Introduction

For the last few years, digital forms have been one of the fastest-growing healthcare technologies. From expediting patient intake remotely and obtaining consents digitally ahead of visits, to increasing efficiencies with insurance forms, financial forms, and application to patient surveys, eForms are shaping how patients interact with their providers.

Having the ability to extend digital eForm solutions to patients and clinicians, however, does not automatically translate to a positive experience. What does it take to design a form that works well? What can we do to ensure your users, patients, and clinicians fully adopt your hospital’s eSignature program?

Designing a digital form for healthcare that’s beautiful and intuitive can be tricky, which is why many hospitals have a dedicated forms designer on staff. Forms designers need to consider user experience, accessibility, corporate standards, and regulations that may apply. As a designer/developer of digital healthcare forms, it’s important to know what you’re doing. If you want a successful adoption, learning best practices from others can help pave the way to a successful eSignature application.

For this blog, we interviewed one of the healthcare industry's best eForms Designers, Jenni Mihm of Parkview Medical Center, to share her expertise on the 11 best practices when designing a proper eForm for healthcare.

11 Best Practices in Digital Healthcare eForms Design

1. Don’t Have a Cowboy Form - Use Templates
2. Enterprise Form Consistency is King
3. Use a Catalog Feature
4. Use Automation Functions within eForms
5. Test Your Forms & Use Run Preview
6. Use the Entire Form Real Estate & Design Within a Single Column
7. Reduce Risk & Only Get the Information That You Need
8. Use Hard Stops to Eliminate Incomplete Forms & Flag Important Information
9. Harness Automation in eForm Elements
10. Condense Forms & Watch Out for Multiple Form Variations
11. Design with the User(s) in Mind

 

1. Don’t Have a Cowboy Form - Use Templates

One of the most significant advantages of an enterprise eForm solution and eSignature Platform is the ability to stay consistent. Consistency is important when it comes to audits, accuracy, and user adoption. Jenni explains, “There is this term I use and I call it a “cowboy form,” and I can usually tell when these are cowboy forms by the fact that they don't match the formatting or templates that are in place. They've been reprinted so many times or sideways on the paper, like the logo is all askew or the bar is not straight or anything like that. It just obviously looks like somebody went to work and made their own form. One of the main tools that I use in my job is templates. I have a template for consents, informed consents, order sets, protocols, and pathways. I have these templates that I can distribute to leadership, directors, or staff that need to create a form. A recent example I have, a Bariatrics program wanted to create a clinical care pathway for their staff to utilize to care for patients pre-operatively and post-operatively with set goals. I was able to give them a standard template that they could fill out and give me all the information I needed to create the form digitally for their program. These templates include things like the logo, patient label area, title area, and if needed a signature area, so the staff member can visualize the form and use the real-estate of the form properly and to their advantage. This single tool right here can eliminate unnecessary time that used to be a lot of back and forth in email, or even worse yet, a whole meeting. Using agreed-on templates saves time, money, shows consistency throughout the organization, and honestly, reduces frustration for the form designer and the staff member requesting the form. If they're like, hey, I want to make this new pathway for, let's say, Bariatrics recently needed a pathway. This step is key so as not to end up with “cowboy forms” because if they don't have the proper markings or anything like that, it's possible they could not even end up in the medical record because they don't have the barcode or the logo or anything like that is required for a proper form.”

 

2. Enterprise Form Consistency is King

“User adoption, whether it is a patient, clinician, or someone who actively works with the form itself, is better achieved through consistent form design standards as set by the Forms Committee,” says Jenni. “For example, I like having the same signature line, margins, font, functions, and layout across all the forms. If the signature box is in the same spot every single time, if the delete button is in the same spot every single time, the end-user is familiar with the design, and they are not constantly having to re-learn their next steps. It can become very frustrating for the user if there is no consistency.”

“Make use of catalogs and templates exclusively for this, as it will save your preferences. I very rarely go out of my templates just because I know that it helps with the end user's confidence about the process and makes a better impact,” she adds.

Catalogs and templates reference specific functionality within the design tool that enables a user to setup commonly used items as resources that can be centrally managed and easily applied to any form. This significantly shortens form design time and enables easy changes across many forms.

