Take Control Of Your Forms
HSC is like most healthcare organizations feeling a strong push to go electronic. The hospital selected an EHR solution from HMS to address these initiatives in the clinical setting, however HSC had already identified another paper-laden challenge to address — preprinted forms. Preprinted forms are one of those things you don’t necessarily put much conscious thought into, but in a healthcare setting these forms are the lifeblood of most departments, necessary to support every process whether it be clinical or operational. At HSC, consent for admission, rehabilitation forms requiring signatures, insurance provider paperwork are just a few common examples right off the top in one patient encounter. And this doesn’t take into account nonclinical forms needed in daily hospital operations. Everything from materials requisitions to finance records require some type of form. Stephanie Gray, director of HIM at HSC, says that a pig part of going electronic was addressing the 100+ of forms used across the hospital.
“Going electronic is a big goal HSC is pursuing,” says Gray. “We just had so many forms, and achieving our goal meant we needed to make all of them available electronically.” One of the biggest concerns driving this need was the ongoing quality of the forms. “The simple fact was that we would have a form and everyone would just continue to make copies, and copies of copies,” says Gray. “It just brought down the quality and look of the form. It literally would get to the point that forms were simply too illegible to read and use.” And the danger of poor quality forms can impact more than just patient care. When you consider that a medical record is a legal document, an illegible document presented to an attorney can cause big problems for a hospital’s legal team during the review process.
Consistency of the forms was also a concern. Using preprinted forms, which are designed and then ordered in bulk quantities, poses a significant challenge when it comes to form modification. “We would come across instances of several different versions of a form circulating at any given time,” says Gray. “Instead of going through a formal process of getting a form modified and reprinted, staff would sometimes just make modifications to existing forms.” Even changing a form officially, that didn’t guarantee that all of the outdated forms were discarded and replaced, and the inconsistency of forms could cause conflict in how patient care is or could be rendered to patients.
To address the concerns revolving around form readability and reliability, HSC and Anthelio, the hospital’s outsourced IT provider, partnered with FormFast to implement a new, server based, electronic forms repository and Form Designer, an electronic form design tool. Form Designer enables HSC to quickly convert existing preprinted forms into electronic forms, and create new forms, as needed. With the ability to manipulate forms electronically, forms can be changed quickly, eliminating obsolescence and reducing cost while also enabling better control over the documentation process.
Being able to recreate forms electronically has eliminated most of the headache from the design process while also solving both readability and reliability concerns. “In the past, staff would give us form, we’d design it, print it, and often they would want to change it so we’d start all over,” says Gray. “The process is the same, but is much easier in Form Designer. We can create a new form or modify an existing for electronically, and it is available immediately.”
HSC also embraced its new FormFast server-based forms repository, which provides centralized forms storage and access. Users can access the required form, based on user-level permissions, within the FormFast database and print the form on demand. Now, instead of having preprinted forms scattered in file cabinets and storage rooms throughout the hospital, all forms are kept in one central location. In addition, this centralized repository with controlled user access enables HSC to address version control, ensuring that only the current, approved version of the form is available.
Overall, Gray says the response to the electronic forms migration was a positive one. “The only initial user concern was that there were so many forms,” says Gray. “Staff was asking how they were going to locate them all in this new repository.” To combat this, Gray knew that specific document title formats and naming conventions had to be determined and agreed to. “Before any form is placed into FormFast, the document title had to be approved by a committee,” says Gray. “If the committee felt it should be named differently, we could do that. It was a consultative scenario that worked out pretty well.”
With users so accustomed to pulling forms out of a file cabinet, having to rely on an electronic database can be intimidating. Once complete, HSC introduced the new forms repository in a series of training sessions, with each department — nursing, physicians, respiratory, and so on — having its own session. “Nursing was probably the biggest challenge in this regard. “They were so used to going into a drawer and pulling a form out,” says Gray. “They just didn’t want to log in, access the proper form, and print out that form.”
Early in the process, users were concerned with not being able to remember document titles. It was an issue that was easily solved, with the HIM director creating a master list of forms by department. That listing was then given to department supervisors, and supervisors used the lists to train their specific departments. “It was an approach of educate and reeducate, but there was minimal resistance overall,” says Gray. Currently, HSC has about 300 users across the facility with access to this repository.
With forms now available to anyone whenever needed, from a central electronic forms repository, there is no longer a need to run to a file cabinet that might be three floors down or stuck in registration. Users can gain access from any computer station to simply pull form, print, and complete. In addition to reliability and convenience, HSC has uncovered dramatic savings. The HIM department used to have an annual budget line of $80,000 specifically marked for preprinted forms. With the FormFast repository and Form Designer in place, that budget line has been reduced to zero.