Mobile Forms: an indispensable tool in Healthcare

Introduction

For decades, hospitals have relied on paper forms to keep track of patients’ registrations, symptoms, consent, and questionnaires. While practically all other medical devices and tools have developed and modernised with the times, the shift from paper-based forms to mobile forms in healthcare is a necessary evolution yet to occur.  

Despite the growing availability of electronic medical records and online data collection software, it seems that a paperless world inside hospitals is still far from reality.

In this article, we will discuss the reasons behind the continued widespread use of paper forms in hospitals and why mobile forms (iOS and Android based) are an overdue and indispensable tool in healthcare.

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Healthcare’s attachment to pen and paper

Much to the disdain of healthcare professionals, paper medical forms remain the norm in the majority of healthcare institutions.

Printing forms, having patients fill them in and sign them, copying them, scanning, replacing old versions with new ones - the list goes on and on, and so does the time taken to do it. This, however, is the way it has always been. The reduced upfront costs, ease of use of a familiar format, and physical form factor of paper and pen ensure that these forms retain a special place in the hearts of physicians.

However, these conveniences should not overshadow the more long-term issues of paper forms. Namely, storage is not scalable; and all these physical records require space with often limited security; space that many hospitals cannot spare. Backups would further require scanning and copying, and storage at a different location; time and capacity that for many institutions is just not realistic. Moreover, inconsistent layouts, no clear audit trails and version history, can lead to much frustration when following a patient's medical progression.  

Nevertheless, the transition from “good-old and trusty” pen and paper to “new and unknown” electronic data forms has been a slow and hesitant change for a large part of healthcare. But why?

The industry argues the shift from paper to Electronic Data Capture to be a costly, time-consuming, and complicated process that often requires expensive technology not currently in-house.

Long story short, the motto “if it ain’t broken, don’t fix” remains as the persistent mindset when it comes to paper forms. The expected investment in time and money is, therefore, often regarded as “too high” for the potential benefits of mobile data collection.

Not only that, but completely digitalising the medical workflow is an endeavour few hospitals and physicians are eager to undertake. 

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The problem is that at times we are expecting quite a lot from those using the technology.  Most times the users are not specially trained data collectors or research assistants, commonly found in research interventions. In international health programmes, the users are largely clinical service providers.

There often isn’t time to undertake lengthy user training, nor to assess ability before or after. 

In an extraordinarily complex, knowledge-intensive industry such as healthcare, however, paper forms cannot keep up with an increasingly data-driven world at a sustainable cost of the process. We are only now understanding the intricacies of various disorders (and viruses) and developing the tools to record and analyse these. These are tools and systems that require more than fast handwriting and a locked storage room. They require automatic data collection, validation, analysis and feedback. 

These issues with paper-based medical forms is, however, not constrained to within the walls of a hospital. Clinical research similarly suffers many of the same difficulties of pen and paper when working in the field. These data collection methods still rely heavily on a clipboard, physical interaction, and a functioning scanner. The danger of misplacing any type of medical forms, consent forms, or examination forms could thus be catastrophic for any clinical or field study. The evolution towards mobile forms as a new method of data gathering in research is offering a cheap, efficient, and safe alternative. 

Mobile forms: The next evolution for EHR

The digital age has empowered a revolution for how we collect, store, and share medical records.

Previously paper-based forms, such as patients’ demographics, progress notes, problems, medications, vital signs, past medical history, immunisations, laboratory data and radiology reports, can now be completed digitally.

This electronic data, extensive and immediately accessible will enable providers to make better decisions and provide better care. Electronic health records (EHR) are the next step in the continued progress of healthcare that can strengthen the relationship between clinicians and their patients.

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This progress is propelled forward through the widespread use and user-friendliness of daily electronic devices such as mobile phones and tablets.

4 benefits of using mobile forms in healthcare:

1. Accessibility: Making data entry user-friendly

These can ensure that everyone has access to a digital pen and paper. Not only does this generate legible universal handwriting, but it also allows the user to personally adjust the size, zoom, and even language of their “paper”. These forms can be filled in with your fingertips, saved, copied, and shared within a matter of seconds. A process that previously required a lot more time, physical input, and contact. 

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2. Time: Enabling time-sensitive data collection

Many health records or medical forms must be filled out in a timely fashion or at a particular moment. With the ability of notifications and reminders as a standard option of mobile data forms, a patient or participant can be reminded (or re-reminded) automatically by the system.

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3. Mobility: Allowing for bedside data entry

The status quo for collecting data at the patient's side is with a pen and paper clipboard. The data must then be transcribed to an EHR or a spreadsheet for analysis. Mobile forms allow healthcare staff to input data digitally right at the patient's side.

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4. Data validation: Cleaner and higher quality data

With the addition of data validation options, healthcare practitioners and researchers can ensure the forms are filled in correctly and entirely, reducing the need for checking errors and manual data cleaning.

Storage, sustainability, and security of mobile forms

With the further development of cloud storage, a way of storing data on the internet, physical limitations on safe storage space are no longer a concern.

At an average cost of 0.021 $ per GB per month using Amazon web services, for example, exponentially storing data digitally is a cheap and sustainable alternative to conventional filing cabinets.

