In recent months, nurses across the globe have received well deserved overdue public accolades for serving as the front line during our nation's greatest epidemic threat. Without these healthcare heroes' day in and day out service, the world's greatest healthcare system would not work. However, just outside of the trenches, underneath the infrastructure and orchestrated chaos of health systems lies an integral person. An individual role that is so important that if it did not exist, patients would not be able to receive adequate care. We’re talking about the Forms Designer, Horah!! Exciting, right?!
“Forms designer” wasn’t what you thought we were going to say was it?
Well, you may not be jumping out of your seats, but you should be!! If it were not for forms designers, our health systems would not move. Without forms, and more specifically without digital forms in consideration of the recent pandemic, patients would have difficulty receiving care where remote visits have become increasingly necessary, and patient exposure has become a risk. Crowded waiting rooms are a serious concern when it comes to transmitting airborne pathogens and controlling patient throughput has become a top priority for hospitals. The ability to send, sign & receive patient forms contactlessly, remotely and digitally has become a redeeming feature for hospitals controlling patients throughout. Enter Jenni Mihm, an unlikely hero to most, but the prime example of why hospitals cannot live without an internal eSignature Champion in a Forms Designer.
Paper Forms Designer Becomes an eSignature Champion
I had the opportunity to interview Jenni to discuss her unique role recently. Speaking with Jenni was an absolute privilege, and to be honest, a huge surprise since I don’t actually wake up thinking about “what does an eForms Designer do?” Jenni’s vivacious positivity jumped through the phone with infectious laughter – you could tell she is one of those people with the unique ability to disarm any tense situation, which she does day to day working with all the different departments as the primary form designer for Parkview Medical Center. She also walked me through her flexible role, as the Clinical Forms Designer in this day in age and the subsequently adopted eSignature Champion.
As some of you may know, a successful healthcare project usually always starts with a champion. This is an individual who at the onset of identifying a need within the hospital, takes action on the steps to get a project, such as the need for an eSignature platform, into the hands of the decision-makers.
This initial champion is the keystone for constantly keeping a new project in front of the right people, collecting all the information needed, and working rigorously between internal teams, vendors, and a budget timeline to see that the project is successful. But, what happens after an eSignature project has been approved and implemented? Does a successful eSignature program still need a champion for ongoing success and user adoption? The answer is emphatically yes. And this role often finds itself in the hands of an experienced individual who works across departments on their different forms needs and can be found in an array of titles similar to Jenni Mihm’s.
Jenni Mihm had a unique introduction to healthcare starting just after high school in what she thought would be a small job while she attended college. 21 years later, Jenni is still leading the charge in healthcare. When asked about this Jenni makes her feelings crystal clear. “I absolutely love to help people and solve their problems. I started in the Nursing Department early on at the ground level, so I have the unique advantage of having a real-world understanding of how to handle situations when things don’t go right.
Because of my experience, my philosophy is to approach each situation with empathy and understanding because I have been there, and I know the frustrations and anxiety when things do not go as planned. People who know me, probably think of one thing – process improvement. I believe everything should be questioned with the mindset of improvement. We should always look at a process and ask questions like, why do you need to do this? Or why do you do it this way(over and over again) when you've already done it one time?
Exploring better ways to do things is always at the top of my list for process improvement - people are happier if their jobs are easier and we save money. The result is a trifecta!”
Though Jenni’s role has changed through the years, she does remember when processes were largely inefficient because of the broad reliance on paper-based form processes at Parkview. “Prior to being a clinical form specialist, I was on the nursing floors and in the E.R. I was the unit secretary, staffing coordinator, and a PAL which is a physician assistant liaison that followed the doctor around. So, my experience as an end-user with paper was my whole job. It was just awful.”
Life before eSignature & eForms Automation | A Painful Paper Latent Problem
“As an end-user on the nursing floor, I was constantly getting papercuts putting together packets and stuff like that. I am not kidding – it was bad! And, the amount of time it took to put together new patient packets was ridiculous. I would spend a whole shift just putting together packets of consents order forms, patient information, all that kind of stuff just so it was all in one place for the nurse to grab and do a new admission on. I would have to chart the vital signs on paper. I would have to make sure they were in the chart, make sure they were in the right chart.
And, you would not believe how many times the paper would just go missing because it was just on the wrong chart, which is of course a huge HIPAA problem if it makes it to the medical record. As a unit Secretary, my entire job was paper. I would put the charts together, make sure the papers were in the chart. And back then, you would have to manually make sure you had the right paper type, make sure you had the right printed consent form, make sure you had the right forms filled out so that the hospital could be paid properly. Additionally, you would be constantly checking to make sure everything is signed and dated, signed and dated. If it wasn't signed, and if it wasn't dated, we wouldn't get paid, so that was always a huge concern.
When I realized that I could have automatic date and times on the e-signature stuff, oh, my little heart just couldn't take it.
I remember a time when I worked a night shift as a CNA during our downtime, putting together a towering stack of new patient packets on the nursing desk and I'd say to myself, there must be a better way. Then I would line up twenty-five to thirty papers, take out my little finger cot, and just go down the line making these packets for a whole month's worth of admissions - it was awful. But now with Access eForms Platform our forms process is mostly automated, and my past role has become my motivation in my current role as the Forms Designer. And, so many things have been eliminated because it’s electronic.”
