Even if one uses an EMR for the majority of patient management, it is highly likely that there are drawers full of preprinted forms that are used every day by physicians as well as administrative staff. These include new patient registration forms; requisitions for a wide range of services including radiology, laboratory, and pathology; and referral forms for physiotherapy, specialty clinics, auditory assessments, and orthotics — to name a few. Each form is unique, despite requiring all of the same demographic information when completed. And due to the need in some cases to only use the most up-to-date version, scanning a form for later retrieval and printing can become problematic because of a need to manage different versions.
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:
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.
Forms are an incredibly difficult part for any medical clinic to manage, simply due to the sheer number of forms that are available. In Alberta, a study was done to determine the number of forms in the province; they stopped counting after reaching 30,000. Consolidation of common forms is a must, and likely requires provincial intervention, but a good EMR can help immensely. Healthquest currently contains over 1200 unique forms, and more are being added on a daily basis. Each one can be completed electronically with a copy stored in the patient's chart. It certainly helps with the drawers of forms, but we still receive requests for new or updated forms regularly.
Posted by: Brandon Blanck | November 02, 2012 at 12:10 PM
Ah the tyranny of paper forms! We are a rural community with one hospital being the only radiology provider. For years we begged them to change from a duplicate, carbon copy form, which was becoming nonsensically useless (and expensive) for their and our needs. The one thing we ask was to please have some input into the layout (all we wanted was a spot for a patient label!). Well you can guess what happened. And then there is the memo, "Here is the new form. The old form will not be accepted and must be discarded".
Our EMR, MOIS can incorporate PDF forms which can be prepopulated with critical data to save time. However you can fall prey to the same tyranny of too many forms if you try and incorporate all the forms you may possibly use into the electronic system. Then you end up scrolling or searching through a huge long list and wasting possibly more time. We have kept our selection to the most important ones and have designated a "top five" which we have "float" to the top of the list.
Still come up against the problem of "Thou shalt use the new form without any prior warning" as these PDF forms can be complex to build and can't always be reproduced overnight.
Posted by: Paul Mackey | November 05, 2012 at 06:01 AM
We are giving up on forms. We just use the Diagnostic req generated by the EMR. We change the address of the DI facility on top as required, using a drop down list. This produces a "generic" req. If I need a pelvic Ultrasound, I have the prep on the bottom, and it is saved as "pelvic US". We have had no problems at all, except for MRI at my hospital, where the clerk told me that she won't accept it, she wants "their" form.
I have to generate forms for public health lab (scanned in), they refused to accept generic. Specialist referrals are generally ok, except for a few programs that want a form. Our screening colonoscopy program at the hospital has now OK'd generic. Diabetes education welcomes EMR referrals with appropriate information, not forms.
People need the information, not the form. It is the information that matters. Eventually, it will be transmitted as electronic data.
My lab continues to insist on "their" form for histology and paps. I told them that if it is generated within my EMR, I can track it, but not from "their" paper-based form. My patient had an endometrial Bx that was cancer, and it was not sent to me as my address was accidentally truncated in the lab system. I knew other patients had recent histo, but could not find the missing reports as they ware not generated from the EMR. Paper forms are unsafe for our patients. The lab was informed and asked to consider changing their process to improve quality; this was 2.5 years ago.
Try sending a "generic" form generated from your EMR to the receiving organization, with no special formatting. The better organizations might just surprise you and accept it!
Forms are illogical, unsafe, and impossible to manage efficiently. They are a significant barrier to the transformation of care through the Meaningful Use of EMRs. Our provincial regulatory Colleges, as advocates for the protection of the public, should be asked to help us with this issue.
Michelle
Posted by: Michelle Greiver | November 11, 2012 at 11:05 AM