Why should sustainability be an issue in healthcare? And why should we care? The billions of papers, forms, and folders produced yearly takes an incredible toll on the environment. Digital copies of these electronic health records could, therefore, substitute the use of paper, making the use of conventional paper-based forms obsolete. Based on the estimates of the US health insurer, Kaiser Permanente, this substitution from paper to digital could lead to a savings potential of over 21,000 tons of CO2. Digital technologies, however, also incur costs as they require devices and infrastructure (such as data centres), which consume energy and create waste. The emission from these, however, are far lower than those involved with the carbon footprint from paper waste. 

Furthermore, digital health solutions and mobile data collection can also contribute to the implementation of the UN Sustainable Development Goals (SGDs). Specifically, Goal 12: Ensure sustainable consumption and production patterns.

The earlier and more widespread use of these digital solutions in healthcare may promote the development of more innovative services and products.

This advancement simultaneously ensures stricter regulation and security for sensitive data. 

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While EHRs have increased the efficiency and quality of healthcare services, the security and protection of health data remain the priority.

The General Data Protection Rules (GDPR) aim to assure the safeguarding of patients sensitive health data. Nevertheless, one study noted that roughly 90% of healthcare organisations experienced a data breach in the last two years.

Due either to a hacking/IT incident (111,812,172 cases), improper disposal (82,421), loss (47,214), theft (740,598), and unauthorised access (572,919). These shocking numbers do highlight the need for increased security features to ensure sensitive data is safe.

These features include data encryption, (both at rest and in transit), audit trails, access management, session timeouts and passcode locking, as well as data backups. More on these security features can be read here: https://www.teamscopeapp.com/mobile-data-collection-guide/how-to-keep-sensitive-data-secure-when-using-mobile-forms.  

On paper (excuse the pun), electronic questionnaires seem like the panacea for data collection forms in healthcare.

However, inadequate quality information and gaps in software functionality can also pose some new risks to patient safety. Of the former, there are no standard use cases for mobile apps, and so the implementation of information and communication services is left to the developers.

The NICE guidelines for digital health technologies do distinguish broad categories of functionality; however, their application is often still based on the preference of individual apps. With further restrictions through the GDPR, developers are forced to prioritise user security and safety when creating data collection software.

No internet connection? How to collect medical forms offline. 

Healthcare is of global importance, made safer and more productive through digital changes. However, the developing world is still far from the levels of connectivity that the developed world has reached. More than 4 billion people have no access to the internet in over 20 countries.

Granted, paper forms work just as well in offline and online settings; however, the disadvantages of pen and paper remain.

Those disadvantages being mainly the lack of instant validation, analysis, and secure storage which mobile data collection provides.

Through the development of electronic data capture applications such as Teamscope, we can store data temporarily in the memory of a smartphone, tablet or iPad, and once an internet connection is available, upload it to a server. This allows us to take higher precautions with our data while still benefiting from the expansive capabilities of the mobile devices.

For more information on quality data collection methods when working or researching in offline environments: https://www.teamscopeapp.com/mobile-data-collection-guide/how-to-capture-data-when-offline-or-without-internet-connection

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Using mobile reminders for patient follow-up

During these difficult times of COVID-19, the motto goes “the less contact, the better”. The beauty of mobile data forms is that they no longer require a physical interaction for the healthcare professional to get a patient's information.

Waiting rooms can become digital; a patient can fill in a mobile patient form with the necessary information before even going to the hospital, or fill it in from the safety of their home.

These can be shared effortlessly to the physician or nurse who no longer has to decipher any handwriting or make copies. At their fingertips, these healthcare professionals now have all the necessary information they need without any unnecessary contact.

After the appointment, this contact-less communication can extend to patient follow-ups. A physician can send further medical forms to be filled in at predefined time points, using reminders to prompt patients in a time-specific manner.  

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Giving patients a voice

By filling in mobile forms, from their own devices, patients also feel more in charge of their health. They have the freedom to fill in their information or sign medical consent forms, in their own time, and with more privacy than in a waiting room. The health data collected can also be specific for a patient, these Patient-Reported Outcome Measures (PROMs) are a fundamental tool for understanding the before and after of a patient and putting their needs and preferences at the centre of their care. For more information on the use of smartphone-based PROMs in research and healthcare, you can read: https://www.teamscopeapp.com/blog/using-smartphone-based-proms-in-quality-of-life-research

In light of the recent pandemic, patients and patient-specific monitoring of vital importance. With symptom trackers and case-report forms, securely collecting and sharing accurate data on COVID-19 progression helps not only the healthcare professionals but can assist overwhelmed health care systems in planning and distributing vital and inadequate resources.

Identifying risk-factors and precarious deterioration in an outpatient or home setting is invaluable during this time. 

Conclusions

The evolution of digital health technologies, and specifically mobile data forms are proving to be an indispensable tool in healthcare.

The continued reliance of many medical institutions on paper forms is based on short-term economic safety, yet patients and healthcare practitioners pay the price for lost forms, lost time, and lost efficiency.

The shift from purely online data collection towards mobile data forms instead, encourages greater usability, accessibility, and reliability in the healthcare and research sector. The sustainable benefits that accompany this transition, both logistically and environmentally, pave the way for a more transparent and green healthcare sector.