Paper MAR or electronic MAR? What a small home should weigh

A paper MAR works when the same experienced person does every pass. It gets harder with new staff, more residents and frequent order changes. Here is how to decide.

Updated 11 October 2026

General information, not legal advice. Rules differ by state and licence type and change over time. Check your own licensing guidance before you change how your home works: in Virginia the VDSS Division of Licensing Programs and the 22VAC40-73 standards; in North Carolina the DHSR Adult Care Licensure Section, your county DSS adult home specialist and the 10A NCAC 13F and 13G rules.

What paper does well

• No devices, logins or Wi-Fi to fail.
• Pharmacies in many areas print it for you each month.
• Everyone already knows how to use it.

Where paper starts to hurt

• Blanks and late doses are found at the end of the month, not at the moment.
• Order changes mid-month mean hand-written lines that are easy to misread.
• PRN follow-up: the reason and the result are often missing.
• Refills are noticed when the card is nearly empty.
• Hospital returns: comparing the discharge list with what's on the MAR is slow and easy to get wrong.

What a good eMAR should do

• Show what is due now, what is late and what was refused, for each resident.
• Use your home's medication window and record a reason for anything given outside it.
• Ask for the PRN reason and remind staff to record the result.
• Warn before a medicine runs out, and keep controlled-drug counts.
• Keep working through a short internet outage, and let you print a paper MAR at any time.
• Only let qualified staff pass medications, and keep a record of who did what.

Questions to ask before switching

1. Who enters new and changed orders, and who checks them before they reach the pass?
2. What happens if the tablet dies mid-pass?
3. Can we run paper and electronic side by side for a few weeks?
4. Can we export every record if we leave?
5. Will the vendor sign the agreements a health-data service should sign (for example a business associate agreement)?

How Ralfor handles it

Ralfor's med pass enforces the dose window with rules rather than an AI model. Order changes arrive as drafts that a nurse or authorised person accepts before anything reaches the pass. Refills show a run-out date. The AI assistant never changes a medication order.