As I pointed out in my previous post on patients filling out forms electronically, it is absolutely essential that your EMR software supports a robust set of preferences for determining which forms a patient should fill out.
Let’s take three example forms to illustrate most of the needed options: HIPAA privacy form, Health History form, Consent for Pap Smear. All of these forms need to be filled out in different intervals.
HIPAA Privacy Form
I think that in most cases, the HIPAA privacy form is something that just has to be filled out one time. Once I’ve filled it out, then I don’t want to have to ever see that form again. What does this mean for the EMR self check in kiosk? That means the computer has to check my account and know if that form has been filled out already or not. Easy enough right. I check in for my appointment, the EMR checks to see if I’ve filled out a privacy form and presents the form to me if one doesn’t exist. No sweat…or is it.
Of course, you can’t forget about the case where the government decides to change HIPAA laws and so now you have to change your HIPAA privacy forms. Let’s assume you change this form on January 1, 2007. This now means that your EMR self check in kiosk needs to now provide the new HIPAA privacy form to anyone who has not filled one out since January 1, 2007. Can this be done? Of course, and it really isn’t that hard. However, it’s an important difference that must be planned for.
Health History Form
How often do you make your patients fill out a health history form? Some may only do it once and then never ask again. If that’s the case, then you can see my comments above on HIPAA privacy form. In our clinic (and I think most others), a health history form should be filled out every year [Emphasis Added]. My clinicians tell me it’s just good practice to get the history if it’s been more than a year, because you never know what else might have happened to them or their family in that time. Is this really possible with a paper chart? Not very easily. However, with a computer it’s no problem.
When a patient checks in for the appointment, the EMR self check in kiosk checks the patient’s notes for the last time they filled out the form called “Health History.” If the form is more than a year old, then the patient is prompted to fill out a new health history form. Of course, we’ve previously set a preference that the Health History form should have be filled out every year. Again, it’s not rocket science, but an important difference from the HIPAA privacy form.
Consent for Pap Smear
This form is even more difficult. Unless of course your EMR is like ours and requires you to use specific appointment reasons when scheduling an appointment. When scheduling an appointment our front desk will choose appointment reasons like Pap Smear, Wart Removal, etc. This makes it easy for the EMR self check in kiosk to quickly check the reason for the patient visit and require patients to fill out forms like the Consent for Pap Smear.
A few other points of note:
Minors: I could easily see an EMR self check in kiosk determining a patient’s age and displaying special minor consent forms for those that are under 18. We’ve solved this problem using conditional questions on our forms which I think I’ll leave for a future post if people are interested. Minors is another good reason to capture the electronic signature as opposed to just using some sort of individually identified login for a signature.
The Unseen Procedure: Often you won’t know if a patient needs to fill out a consent for treatment form until after they’ve seen the doctor. This is obviously a problem since they can’t just fill this form out when they check in for their appointment. We’re still working through this problem, but we’re either going to go with scanning a paper form or possibly some sort of portable workstation with signature pad. I sure wish that UMPC’s were a little farther along. I’ll let you know how it turns out. This could also apply to forms like birth control and the unplanned pap smear.
One thing that’s important to understand is just because you could sign the form electronically doesn’t mean that it’s always beneficial. Does it really matter if you have your consent for treatment or HIPAA privacy form in your EMR immediately? It’s certainly nice, but it’s not like someone’s going to go looking for it in the EMR the next day to see what was done. The EMR notes contain the time sensitive information. As long as it’s eventually scanned into the EMR, then some forms can wait. Of course, don’t forget to weigh the cost of scanning to the cost of signing it electronically.
In the end, there are a bunch of business and operational decisions that are required to make using an EMR self check in kiosk work properly.