Forms are an area about which there has been very little discussion in the private medical practice setting and yet could provide significant improvements in efficiency if they could be better managed. Not only is there an environmental aspect to reducing paper usage, the need to reduplicate information could be significantly reduced. Many practices have dealt with this problem using demographic labels printed in sheets or at the time of an encounter. Some continue to fill out the forms manually and for the most commonly used forms, others use scanned forms with overlaid demographic fields, which can be populated from the EMR or patient registration system at the time that a form is needed. This still requires manual entry of some information such as main complaint or reason for referral plus history; however, it does improve efficiency as the need for separate labels can be reduced.
Solving the “form problem” is no simple matter. Forms are a primary source of communication between organizations and providers. The format of these documents is meticulously managed in many settings and are usually developed through a consensus process. Because of the “management by committee” approach to the development of forms, individuals as well as organizations are very protective of their forms. Changing forms is frustrating to busy care providers and the layout is often designed to capture highly specific information in a way that is most useful to the receiving entity. I recall an orthopaedic specialty group that would not accept a referral unless it was written on one of their most recent forms. Multiply this by dozens of consultants and one has a major challenge standardizing forms. Incomplete forms require phone calls to fill in the missing information and, in some cases, the investigations or referrals are not booked due to this lack of information.
What can be done to take better control over forms in a medical practice? The following strategies can help:
- Do an inventory of all the forms used in your practice. This should be repeated on a scheduled basis, e.g. twice yearly to ensure that forms are the most recent versions. One administrative staff member should be designated with the task of managing the form inventory. If a new form is added, such as a consultant referral or for a diagnostic facility, this should be tracked as part of forms management.
- Next divide the forms into categories such as frequently used, infrequently used, or original required. The “original required” group of forms are those that have to be submitted using the original form. These can include forms that have duplicate copies attached, provincial requisitions, or mandatory reporting forms for infectious diseases.
- Designate a single location to store scanned versions of those that do not require the original to be used and ensure that everyone in the practice knows how to access the forms. If it is the policy of the practice to print certain forms, e.g. less commonly used referrals, make sure that it is easy for the physician to print the form and complete it without having to leave the consultation room. This means printers at convenient locations and ideally in the exam rooms.
- The hard work is trying to get consensus within one’s community or referral catchment area regarding a standard referral form for as many of the specialties as possible. This is extremely challenging if there are distinct differences between the types of information that one specialist requires in comparison to another.
- Ideally, one should be able to configure these nuances into an EMR that is able to send referrals electronically (referrals being just one of many forms that a practice needs to be able to complete). The EMR should be able to pre-populate the referral form with the needed clinical information and append the appropriate attachments that can be electronically submitted to the consulting physician for review and acceptance.
These are just a few tips and suggestions for a very complex challenge. Have you had any experience with forms in your EMR that you can share? How have you dealt with these problems in your practice? Click on the “Comments” link below to add your thoughts.