Moving paper EHR processes to electronic medical forms

Using Software as a Service to port paper processes to electronic medical forms can reap efficiencies for small practices: Here are steps for planning a migration.

Meaningful use compliance is not built in a day, many clinicians are discovering as they wrap their heads around soon-to-be-finalized federal rules on electronic health record (EHR) technology. Software vendors like to tout their EHR systems as complete, end-to-end solutions to every workflow issue a medical practice, hospital or lab could possibly have. Chances are, however, that at least one everyday process could be better suited...

to a separate electronic medical form that later gets piped into the EHR system via a well-organized database.

Every office workflow has its quirks (read: nonstandard processes). These include intake; discharge; billing information handoff; personal health record, or PHR, request; reporting; specialist patient referral -- or some other real-world information-routing scenario a vendor cannot anticipate when it programs an EHR system. To solve those quirks, electronic medical forms can provide on-ramps for EHR processes into the EHR system for data presently typed or transcribed in.

Bill Bard, volunteer ombudsman and technology committee chair for the state of Oregon's Office of Long Term Care, recently took the agency's field caseworkers' reporting process from paper to an electronic workflow. The paper process involved carbon copies and had become so onerous that it turned off volunteers who otherwise would contribute to keeping watch on patients in the system, he said.

The electronic version of the same process slashes the time needed to file reports. It also creates efficiencies by pointing out conflicts in descriptions that the regulations do not permit. This happens on the fly, before the reports flow downstream and a clerical worker has to follow up on the error.

"You have to define a workflow, and you have to define the people involved in it," Bard said. "In a small doctor's office, you could run everything from your appointments to your prescriptions to some of your patient record keeping [on electronic forms, or] at least you could get started on it."

Having worked with the travel industry's Sabre database in its formative years in the late 1960s, Bard is a veteran of electronic workflows. To that end, he offers the following three tips to physicians and IT leaders porting their own paper processes to electronic medical forms:

In a small doctor's office, you could run everything from your appointments to your prescriptions to some of your patient record keeping [on electronic forms, or] at least you could get started on it.
Bill Bardvolunteer ombudsman and technology committee chair, state of Oregon's Office of Long Term Care

First, consider where the data is headed. As you create a form, you also must create a place to put all the data being collected and figure out what to do with it. That place typically is a database; better yet, it is the EHR system you are either using or upgrading. Here, Bard said, the devil is in the details -- specifically, creating relevant form fields and a logic tree that feeds information into corresponding database fields on the EHR server.

Next, decide what kind of electronic medical forms to use. HTML forms offer the convenience of online filling and submitting. PDF forms can be online and offline, and have paper equivalents that patients without access to a computer can fill and hand to a staffer for entry. Bard used a vendor called PerfectForms Inc., which uses Adobe Flash online. Other vendors, including FormRouter Inc., offer such features as offline filling, digital signatures and barcode interactivity to cut data-entry chores. Whatever system you choose, consider whether your workflow requires occasional paper use. If it does not, you need to decide -- before making a purchasing decision -- whether patients or staffers will be able to complete forms offline.

Lastly, decide whether you need to host the forms yourself or can use a Software as a Service (SaaS) vendor to host them remotely. There are pros and cons to each approach. SaaS vendors typically charge a monthly fee based on usage. Applications tend to use point-and-click forms-building as opposed to hand coding; once the use of electronic medical forms is shoehorned into your workflow, it takes little time to get started.

"You can get something up and running in 30 days. It's not rocket science," Bard said. Nonetheless, he added, you should test early prototypes of the forms with the employees who will be using them, and take to heart their input, positive or negative.

If the forms cannot be fully customized to your liking, and if a vendor's security measures -- particularly its ability to implement HIPAA-compliant security measures -- fail to impress, then making your own electronic medical forms might be the right decision. That, of course, is contingent on having both IT and user-experience design resources available, Bard said.

Let us know what you think about the story; email Don Fluckinger, Features Writer.

This was first published in May 2010

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