Introduction

This guide is to assist form creators, physicians, and administrative staff, with creating, editing, and distributing forms. This guide offers best practices on how to create and update a form, and whether or not a form is needed, and how to support the update process.

WorldOSCAR.org has been recognized as the source of truth for all OSCAR eForms. After creating or updating an eForm for OSCAR EMR, store it on WorldOSCAR as the primary means of distribution. See WorldOSCAR to upload your eForm.

Considerations Before Starting a Form

Before you begin creating or updating a form, use the information below to help determine if a change is necessary. Creating or updating forms impacts multiple peoples, form users, form recipients, patients, and EMR vendors, try to only take action when needed.

Consideration

Description

Need for another Form?

Identify the problem(s) with the form and consider if a change will solve the problem. Adopting new forms will add workload to EMRs and clinics. Create/update forms sparingly and explore which forms are already available in EMRs, or if EMRs have functionality which could be leveraged in place of a new form.

For what Benefit?

Consider who will benefit from a new form, and verify that they want/need a new form. Forms should be valuable, practical, and meaningful for the user.

Limited Changes

Change only what is required to resolve the problem to limit scope and reduce frequency of updates. The frequency and degree of change will impact how long it takes to adopt the new form.

Contact Email

Provide form users with a method to communicate with form creators. In the form, clearly identify the appropriate email contact within your organization to send questions and feedback.

EMR Lead Time

Engage with the EMR vendors early in your process to account for the EMR lead time needed to develop your form. EMR vendors have limited resources.

Impact

Changing forms will impact form users and workflow. Will training be required and who will provide that training? Plan for the training if it is required. 

Engaging Form Users

Engage with the admin staff and physicians for feedback to validate the new/updated form. Feedback can provide valuable information to improve the effectiveness of your form. Gather this feedback early in the process.

Budget

Ensure there is a business case for the form changes, consider the costs which could be incurred, and identify a source of financial backing. Consider the time-cost of a new form as compared to the time-cost of not having a new form, and if it offers a time-savings. Planning for the costs associated with a new form ensures you can successfully roll it out. 

 

Form Layout and Content Guidelines

These recommendations can be used to improve the structure your form, but they are not hard and fast prescriptive rules. Use best practices insofar as they are not onerous to your organisation. An example of a form which was edited to improve its quality can be seen Appendix A of this guide.

Item

Details

Example

Filename

Be consistent in the structure of your filenames to avoid confusion on the purpose of the form. Structure your file name to best suit your organisational needs, including details such as organisation, title, date, and version.

e.g., WSIB-FORM8491020200301-v2

Use the standard date method in your filenames and throughout your forms to be consistent. 

e.g., YYYYMMDD, 20200301 

Form ID

If the producing organisation uses form IDs to organise their forms, include a form ID.

e.g., Form ID: 4910

File Size

Keep the file size less than 1 MB if possible, larger file sizes can cause slow-downs in the EMR.

e.g., Avoid using unnecessary text and graphics

Form Logo

Keep the dimensions of logo/image small to decrease the form size, and place them in the top left of the form. 

 

Form Title

The form title should clearly express the form purpose.

e.g., Medical Imaging Requisition

You do not need to include the word ‘form’ in your form title. 

 

If relevant, include the facility/clinic name, service provided, and conditions being treated in the title or subtitle.

 

Versioning

Add a version number to forms to keep track of the most current version. 

e.g., v1.2.0, or v12

Add the last updated date to forms. 

e.g., Updated 20200301

Add an organisation contact email to the form.

 

 

Item

Details

Example

Footer

The form version number/ID should be included in the footer.

 

If the form will not be stored on the central repository, include a URL of where to acquire the form from.

e.g., A PDF copy of this form can be found at…

Page numbering should include the total number of form pages. Try to keep forms limited to one page. It is recommend keeping page numbers on the right side of the form. 

Page 1 of 3

Page Size

Use standard letter page size, many practices may not have the ability to print legal (or other) page sizes.

251.9 x 279.4cm (8.5 x 11”)

Margins

Keep margins small, but ensure there is enough space for a three-hole punch if needed. 

2.54cm (1”) for three-hole punch and 1.52 (0.6”) for narrow margins

Form Disclaimer

If your form requires a disclaimer, keep the disclaimer within the bottom margin, or footer. 

 

Labels or Barcode

If a label or bar code is expected to be used by your organization, leave enough space for them and be consistent with that space between forms.

 

Font Type

Use a single common font per form and remain consistent with the font type. Consider using Arial as the font for your forms for ease of use and readability. 

