The process of setting up a new pain management clinic has allowed me to critically consider the role of patient intake forms, an area that has traditionally been ignored by technological advances and institutional innovation.
Health care must empower patients to conveniently complete intake forms digitally — whether at home, en-route to our clinics, or in our waiting rooms. When done correctly, the forms can greatly enhance the patient experience by empowering our patients and improving our workflows.
Intake forms are inconvenient for patients
My perspective on intake forms was underscored this year when I became a patient of a clinic at a top-10 ranked hospital by US News & World Report. Prior to my visit, the clinic emailed me a poorly scanned eleven-page patient questionnaire with instructions to print and complete the form prior to my visit. Like many, I lacked immediate access to a printer.
After showing up to my appointment without the form, I was expected to complete it in the clinic’s lobby. As a returning patient of this health system, most of the information asked was already available in the electronic health record (EHR). Did they really need to ask me about my city of birth again? What is already known in the EHR should populate onto our forms so that patients are only asked about information that needs updating.
Many patients with complicated medical histories travel between clinics with stacks of medical records and medication bottles, attempting to transfer their data through analog processes in an increasingly digital world. They are then asked the same questions again and again by their nurses and providers once in the examination room. Patient fatigue from this repetitive process can lead to incomplete and neglected intake forms.
Intake forms are difficult to understand
Another issue is the inability of most systems to provide documents that are understood by our diverse patient populations.
There should be functionality to see video-based explanations of the information that they are being asked. Intake forms often include consents about critical issues such as financial burden and data privacy, but are worded in language that many patients don’t understand.
This problem is exacerbated for those who do not speak English as a first language. Ensuring that our patients understand these forms will help them achieve greater autonomy.
Intake forms are not used effectively by providers
Paper forms are often lost or filed immediately so that they are never seen by physicians. Redundancy is a theme, with clinics requiring nurses to ask many of the same questions and then type the same information into the EHR.
This is a waste of time and resources. Every time there is an intermediary between what the patient wants to communicate and the physician — such as a nurse transcribing handwritten forms into the EHR — there is room for error. I can think of many instances when crucial medical information that was disclosed by patients on their forms was lost when being translated into the EHR.
These forms also cause significant delays, so providers sometimes ask their patients to leave forms blank. Delays could be reduced by allowing patients to complete or update their forms digitally prior to their visits.
What these forms can mean when done correctly
As a physician, I believe that the intake form is more than simply a formality. At its core, the information serves as an impartial baseline of the patient’s chief complaint. It helps guide us during the intake process, identify crucial medical information such as allergies, and even gives the provider a chance to investigate the patient’s pertinent history prior to entering the examination room. These forms can also help health systems promote preventative health, with screening tools that have already been validated for conditions such as breast cancer and depression.
The forms can further improve patient care by obtaining routine medical information before the visit so that providers can spend their time conducting a tailored examination and discussing potential treatment options. Providers can even pull the responses from digital intake forms into their medical notes to auto-populate the chief complaint and symptoms.
In a pain practice such as mine, these forms play a particularly important role since they help guide the patient interview which can sometimes be complicated by complex psychosocial factors. In past pain practices, I have often found the information asked by these forms inadequate. We need to use predictive analytics so that a patient with facial pain is not asked primarily about back pain.
Existing solutions and the future
There are a few medical technology companies tackling these issues by using digital forms accessible from any computer, tablet or phone, so that our patients can fill out this information in their own time and native language. The forms employ predictive follow up questions and synchronize with the EHR so that patients are prompted to complete only information that needs updating. Some of these companies even provide educational content to give patients context on the questions that they are being asked and the consents that they are signing.
I have seen first hand how competitive the health care landscape can be. These technologies can save our providers valuable time, and through predictive analysis and reduced human error greatly increase patient outcomes and satisfaction. I plan to provide the best patient experience possible by starting at the very first encounter — through the intake process.
Koorosh Joshua Elihu is an anesthesiologist and founder, SureConsent.
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