In 1995, three hospitals in Brevard County, Florida — Cape Canaveral Hospital, now with 150 beds; Holmes Regional Medical Center, now with 514 beds; and Palm Bay Community Hospital, now with 60 beds — merged to create a not-for-profit healthcare delivery system called Health First. With a common mission of improving the health of the communities they serve, today, Health First also includes the largest medical group in Brevard County — Health First Physicians — as well as the only trauma center on Florida’s Space Coast; specialized programs for cancer, diabetes, stroke and rehabilitative services; outpatient centers, home care services, fitness centers, as well as commercial and Medicare Advantage health plans.


The heart of any successful system is the collection and retrieval of information necessary for management and staff efficiency and effectiveness. Health First’s story is one of implementing technology to improve service and healthcare excellence. One example of this commitment is Health First’s integration of FormFast and McKesson ( now Allscripts) products to enhance patient safety and security

“We installed FormFast a few years ago to handle our registration forms, using an interface from the EHR,” says Health First’s Senior Software Engineer Judi Spillers. This allowed us to replace our preprinted forms, embossers and imprinters in registration.” Then, Health First administrators decided to take the technological advances forward. Adds Spillers, “We wanted to reduce cost of preprinted forms throughout the hospital. Since we already had FormFast and knew its capabilities, our IT management decided we would use that system to replace as many of our clinical preprinted forms as possible.”


The Health First team set about collecting the hundreds of forms in use across the three hospitals. “Our Health Information Management Department (formerly Medical Records) became the official owner of the system since most of the forms would be included in the electronic medical record,” Spillers says. The discovery process was an education. “We found that while some forms were coming from our forms vendor, others were available through our intranet, some came from another print shop, others existed as MS Word documents on individual computers. And when we gathered them all up, we discovered that we had different versions of the same form. So we had to find out which was the most recent official version of these forms. It was a huge project.”

Health First has realized a significantannual savings from the elimination of preprinted forms; but other savings have been equally impressive.


“I think the greatest savings are related to productivity.


It’s so much simpler for the units to print a packet of forms from FormImprint instead of manually compiling forms and sticking labels on them,” says Spillers.


And there are aesthetic considerations as well. “Our forms look so much more professional now,” she adds.

After the forms were collected, the work of redesign got underway. Spillers and her team created a header and footer that would become the standard for all forms as they proceeded. But this wasn’t the only change taking place at the time. Health First was also installing McKesson’s Horizon Patient Folder (HPF). This meant that some forms would have to be scanned into HPF; and so the redesigned forms had to include a bar code to automate the indexing. Adds Spillers, “Rather than going to our forms vendor and having everything redesigned through them, we put them through FormFast’s FormImprint.”


Because of the unique capabilities of FormFast software, Spillers and her team could scan and edit all the forms they collected. “Since we had 99 percent accuracy of character recognition in the scans, we had to do very little correcting of the scanned forms,” she says. Success, according to Spillers, lay in three concepts: standardizing, organizing and simplifying. “Using FormImprint and Tool Box, I could set up the template, and with the click of a button others could get standard headers and footers. It made things simple, and that really speeded up the process. The software did a tremendous job of that.”


Spillers and her team created templates and used FormFast to add bar codes to chart forms. “Our forms have two bar codes that meet McKesson’s specifications,” she says. “One identifies the document type—such as a consent form, physician order, or other form. The second bar code carries the patient’s account number.” The form redesign had to encompass other considerations as well. At Health First, physician orders are automatically scanned into the Pyxis pharmacy system. These orders also carry special ­fields, to indicate STAT orders, for example. Again, Spillers easily accommodated the challenge using FormFast software. And as forms were developed, they were sent to a multi-disciplinary committee for proofreading and approval.


“People were initially hesitant to take on another project, just because we had so many going on at the same time. But once they understood the capability of the system, and once it went ‘live,’ people just loved it—Nursing especially—because they understood how much time it was saving them. Once the system went up, people took to it immediately. It not only made the project so much easier, but our forms now look so much more professional. Some of our old forms were poorly designed, or were the 50th copy of something someone had hidden in a drawer. That’s all behind us now.”