 

Font Size

Consider selecting a standard size of text for different text elements (such as titles), and remain consistent to those selections. Do not use font sizes over 18 to ensure enough space for other details. Do not use fonts smaller than 9 in your form body to keep it readable. 

e.g., set all titles to size 16, all subtitles to size 14, segment headers either size 14 or 12, body text to size 10, and header and footer text to size 8

Formatting 

Use formatting (such as bolding) sparingly. When used, select a standard for use and remain consistent.

e.g., use italics for descriptions, use bold for critical information, and use ALL CAPS for titles and headers

Consistent Patient Details

Keep the patient demographic details and structure consistent between forms. For an example of this structure, see Appendix A of this guide

Key patient details: Patient Full Name, Date of Birth, Personal Health Identification, Email, and Primary Contact Number

Consistent Provider Details

If including provider details, keep the content and structure consistent between forms. 

Key Provider details to consider: Provider Full Name and Provider Billing Number

 

Item

Details

Example

Consistent Detail Placement

Keep the detail placement consistent. Place the patient details in the top left area of the form, and the provider details in the top right area of the form.

 

Mandatory Segment 

When building a form, only include segments (such as patient details or clinical information) as needed.

 

Mandatory fields

It is best practice to only include mandatory fields necessary to complete the form to reduces the number of clicks for completion. 

Form users report higher satisfaction on forms with fewer clicks/actions to take.

If your form is not limited to mandatory fields, use an asterisk to mark mandatory fields. Include explanation in footer as to the purpose of asterisk.

Red text can also indicate a mandatory field, but does not transmit well over fax. 

e.g., Patient Address *

If using optional fields use (optional) to indicate the optional field; subscript (optional) to further differentiate it from the field text. 

e.g., Religion (optional)

Fax/Print Friendly

It is recommended to use greyscale only, if using colour be aware the recipient may not receive it. Keep the background white, and use dark graphics sparingly.

 

Avoid highlighted text and shading as it does not transmit well over fax/print. 

 

Avoid fine lines or fine logos which can be distorted over fax/print.

 

Avoid small text or images which can become unreadable over fax/print.

 

Keep the original form as high quality as possible, avoid using scanned material or pictures. 

 

Consolidate Supporting Information

If space is limited, consider consolidate supporting details (patient, maps, instructions, clinic location, etc.). Put this information on a separate page or document.

 

 

New Form Files

Create a new form from a PDF or Word document. Keep this file unlocked for easy access when working with others.

Unlocked forms are easier for EMR vendors to work with.

 

Electronic Form Suggestions

Not all functions raised in this segment may be available on all EMRs. Work with your EMR vendor to identify available form functionality. The definitions of terms used in this area can be found in Appendix B. An example of an updated form can be found in Appendix A.

Some fillable electronic forms have all fields entered manually (e.g., editable PDFs) while some automatically populate fields with details such as patient demographics. Auto-populating fillable forms save time and increase accuracy. They are stored within the EMR to access the information.

When creating or updating electronic forms, consider the amount of mouse clicks it will take to enter the information. Physicians and administrative staff will save time and respond more positively to a new form that requires less clicks.

Use the suggestions below as best practices not as prescriptive rules.

Item

Details

Example

Consistent Field or Control Size

Keep the size of your fields and controls consistent within and across forms. 

 

Auto-population Data

Consider what kind and the amount of data you want to auto-populate, how that data will display, and if that data is needed. 

e.g., if auto-populating in a medication list, consider which parts of each medication should auto-populate- Name, DIN, Dose, Frequency, etc..

Checkboxes

Use checkboxes for a declarative statement such as ‘Patient is Pregnant’ or in a multiple-choice scenario with one or more possible selections, such as a list of chronic diseases experienced by the patient.

 

Radio Buttons

Use radio buttons in a multiple-choice scenario with only one possible selection, such selecting a referral facility from a list. 

 

Dropdown Menus

Dropdown menus can be used to keep a list of selectable options hidden unless needed.

e.g., a dropdown list of facilities to refer the patient to instead where the form user can select a facility.

 

Item

Details

Example

Lookup Text Boxes

Lookup text boxes allow a form user to make a selection from a table of data, such as looking up a drug from your drug database.

e.g., a lookup text box can link to the list of cardiologists and allow the form user to search for, and select, one of them.

Functional Buttons

Buttons can be used to trigger other actions, such as opening a different form, sending the form for eFaxing, or to automatically print the form when it is saved. 

Buttons are flexible tools, the actions performed can change depending on need.

Mouse Over Text

Mouse over text can display suggestions, hints, or additional details. These can be useful if those text details are infrequently used/only used as reminders. 

