Posted by: RedaChouffani
EHR, electronic forms, electronic health data, PDF, tablets
For much of the healthcare market, whether you’re part of a hospital system or medical practice or not, you are constantly faced with paper-based documents. And for those who’ve made the leap and gone digital, there are still challenges to be faced in the effort to liberate the industry from paper altogether.
For organizations that have selected an electronic method to capture patient information and clinical data, there are several options from which to choose:
Web-based forms: These forms are browsers based (such as html forms) and offer the flexibility of being available and accessible without the need to pre-install anything. They also can be viewed using almost all current platforms and provide the ability to store all data captured from the users as discrete. However, the organization would still rely on web developers to make changes to these forms.
Thick forms: These are the forms that run within specific applications. They are similar to the forms that are available in most EHR packages that are used to capture clinical data as well as registration data. Unfortunately, these forms often are fixed and not easily changeable. They are also only available in the package of which they are a part. We can classify some of the forms available through mobile devices, such as the iPad and Android tablets, under this category as well. MHealth tablets have already seen several apps in their repositories that enable end users and/or patients to enter the data directly into the devices. These forms are, in most cases, written specifically for that platform (iOS or Android).
PDF forms: PDF forms have been one of the most commonly used forms in the industry. These forms can be generated from MS Word documents, or simply by using many of the available off the shelve form builders. They also offer the flexibility to store the data in XML and/or directly to a database. They provide the ability to perform front-end data validation and can run on almost any platform.
Digital Pen: These not so ordinary ballpoint pens can capture handwriting and drawings from special digital paper forms. The information is captured in the device and then uploaded to a central server, where it is then processed and automatically converted into text. While this concept simplifies the capture of data, unfortunately there is still the dependency on the accuracy of the handwriting recognition software and quality of the symbols, which may cause some concerns if the information is not readable.
OCR-based forms: Optical Character Recognition, or OCO, has been around for a while and utilized in many markets, from banking, to the justice system having the ability to scan through a document and recognize the handwriting. An organization can use any form, which provide tremendous flexibility, but unfortunately you are still dealing with a paper document that requires scanning and then disposal as part of the workflow.
The reality is that we are simply finding hospitals using a combination of the above solutions to resolve their data capture challenges. The market had some promising technologies out there, and at one point, xforms showed some promising results, but lacked wide adoption. I was very disappointed to see that xforms did not gain popularity, as it made a lot of sense from a conceptual design standpoint. Similar to XML (XML is a widely adopted method to exchange data across systems in a standardize format), xforms relied on a standard “xml” like method to describe the fields, data types. That meant that many applications had the ability to easily display the forms included mobile devices, as part of an application or simply viewed via browser.
But luckily the dream of having standardized coding for form building has been reborn again through HTML5. Not only can HMTL5 be viewed from any browser or device, but it also means that the forms can easily be modified using web based tools and some of the advanced web authoring applications.
I am most definitely not asserting that HTML5 is the only way to go. There have been many more successful technologies available that enabled efficient data capture across applications and platforms. But we simply need to have some standardization and interoperability in these forms.
Healthcare will always require some data input from patients, family members, clinicians and other staff members. Different devices will be made available for this purpose from tablets, kiosks, mobile devices and desktops. And to ensure ease of use and improved workflow, the technology has to be there to support the overall mission, and so far it’s still too early to tell which technologies will be best suited for the age of electronic data exchange.