Case Study

Hilo Medical Center

Hilo Medical Center (HMC) is the largest facility in the Hawaii Health Systems Corporation and is Joint Commission-accredited. Established in 1897, HMC has grown from a 10-bed hospital, erected by the Hawaiian Government, to the present facility of 276 licensed beds, consisting of 142 acute-licensed and 22 skilled-nursing beds, including a 20-bed psychiatric unit, a separate 112-bed licensed extended care facility, numerous specialty clinics and an accredited home care agency. Learn more at

As Hilo Medical Center progressed through the stages of the HIMSS EMR Adoption Model, the hospital looked for new software that would remove paper, improve patient engagement and automate processes. The leadership team realized that while many areas had transitioned from paper-driven to electronic workflows, patient registration still required patients to apply ink-on-paper signatures to hard copies of consents. With HIMSS Stage 7 attestation fast approaching, Hilo looked for a better way forward and selected enterprise forms management software from Access.

“One of the primary goals of our EHR project is eliminating as much paper as possible, and we chose Access to help us do this in those workflows that our other systems hadn’t automated,” said Hilo CIO Money Atwal. “The ED was mostly paperless but consents weren’t, and that’s where Access electronic signatures came in.”

One of the challenges of the electronic signature deployment was the time frame. With the Stage 7 assessment just six weeks away, Hilo worked closely with Access’s professional services group to deploy e-signatures on the hospital’s Wacom tablets.

“Our six-week implementation goal was aggressive, but Access was up to the task,” said Kris Wilson, Regional Director in Hilo’s Project Management Office. “Their project manager was responsive, knowledgeable and did what was needed to beat the deadline.”

New software deployments only can be successful if users embrace the technology. Wilson says that has certainly been the case with ER staff members and Access.

“Registration is a high-turnover area, and the fact we’ve heard no complaints about the Access system is a testament to its ease of use,” Wilson said. “We’re also finding the solution to be low maintenance from an administrative standpoint.”

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Streamlining the Consent Process

Prior to using Access, patients signed hard copies of consent forms when they presented to Hilo’s registration desk. These were then put into a paper chart and scanned into the patient’s electronic health record (EHR), a time-consuming, error-prone process. Now the patient simply applies electronic signatures to an e-form via a Wacom signature tablet, and the forms go directly into the correct place in the patient’s EHR. A similar process in the ER has improved patient flow for same-day surgery and other short-stay patients.

“We’ve got the second busiest ER in Hawaii, and so stopping patients at the desk to fill out and sign paper forms was a real issue,” Wilson said. “With Access e-signatures, shortstay patients can sign electronically right at the bedside, meaning they get the care they need without being slowed down by paperwork. The Access system also saves time for the HIM team as the consent goes right into the MEDITECH EHR.”

Another advantage is that at the end of each day, the Access system generates a report listing any consent forms that are missing patient signatures. This makes it easy for Hilo staff to quickly and proactively collect the authorizations.

“With the Access system, we know we’re collecting all the patient signatures on consents that are required for billing,” Wilson said. “This is helpful from a revenue cycle perspective and also helps with auditing.”

Meeting HIMSS Stage 7 Goals and Reducing Risk

One of the key requirements hospitals must satisfy to reach Stage 7 of the HIMSS EMR Adoption Model is getting data into patient records quickly and showing that there is a standardized method for doing so. As Hilo moved from Stage 6 to Stage 7, Access’s e-forms and e-signatures software was an important part of the process.

“During the HIMSS Stage 7 assessment, we showed the old paper consent form, and then pulled out a Wacom electronic signature pad to show how we’ve gone paperless with Access’s solution,” Atwal said. “Access has made our journey to Stage 7 a lot easier.” 

One of the benefits of moving from ink-on-paper signatures to electronic versions is that it’s easy to know exactly when e-forms residing in the content management system were signed and dated. Hilo put this to the test when a woman claimed that the electronic process did not prove that she had signed a consent form. The hospital’s IT team quickly produced the electronically signed time and date stamp, showing beyond a doubt that she had authorized the document.

“Access’s electronic signatures protect us from a liability standpoint because if there’s ever a legal proceeding, we can prove that a patient signed consents and when they did so,” Atwal said.

Achieving Fast ROI and Other Benefits

When Hilo first started its e-forms and e-signatures project, Atwal said that the main goals were removing paper and improving patient engagement. However, since the solution was implemented, Hilo has recognized a third significant benefit.

“As patients are electronically signing the 44,000 consents we generate each year with Access’s system instead of authorizing hard copies, we’re saving around $200,000 a year just for one form,” Atwal said. “Ninety-eight percent of patients don’t want the paper copy, so that’s another paper savings.”

To achieve even greater cost savings and efficiency, Hilo will soon convert another type of consent form to an electronic version using Access’s E-Convert tool. The hospital has already eliminated much of its paper, and Atwal believes that this next phase of the e-forms project will make a big dent in the remainder.

“Our consent form accounts for about 80 percent of the paper that’s left in the hospital,” he says. “Managing this document in Access’s e-forms system will not only deliver cost savings, but will also advance our green initiative.”

Another benefit of using Access e-signatures for consents is that it will help support Hilo’s policy for physicians and patients signing forms at the same time. Hilo also plans to expand its paperless forms initiative to include utilization-review and change-of-service documentation required by the State of Hawaii. Atwal believes that his team will continue to grow the solution throughout the hospital.

“We came to Access to solve a specific issue: getting rid of paper at registration,” he said. “Now that we’ve seen the flexibility of the system, we can go after other efficiencies.”

Enhancing User Adaption with Seamless Integration 

As it looks to further improve patient care and service through technology, Hilo will continue to use Access software alongside the latest version of its HIS platform.

"As we upgrade to MEDITECH's web-based EHR, we're looking forward to the continued efficiencies with integration of Access's system," Atwal said. "We need our applications to be integrated because our patient flow is integrated, and that exactly what we've achieved with Access and MEDITECH. The tight link between the systems makes things easier for all our users."


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“As patients are electronically signing the 44,000 consents we generate each year with Access’s system instead of authorizing hard copies, we’re saving around $200,000 a year just for one form. Ninety-eight percent of patients don’t want the paper copy, so that’s another paper savings."


Quick Facts

Location: Hilo, HI

Integration: MEDITECH

Focus: Paperless EHR and consent forms 

Departments: Emergency, registration, HIM

Access solutions: Intelligent eForms, Electronic Signatures, Process Automation and Enterprise Integration


Replacing paper consent with electronic version saves $200,000+ annually.

Fast, automated process speeds admissions and care delivery.

eSignatures help Hilo successfully attest for Stage 7.

Clinicians and patients apply eSignatures at the same time, enforcing standards.

Completed consents are sent directly into the EHR with no user intervention.