3. Use a Catalog Feature

One thing that Jenni loves about the Access eForms Design Tool is the catalog feature because it “allows you to organize and share form design assets, like fillable fields, signature layouts, action buttons, orders, logo placement and size, and margins by the department to keep consistency across all your form design layouts,” she explains. “It’s so useful that I have a whole library of catalogs covering different departments’ case uses, such as times and calendars, specialties like pharmacies, and order sets associated with them. As a forms designer, I have seen various forms and can tell when something is off because they are not using the format and layout that we typically use.”

Jenni continues, “The reason I love this catalog feature is that I can share these assets easily with anyone like other forms designers so that the forms will always look the same. So, my signature lines all look like her signature lines and every signature line looks the same in the hospital. All of our logos are in the same spot and have the same size now every time. Our barcodes, patient labels, and stuff like that will always be in the same spot and have the same layout.

“When I first started, I did not utilize the catalog. I spent so much time adjusting elements individually and then I'd have to go in and manually put in the properties. I'd have to set the font, margins, color, and stuff like that each time. With catalogs, it’s all pre-set. All you do is just click and drop it in. The only thing that would have made this like a million times better would be if Access just gave me a catalog.”

4. Use Automation Functions within eForms

One of the biggest advantages of an eSignature Platform is the ability to leverage your EHR’s patient data to increase efficiency. Jenni suggests using automation to leverage your patient data: “Using the functions within the forms will allow you to automate filling in information like the patient's name, date of birth, address, Social Security number, any relevant information that can be pulled from the EHR, automatically. This helps the patient and the staff member save time, and, as I said before, it also helps make sure that the information that is in our EHR is correct by serving as a checkpoint for the patient to review.”

5. Test Your Forms & Use Run Preview

Jenni also advises clients to test their forms. “I don't know how many times I've been online trying to fill out a form and it jumps to the wrong field. Just start at the top and go to the bottom, making sure everything is working as it should,” she says.

“Before Access, I worked with another vendor who had a form preview function that would require you to upload the form live to review, and that same live form could potentially be out in the world for people to use when it is not ready.”

“Within Access eSignature Platform’s built-in Forms Designer toolset is the Run Preview function, which allows you to check your digital form to make sure the entire form is working correctly before going live.” She adds, “The Run Preview is just a part of my forms design process, and I run this preview function hundreds of times before I make a form live.”

 

6. Use the Entire Form Real-estate & Design Within a Single Column

What works on paper, doesn’t necessarily make sense for a digital form. Jenni explains, “If you can keep it all within a single column, do it. Healthcare forms are a little bit tricky sometimes because you want to utilize all your real estate. Be concise.

“It is common for many healthcare forms to be in columns instead of a straight line. But if I can make it in a straight line, I’ll do it on the straight line. And make sure the information is correct because you do not want to get a HIPAA violation fine for having the incorrect information in a patient's medical record,” she advises.

Single Column Design VS. 2 Column Design

 

7. Reduce Risk & Only Get the Information That You Need

Use thoughtful design to eliminate redundancy and eliminate the opportunity for error. Jenni explains, "some patient forms that I have seen in the past or other facility form examples would have the patient's name at the top, the patient's name AGAIN within the content, and then the patient's name on the label. You may not know why there are multiple times, but you know that it increases the opportunity for an incomplete form. So, ask yourself: Why do we need the patient's name in three different places?

“It only introduces the opportunity for error, which could cost you with CMS. If the patient's name is filled out in two spots on the form, and the third spot is not filled out, and this form information makes the medical record incomplete, you can get into big trouble with CMS. It’s also very frustrating for patients to have to complete redundant fields. Therefore, approach form design with a ‘less is more’ mindset but also make sure to work closely with your legal department when considering some of these changes.”

 

8. Use Hard Stops to Eliminate Incomplete Forms & Flag Important Information

“My eForms design mentor taught me how to put in hard stops, and looking back I am so grateful for his insights,” says Jenni. “Our informed consent to treat not only has to have the patient's name on it, but they must either opt-in or opt-out of our patient directory to allow friends or relatives the option to reach the guest after surgery. If they forget this easy-to-miss checkbox, it can create a very stressful situation and upset our patients, their families, and friends. Just imagine, you get out of surgery, your loved one calls, but the hospital won't let you speak to them or give you any information.”

iStock-1296144567Jenni continues, “Well, my mentor taught me how to put in hard stops so if a field I choose is not filled out and they click save, it's going to say, ‘sorry, this section is not filled out and it will direct the patient or the staff member that it needs to still be filled out.

