FormFast, Inc.

E-Forms: History Lessons Help Avoiding Pitfall

By Rob Harding, CEO - FormFast, Inc. (reprint from Advance magazine)

The philosopher Georg Wilhelm Friedrich Hegel wrote: "What experience and history teach is this—that people and governments never have learned anything from history, or acted on principles deduced from it." Well maybe its not all that bad but there is more than a grain of truth there regarding health care. While Hegel wrote those words in 1832, he might just as easily have been describing the rush to technology that besieges healthcare providers today. Pressures to do things faster, smarter, cheaper, and safer have never been more pronounced. But technology by itself is not a panacea. And the failure to learn from past missteps can prove costly.

Case in point: the world of electronic forms and documents. The groundswell toward the paperless office cuts across all segments of business, and continues to attract new software providers. Adobe systems and Microsoft are among the latest vendors to throw their hats into the e-forms ring. And with the influx of vendors, some healthcare providers are enthusiastically deciding to leap into the world of homegrown document automation.

Which is where Hegel comes in. He didn’t live long enough to see the rise of document automation. But we did. And while it might feel as painful as reviewing pictures of your self from the 1970’s, I believe that remembering the past can be instructive. Let me explain: Back in the 1970s, our businesses relied on business forms companies, commercial printers and print shops to produce printed items to tell our stories. This meant securing work from writers, graphic designers, professional forms designers and other specialty staff. It was often time consuming and expensive to get a message from "idea" to "hard copy." But then desktop document automation entered the picture. It was a wonderful, cost-saving tool, no doubt about it. But the technology wasn’t magic: it didn’t turn office staff into talented workflow consultants, graphic artists or writers. True, almost anyone could "lay out" a newsletter, an annual report or a form, but it didn’t necessarily have the same polish or cohesive message.

Fast forward to the present day, and enter the world of e-forms, e-documents and the move to the electronic medical record. The pressures on providers are more pronounced than ever before: budgets are squeezed by soaring technology costs, risk premiums, third-party demands, and staffing shortages. The paperless office promises to streamline business processes, reduce errors, reduce or eliminate printing and shipping costs, and enhance communication flow—to say nothing of conserving our limited natural resources by sidestepping the unnecessary (and overwhelming) sea of paper we all contend with.

All right, so electronic forms make sense. They save money. They save time. They can significantly reduce errors and staff frustration. And the technology is there. So why am I advising you to look before you leap?

As the CEO of FormFast, let me go on the record in support of process improvement. It’s our business. And I believe we do it well. The move to Process Improvement requires effort and planning. Whether forms are pre-printed, printed on demand, or exist solely in electronic format, providers must first implement a solid system of forms control. It’s not enough to buy a software package, scan your forms, and send them out into the world.

Forms control is more important in the paperless environment—not less so—because the technology can quickly get out of control.

Forms control will also help you control the size of the patient chart. When forms control is successful, it decreases staff frustration, increases staff satisfaction (really), and frees up staff time for patient care, it also makes coding, indexing and storing the chart easier. In short, it hones your forms into the useful tools they should be. Without control, you can create a nightmare for your facility.

So how do you get started? Every facility should already have a process to review all current and proposed forms. Even so, the effectiveness of that process can vary widely. A hospital’s Forms or Medical Records Committee can and should review all forms to ensure that documentation isn’t allowed to bypass the review process. If forms proliferate without review, then you may find yourself unable to determine if a given form is still relevant. As a result, your facility could end up with forms that actually bog down processes and cost you needless dollars. Without forms control, you can end up wasting money and energy on obsolete forms. And since the costs of poor e-forms control is harder to track than with paper forms, you could be inviting a work-inhibiting scenario without even realizing it.

It’s critical and potentially time-consuming for your facility to identify, categorize and analyze all the forms in use. But it’s necessary. As your Forms Committee begins to assess and evaluate your forms, you must include all electronic and printed forms. That includes forms made in Adobe Acrobat, Word, Frontpage, Excel, PageMaker, whatever. Today everyone is a desktop publisher and bootleg forms are proliferating by the hundreds with forms unexamined by forms committees, risk management, and materials management that duplicate themselves from department to department.

Storing and maintaining either paper or electronic versions of these forms also requires planning. Many firms are turning to web storage (FormFast Site is one example) for all their forms. Using this approach, when a form requires updating, because of changes in regulations/laws or internal practices, it can be done once, posted on the site, and then downloaded or filled out on line for use throughout your facility.

Of course, the promise of electronic forms is only the beginning. Bar codes, data tracking and retrieval, electronic signatures and other advances within this arena promise to also enhance staff productivity while maintaining patient safety and satisfaction at new levels. It’s all within reach, but it requires planning…and learning from past missteps. Hegel would be proud.