builder
• Corporate Library
• Report Builder.

Let's take a closer look at some of these sections.

User Groups

When you go to the User Groups section, you'll find a table with details about:

• All user groups
• Positions
• Units

The initial tab displays a list of all user groups, including details such as name, type, facility members, and permissions. There's also a button to add a custom user group.

Clicking the Positions tab displays a list of facilities, the number of employees in each, and the names of the positions. You can edit the information in any of the Facility cells.

In this section, you can add positions using the button labeled with the corresponding name.

The Units section displays a table with information about Facilities, Units, and Residents. Each cell in the Facility column is editable, allowing users to add units in this section.

Report Builder

The report can be generated using a specific form and is always in PDF format. Users who can access the Report Builder include:

• Super Admin
• Company System Administrator
• Form creators
• Participants of a user group with "Report building" permission.

To create a customized report, users need to specify all the required parameters listed on the right-hand panel and fill in the following fields:

• Select a form
• Initiation date
• Submission name
• Header fields
• Fields to combine
• Sort by

Once all parameters are set, the user can click on the "Generate Report" button.

Corporate Library

Unlike the General Library section, the Corporate Library contains data directly related to the selected company.

The Corporate Library is divided into two sections

1. Forms: This section contains forms.

2. Files: It contains files taken from the General Library or added by company users (we need to specify who can do this).

Users with the ability to create forms can place them in the Corporate Library either directly or inside folders. A folder can only be deleted if it does not contain any forms or files. The same rule applies to deleting folders with subfolders - they can only be deleted if they do not contain any forms or files.

Now let's explore the mobile version of the nursing home DMS and the options available to users.

Mobile Version of the Document Management System

When a user logs in with a mobile phone or tablet, they are automatically logged in to their company. From the very first page, they enter the Company Library section, where they will find the following folders:

• Forms Available to Me
• Forms Assigned to Me
• Forms In Progress
• Public Forms

These folders contain all the forms available to the user from their mobile phone. The simplified functionality of the system on mobile devices aims to streamline the process of filling out forms for company employees, ensuring that they spend minimal time on these tasks and encounter no technical difficulties.

Let's explore each section available to the user from a mobile device.

Forms Available to Me

When users navigate to this section, they encounter a list of folders organized into three main groups:

• General forms
• Public forms
• Mixed forms

Additionally, users can access tabs for quick navigation to other sections of the system, namely Forms Assigned to Me, Forms in Progress, and Public Forms.

The search bar allows users to specify the parameters of the form or file they are looking for. By clicking the icon to the right of the search bar, users can quickly access a list of forms assigned to the Available to Me category.

Forms Assigned to Me

The Forms Assigned to Me folder contains user-initiated forms where the current user is listed as the submitter. It's not possible to create folders in this folder. When a user opens a form, they don't have to log in again.

Now let's look at one of the forms available here. Here's how the form is structured to make filling it out easy and clear:

Forms In Progress

The Forms In Progress folder contains only forms assigned to the current user that the user has started to fill out but hasn't yet submitted. This folder does not contain any subfolders.

What does "In Progress" mean? When an initiator opens a form template, adds some data, and then clicks "Save" (if that feature is available for that form), the form moves to Forms in Progress. This basically means that the form hasn't been completed yet. Both form initiators and submitters can save the form and return to complete it later.

Public Forms

Public Forms refer to forms that become accessible to all specified submitters. Once initiated, users designated as submitters can access these forms in the Public Forms folder without needing to log in again.

For these forms, the following points are relevant:

• The initiator cannot select submitters.
• The initiator cannot save the form during the initiation process; only a Submit action is available.
• These forms never appear in the Forms Assigned to Me folder.

When a submitter opens a form, they see the information entered into the form prior to initiation, as well as previous submissions by other submitters. The submitter completes all the required information in the form and then clicks the Submit button.

Now that we've examined both the desktop and mobile versions of the DMS, let's explore the features that contribute to the effectiveness of such a system.

Features of the Document Management System

Here are some key features of the DMS for creating and managing forms:

• Form Builder: The core feature of the system that allows for the easy creation and customization of various forms tailored to the needs of nursing homes. Users can create forms without technical knowledge, increasing flexibility and efficiency in processes such as signature collection.
• Report Builder: Allows users to create custom reports based on specific criteria, facilitating data analysis and informed decision-making to improve operational efficiency.
• Forms (Special, Public, Mixed): Supports the creation and management of specialized forms for various purposes, including patient intake, medication administration, and incident reporting, ensuring comprehensive documentation.
• General/Corporate Library: Provides a structured place to store form templates and files, making it easier to fill out forms at a later time.
• Permission-Based System Access: Access to the system is based on user group permissions rather than user roles, making it easily and flexibly adjustable to meet the needs of organizations with different structures.

Benefits of the Document Management System

Let's explore the significant benefits of adopting this system:

Security and Compliance

The system ensures regulatory compliance, utilizing AWS for secure storage, implementing regular backups, and maintaining detailed logs. It prioritizes security by not storing patient medical information and restricting access for unregistered users.

Keeping Important Data Safe

By providing standardized templates, automated workflows, and secure storage, the system prevents the loss of vital data, ensuring accurate completion of forms and adherence to regulatory requirements.