Health First has 1,940 form pages and 10,658 jobs in FormImprint. In addition, the hospitals are using FormFast for the creation of their patient wristbands and labels. It’s a success story that has exceeded their expectations. Explains Spillers, “Our initial goal was to do 80 percent of the forms in the chart. But we did 100 percent of the chart forms. Once Nursing realized the system capabilities, they wanted everything in there. So we have also included other non-patient, clinical forms that Nursing uses on a daily basis.” The system has also eliminated confusion regarding multiple versions of the same form. “Now we have one official version of a form. When we update or replace it, that new version is instantly available to everyone—there’s no longer the problem of finding five different versions of a form in the system,” she adds.


While the forms redesign was underway, Health First also developed data mapping for its records. “We have an HL7 interface from the Star System that goes into a sequel server database,” explains Spillers. “We have some 704 elements we’re picking up from the HL7 feed to populate the database. This is currently more data than we need, but we have it available. If, for example, we have a future need to indicate a patient’s tertiary insurance on a form, we will be able to do that.” Developing the data interface was a huge part of the Health First project. “We standardized the patient demographic block where the data would be placed on each form so that once the mapping was done, it was just a case of replicating that on every form. Being able to replicate the demographic imprint information allowed us to bring up more than 1,900 forms quickly. ”


Once the data interface was in place, Health First employees had to be able to access the system. But this step was also easier with the software interface.


Adds Spillers, “I was able to use McKesson’s Vista SQL to import data from Payroll into STAR and then export the FormImprint user fi­le including encrypted passwords. We have more than 3,000 employee log-ins now, most of which were automatically configured using this process.”


The programming requirements of the physician order/Pyxis pharmacy system meant that Health First had to “go live” on a hospital-wide basis, rather than employing an incremental division-by-division approach. “We initially selected Cape Canaveral Hospital as our pilot,” says Spillers. The system went live in January 2006. Holmes Regional Medical Center and Palm Bay Community Hospital followed in April. She describes the implementation as “almost an anticlimax” and adds: “We had our FormImprint team on-site to troubleshoot. But because the system is so intuitive, it really didn’t require much training.”


Spillers continues to be very pleased with the FormFast and McKesson systems. “Things have gone very well. Everyone loves the system and there have been no significant glitches.” She adds that ongoing maintenance is the primary focus at this point. “It’s a challenge because our forms are changing all the time. So it’s very important that we have a standardized process and procedures. We continue to ­fine-tune that.” As part of this process, all three hospitals now rely on a single forms representative for the organization. “Prior to FormImprint, we had different people at each hospital coordinating forms. Now it’s all centralized through one person who sits on our Forms Committee—and she interfaces closely with IT to keep the system updated.” This streamlined approach is also much faster than its predecessor. “In the past, our forms vendor took three to four months to make changes. We also had to waste forms that had already been printed. With our new system, the time period from approval by the Forms Committee to input in the system takes only two weeks. And we have no stockpiles of outdated forms to discard.” It’s a system that has saved the organization considerable time and resources. Health First has realized a significant annual savings from the elimination of preprinted forms; but other savings have been equally impressive. “I think the greatest savings are related to productivity. It’s so much simpler for the units to print a packet of forms from FormImprint instead of manually compiling forms and sticking labels on them,” says Spillers. And there are aesthetic considerations as well. “Our forms look so much more professional now,” she adds.


But this success story doesn’t end there. “FormFast’s support staff have been just great,” adds Spillers. “When I’ve had questions, they’ve been very helpful in making modifications in software, and they’ve really listened to my suggestions. They’ve been wonderful. And I’ve been very happy with that.”


Health First plans to expand its forms on demand to other departments in the coming months. Spillers and her team will likely be front and center as the project moves forward because utilizing technology to provide quality patient care and healthcare excellence is exactly what they do best.