“Another great case use is for a final notice on valuable information being submitted. Bob showed me how to place a hard stop before submitting to offer a second chance consideration with a message like, ‘This is going to be submitted permanently to your Medical Record, are you sure you want to proceed?’

“It so important to me now that when I create a new eSignature form for one of our departments, I refuse to release it until hard stops are in place. It’s 100% necessary now that I know how to do it. I think quality control loves them because all of their stuff is filled out and nothing left it blank when it is routed into the medical record. So, yeah, hard stops are key.”

9. Harness Forms Automation as Your Digital Assistant

“Properly harnessing forms automation is HUGE,” says Jenni, because it allows her to set up, based on the registration information provided, automation to call out what forms they need to complete.

She explains, “When the admissions representative is finished admitting the patient and press enter on their computer to submit, it sends the data through the access servers at our hospital. The Access Servers then read the data and Access Software automatically knows that the patient needs consent to treat, or if the patient needs a race and ethnicity form, if the patient needs a Medicare form, if they need a Tricare form, if they need an injury form. Based on the rules we set up, it already knows what forms the patient needs, and it essentially functions as a digital assistant. The admission representative does not even have to make that decision, the decision is instantly made for them.”

Jenni adds, “It's also super helpful because the paper is not being carried around and the forms are available automatically within the patient record, allowing registrars and clinicians more time to focus on patient care and not paperwork.”

10. Condense Forms & Beware of Multiple Form Variations

Make sure that your organization isn't using multiple forms for the same thing. According to Jenni, this may seem like a lot to ask, but having control of your forms is great “if your hospital is like our hospital, where there are multiple form variations through years of forms collecting everywhere. It’s quite a feat, but the reward of having complete control of your forms is greater. For instance, make sure there is only one consent to treat form across the board. Make sure there is only one template for your informed consent, but the fillables (aka fields) are able to be manipulated. That kind of stuff gives you complete control over what's going out to the patient and what's going out to the staff, so that way you know years down the road which consent form you were using because it’s just one design.”

She adds, “Having the ability to condense forms into single forms versus multiple forms, as most hospitals have done, is very important. Back when we had paper forms, there was a piece of paper for every single step. If possible, you really should condense multiple forms into one single form. For example, surgical consent could also include the pregnancy waiver. Design your form to combine those things so you do not have to have two separate forms. In doing so, all that information is going to be easy to find for the physicians and staff.

“If all of the information is accessible and in one place for the end-user, the physician, the nurse, the tech, whoever, to look at, it makes their life easier for them.

“And at all costs, you want to make eForms easy for the end-user to use because if it's not easy, it will be abandoned and will collect dust.”

11. Design with the User(s) in Mind

When you're designing a form, a best practice is to have the end-user in mind. Jenni tells us, “Whether your form design is for paper forms or digital forms, patient forms are used to convey information to and from the patient or to and from the health care provider, as well as create the legal documentation that you need in place.”

iStock-872291756

According to Jenni, “Forms designers have a major impact on this process. For instance, if a form is hard to use, the end-user will not use it correctly, or worse, they will just abandon it altogether. I have had that happen, and I have learned in my time here that if there are things that I did not think of, the users will simply abandon it and go back to paper. It's very frustrating to watch, but also important lessons to learn. Furthermore, if the form is hard to use, the patient might not use it and lose confidence in the facility, and this can negatively impact the hospital’s HCAHPS Patient Satisfaction scores. However, a highly intelligent form that is properly designed from launch to completion, can speed up the process and make the end-user and for the patient or staff interaction with that form a positive experience.”

Conclusion

The 11 best practices outlined in our interview with Jenni should help you create a digital healthcare form that is easy to use and provides your patients with the information they need. We also included a few tips in this blog to help make sure your eForms are in top shape for user adoption and consistency.

If you have any additional questions or want more information on how to implement these best practices into your own forms, please reach out and let our team of experts assist you.

We want to know, was this resource helpful? Do you have something to add?

Let Us Know

Submit Comments

 

Like what you're reading?

 

Anthony Delabano

Written by Anthony Delabano

With an unparalleled resourceful and systematic approach, Anthony Delabano (A-Train) continually innovates to bridge the gap between marketing and sales. In his free time, Anthony dedicates his passion driven ingenuity to his nonprofit, Foundation45, which gives hundreds of musicians and artists each year, a second chance at life through 100% free counseling services.