Increased Operational Efficiency

The system streamlines the process of filling out, creating, and managing forms, reducing administrative burdens and the risk of errors or data loss. Features such as auto-fill and electronic submission accelerate documentation processes, allowing staff to focus on their core responsibilities.

Cost Savings

Transitioning from paper documentation to electronic forms reduces costs associated with printing, storing, and manually processing forms, resulting in tangible savings for the nursing home.

Enhanced Patient Care

By freeing up time and resources previously spent on paperwork, staff can allocate more attention to quality patient care. This shift ultimately improves the overall quality of life and satisfaction of nursing home patients.

Why Do You Need a DMS for Form Management?

To understand the importance of a DMS in your nursing homes (or other facility), let's get to the heart of these facilities.

Nursing homes aim to provide round-the-clock care for elderly patients, ensuring that all their needs are met. However, paperwork remains an essential aspect of operations, involving tasks such as managing medical histories, medication regimens, special care plans, and various administrative forms.

Juggling these responsibilities can be overwhelming for nurses, caregivers, and staff, often leading to lapses in accountability, regulatory compliance, or patient care quality.

Recognizing the complexity of the healthcare industry and the detrimental effects of paperwork overload, we developed the DMS to address these challenges.

So here are some reasons why you might want to consider developing a forms-focused DMS:

• Employees gain instant access to forms and electronic documents, free from legacy technology issues.
• The system streamlines the assembly of forms into packages, eliminating manual effort.
• Confusion, delays, and human error are minimized as skilled nursing facilities seamlessly manage documents and forms.
• Administrators benefit from reporting capabilities that provide insight into form usage, detailing which forms are being used and by whom.
• It is possible to set up reminders when a form deadline is approaching.
• It is possible to pre-schedule the sending of forms with the required frequency.

The cherry on top: Our DMS allows our client's facility to focus on its core mission: patient care. By saving time and preserving sanity, it ensures that the essential aspects of healthcare are prioritized and honored.

What DMS Can Help a Nursing Home With

Using a DMS to simplify form filling in nursing homes is a game-changer, making paperwork faster and easier. Here's how it can help in real-world situations:

• Keeping track of medications manually can lead to errors. The system automates this task, ensuring accurate and up-to-date records for patient safety.
• When incidents occur, such as patient falls, staff need to report them quickly and accurately. With the system, staff can submit reports electronically, ensuring they're reviewed promptly.
• Nursing homes must comply with strict regulations and maintain detailed records. The system ensures that forms are compliant, securely stored, and easily accessible during inspections, reducing the risk of problems.
• Some training, such as hand washing protocols, is critical. The system can include educational forms and training materials, making it easy for staff to stay informed and follow the latest recommendations.
• DMS allows users to view the entire history of their filled forms, analyze data, and generate reports. This provides up-to-date information and insights into facility performance and trends.

Bottom Line: Ready to Take Your Documentation Management to the Next Level?

As we wrap up our journey through a document management system designed to manage forms in nursing homes, it is clear that digitizing the process is essential. Without it, there's a higher chance of being overwhelmed by paperwork, leading to costly errors and detracting from critical tasks such as quality patient care.

Despite the abundance of document and forms management systems available, our DMS stands out as a breakthrough because it:

• Maximizes ease of use, catering even to those less tech-savvy.
• Frees nursing home staff from tedious tasks, allowing them to focus on their core responsibilities.
• Streamlines forms management, ensuring transparency and efficiency for all involved, leading to refined processes and comprehensive reports.

The most exciting aspect of this forms-focused document management system is its customization. It's not limited to the medical industry but can easily be adapted to other industries, such as online education. This flexibility is made possible by the platform's customizable form builder and other customizable features.

Curious to learn more about how this DMS can serve your needs? Reach out to us, and our experts, who have firsthand experience with the system, will be happy to address all your queries.

FAQ

What is a document management system?

In the broadest sense, it is a comprehensive system or centralized repository where documents of all types are stored, tracked, distributed, and managed in digital format.

Why is a document management system important to a nursing home?

It simplifies paperwork by providing order and quick access to forms and files, saves money, and most importantly, allows staff to focus on their core duties and thus improve patient care.

What are the first steps in building a document management system?

1. Conduct market research to find out what systems with similar functionality are already on the market and what their advantages and disadvantages are.

2. Write a description of the system you need to solve the existing problems of the industry or a specific nursing home.

3. Make a request to the development team.

4. Initiate the discovery phase followed by a detailed specification of the system to be developed.

What are the key features of the DMS?

The key features of this system may include form builder, report builder, library, calendar, messenger, notification, and system access method (permission-based, user role-based, or other).

What are the best technologies and tools for this project?

It is better to use those that have proven to be effective in creating systems of a similar type. In our case these technologies were Django Framework, Django-Rest Framework, OpenAPI Framework, React, React Context, React Quill, React Modal, PostgresSql, Python, AWS.

How did you gather the requirements for the system?

The requirements for the system were gathered through constant communication with the customer (he is well versed in such systems and knows how nursing homes operate and what their needs are for a DMS) and by researching the market and systems of this type.