It’s time to upgrade the outdated intake forms at healthcare clinics
By Koorosh Joshua Elihu, M.D.
The process of setting up a new pain management clinic has allowed me to plan each part of a practice thoughtfully to enhance the patient experience. For many practices, the first point of contact between patient and provider is the intake form, an area that has traditionally been ignored by digital advances and institutional innovation. Healthcare must empower patients to conveniently complete their intake forms digitally — whether at home, en route to our clinic, or in our waiting room.
To ensure the highest form of patient satisfaction, clinicians must offer patients short wait times and first-rate facilities. The way that many of us currently deal with the intake process is in direct opposition to this. Traditional intake forms are often burdensome, redundant and difficult to understand for patients. Perhaps more importantly, they are also underused by medical providers.
These forms contain important information about the patient’s chief complaints in their own words, identify crucial medical information and align expectations. If done correctly, they can greatly enhance the patient experience by empowering our patients, increasing their satisfaction and improving our workflows.
Intake forms can be inconvenient for patients
My perspective on the importance of intake forms was underscored earlier this year when I became a patient of a clinic at a hospital that is consistently ranked in the Top 10 by US News & World Report. Prior to my visit, the clinic emailed me a poorly scanned eleven-page patient health questionnaire with instructions to print and complete the form prior to my visit. Like many, I lacked immediate access to a printer and I may have forgotten to bring the completed form with me even if I did have a way to print it.
After showing up to my appointment without the form, I was then expected to complete it in the clinic’s lobby. As a returning patient of this particular health system, most of the information that they were requesting was already available in the electronic health record (EHR). Did they really need to ask me about my city of of birth again? What’s already known in the EHR should auto populate into our forms so that patients are only asked about information that needs to be updated.
Many patients with complicated medical histories travel from clinic to clinic with stacks of medical records and medication bottles, attempting to transfer their patient 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 exam room. Decreased patient satisfaction and increased patient fatigue from this strenuous process may lead to incomplete and neglected intake forms.
Intake forms can also be difficult to understand
Another issue plaguing the intake process is the inability of most systems to provide documentation that is universally understood by our diverse patient populations. Most forms I’ve seen are only in English or Spanish, leaving patients who don’t speak these languages unable to complete their forms. In these cases, a family member or member of our staff may help fill out the forms, but this detracts from the original purpose of the intake process — to receive the chief complaint in the patient’s own words. Intake forms need to be made available in all languages with matching data fields between languages that allow providers to review this information in English.
For patients who are filling out the forms on their own and need clarification, 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. Ensuring that our patients understand these forms will help them achieve greater autonomy.
Providers may overlook intake forms and find them wasteful
I am aware of additional significant logistical problems related to our current intake process. Importantly, many of these paper forms are filed immediately and never seen by physicians, only glanced at or even lost. Redundancy is a key theme, with clinics requiring nurses to ask many of the same questions and then typing that same information into the EHR. This is a waste of time and resources. Every time there is a 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 intake forms was lost when being translated into the EHR.
These forms can also cause significant delays. Providers in larger clinics with standardized intake forms become so frustrated by these delays that they sometimes ask their patients to leave the forms blank. Delays could be reduced by utilizing the information that health systems already have in the EHR and by allowing patients to complete or update their forms digitally prior to their visits.
What these forms can mean to our practice 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 nursing during the intake process, identify crucial medical information such as allergies and medications, and even gives the provider a chance to investigate the patient’s pertinent history prior to entering the exam room. These forms can also help health systems strengthen preventative health, with screening tools that have already been thoroughly validated for conditions such as breast cancer and depression.
The forms can also improve patient care by obtaining routine medical information before the visit so that providers can spend their time conducting a tailored history and physical exam and/or discuss potential treatment options. Providers can even pull the responses from digital intake forms into our 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 worked at 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 in their native language. The forms employ predictive follow up questions and sync with the EHRs so that patients are prompted only to complete 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 healthcare 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, and I plan by starting at the very first encounter — through the intake process.
Koorosh Joshua Elihu, M.D., recently completed his fellowship in Pain Management at Cedars-Sinai Medical Center. He is a founder of SureConsent and also works as an anesthesiologist at Harbor-UCLA Medical Center.