What is a Forms Designer & Forms Design?
Forms designers design forms, right? Well, yes (otherwise that’s a rather awkward job title), but there’s so much more value they add that often goes unrecognized – and that is the point of this blog.
For the past 8 years of Jenni’s 21-year experience in healthcare she has become an essential member of her hospital's informatics department, and like many others, has seen the technological advancements regarding hospitals transitioning from costly paper forms and scanning to automated electronic patient intake and a timely informed consent process that eliminates lost forms.
Healthcare has is notoriously slow at adopting change, even if it makes sense financially, but changes that make practical sense are often adopted (ex. Patient electronic signature) over time. With the onset of Covid 19, eSignature, telehealth, digital expansion to reach customers outside the hospital, and eliminating paper scanning which could spread germs, initiated a tremendous surge of interest around digital patient forms and eSignature platform technology. And as you might expect, the role of the forms designer for many hospitals has taken on a completely new direction.
The Role of Form Design in a Post-Pandemic World
As one of the earliest pioneers of the digital health frontier and her ever-evolving role handling patient information within Clinical Informatics, Jenni single-handedly tends to an array of form needs across her health system, “...my job title currently is Clinical Form Designer or Clinical Form Specialist in the Clinical Informatics department here, but the job description is vastly different for each hospital. For my role with Parkview Medical Center, I handle the design and development of all form types, whether that is flatforms that we just print off and give to the patient, information forms, or intelligent forms that have code behind them. For instance, our informed consent has a database behind it, and I literally build all of that in our digital ecosystem. I manage all types of forms for the hospital including consents, protocols, order sets are clinical pathways, any flow sheets, insurance, billing forms, and hospital patient-specific information sheets. I handle catastrophic downtime forms in the event if we lose electricity, or if we have to shut off our entire computer systems.
I am responsible to make sure forms are routinely updated for best practices, guidelines, and aligned with current processes because, believe it or not,
I still find hidden papers and consents outdated as far back as 2009.
So I am constantly circling with different departments and personnel, remembering to ask the right people the right questions like, Do we still need this paper? Is this paper important? Why? Do we have another paper that we're using that is like this? I'm also responsible for the management and maintenance of our Access eForms servers. In this, I make sure that the end users have access to the server and their security groups are all set up. Finally, I manage the end user experience for the Access passports product. Such as our forms needs with our admissions group who uses iPads for capturing electronic signatures during patient intake and stuff like that, as well as like our wound care center. And, I work with our help desk so that the architecture is all-encompassing from the form design to form management, deploying patient information back into the medical records.“
According to Jenni, forms design, in general, is a very blanket term for a multitude of different form types, “Whether it's paper forms or digital forms, forms design is 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. 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 a patient or staff interaction with that form a positive experience."
Life After Paper with Patient eSignature & Intelligent Forms Automation
According to Jenni, “A major feature of a form being digital is that it's already got the patient's name, their address, their phone number, their Social Security, anything that can be imaged from the EHR, which makes the forms process it that much faster and easier for the patient. And then all they have to do is verify, "Yep, that's my correct information." Another benefit is that this visible prefilled information serves as a verification for the patient, wherein they can review and update as needed. I've been sitting at the admission's area, and patients comment, "oh that's not my address anymore." Admissions can then update the information immediately, which helps speed up things immensely.
Back in the old days, the old days, like 10 years ago, a patient would have to physically be there with their chart for the person to see their information. With the Access intelligent form design, if a form designer can get that information collected and processed properly back into the EHR, it can save so much time for everybody involved.
Another example, a physician can be talking to a patient on a nursing floor, have them sign their consent immediately. They used to have to wait for the patient to physically arrive with their chart. Now that it's done in real-time, OR personnel can look at the consent and see the patient as they are looking for the physician's progress notes. This gives them the ability to start their whole checklist of things for surgery before the patient has even arrived, whereas before they had to wait for the patient to physically be there with their physical chart."
What is the biggest impact that you have Experienced with Advanced eSignature Form Design?
“Well, I mean here’s a real-life experience, we had a small change on our informed consent with our prior vendor before moving to Access eForms. I was dreading it because I knew what it would entail. Surely enough, it took me over a month to change all of those consent forms. And when I would have to change them, I would have to touch every single one. Now, Upon a request to change, I can automatically update a few hundred forms all at once. When I realized we could do that, I knew that Access eForms was the right fit and would make huge and costly changes quickly and efficiently. “
“So, on a whim, I automatically updated a few hundred forms all at once. When I when I realized that we could do that, I was like, oh yeah, we need to buy this program yesterday.“
Regardless of whether you are using an eSignature service, a proper Healthcare eSignature Platform like Access eForms, or you still rely on paper forms, a forms designer has a huge responsibility and a significant impact on how hospitals communicate with patients, and we hope following a champion outline of best practices and pitfalls will help you and your health system navigate this ever-evolving digital landscape. Follow us on our next series blog article releasing next week with Jenni Mihm, as she gives you her top 10 Best Practices for Forms Design & Healthcare Forms Design, and the following week for 5 eForm Pitfalls to Avoid.
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