This text appears when the user moves the mouse cursor over areas of the form which include mouse over text.

Field/Control Space Requirements

Provide enough space for the expect amount of text being entered, but not excess amounts of space which will not be used. 

 

Avoid Bulky Structure

Avoid using large, bulky content structuring such as columns, tables, and segmented fields. Electronic forms can display the same information in reduced space. 

e.g., a segmented field for a patient PHN where each number is given its own field.

Default Control/Field State

Form controls can be set to a default state other than empty; helping speed up a form’s completion. Set a default control state based on the most-used outcome. Be aware of how this data will be used after the form is completed and if there are patient privacy or safety concerns from over sharing unneeded details. 

e.g., a form with a ‘bill to OHIP’ option which is selected the majority of the time.

Calculations and Algorithms

Forms can include calculations and algorithms which generate an equation output. Use calculations to help reduce the amount of human entry and human error in a form.

e.g., if the form is a patient questionnaire, it can be set to automatically calculate the final patient score based on entered values.

Linking to EMR Data

Completed fields in forms can be saved back into your EMR as discrete data. Be explicit on how the form fields should be stored in the EMR. Will you need this information later? 

e.g., if the form collects information on a patient’s blood pressure, state that the form blood pressure should connect to the EMR blood pressure observation. 

 

Conclusions

We hope you’ve found this guide and its best practices useful. If you have further questions, or would like additional assistance on creating or updating forms, contacting or working with EMR vendors, or engaging with form users for feedback, please contact This email address is being protected from spambots. You need JavaScript enabled to view it..

Appendix A: Example of Updated Form and Form Update Process

Here is an example of a doctor-friendly form:

The next step for this form would be to make into an auto-populating fillable form in EMRs so it can leverage the stored clinical, demographic, and contact information; further reducing time to completion.

Consider the complexity of your form when transforming it paper/PDF or PDF fillable into an auto-populating fillable form. If the form is straight forward, providing general guiding statements is generally sufficient. Use best practice statements such as:

  • All text fields should allow alphanumeric entry
  • All fields should be editable by the form user
  • Auto fill all form controls and fields where possible
  • All form dates should be in

YYYYMMDD format

  • All form data stored discretely and linked to the appropriate terms where possible.

Appendix B: Terminology  

  • Alpha/Alphanumeric/Numeric: Alpha, Alphanumeric, and Numeric, describe which kind of characters will be permitted in any particular field or control. Alpha specifies only letter characters (ABC); Alphanumeric specifies letters and numbers (ABC123); Numeric specifies only numbers (123).
  • Automatic Population (Auto-populate or auto fill): Auto-populate, or auto-fill, describe the expectation that the fields or controls are automatically filled/populated with expected information if that information exists within the EMR. For example, if you had a form that included a list of medications and want it to populate automatically with the selected patient’s medications you would request that that field auto fill.
  • Button: A button is a control which will allow you to click it to trigger another action. For example, a button could be pressed to open another form page, calculate a formula to provide a score in a patient questionnaire, or print the selected form.
  • Character(s) or Character Limit: Characters or a character limit is how you define the maximum length of any given control or field. For example, if you wanted to limit a field to 20 letters and/numbers, you would specify “Limit the field to 20 characters”.
  • Digital or Electronic Form: A digital or electronic form has been made available on a computer, this form may be manually filled or auto-populating.
  • Dropdown Menu (or Sub Menu): A dropdown menu, or sub menu, is the menu list which appears when you click on the dropdown control. This menu can contain any number of items.
  • Field (or Control): A field or control is a designated space were the information is either manually entered or auto-populating. For example, the area where you would enter in a patient’s name, a tick box, or a pair of radio buttons are all types of fields or controls.
  • Lookup control: A specific kind of control which connects to a reference list or data table (where the information entered into an EMR are stored) in the EMR allowing the user to select an entry from that list. For example, you can have a lookup control for patients which will allow you to search all patients in the EMR; or, you can have a lookup control for facilities which will allow you to search all facilities recorded in your EMR.
  • Mouse over/Tooltip: A popup window/dialog box which displays when you move your cursor over an area in a form. The popup window/dialog box can contain custom text.
  • Open Field Box (or Free Text Box): An area in the form where you can type freely to enter in data or information. These can come in a variety of shapes and sizes, to match the needs of the form.
  • Paper Form: A paper form is a form which has been designed, and intended to be used, in the physical, paper format exclusively.
  • PDF Form: Is a form which has been made available on a computer and usually does not have any interactable fields. This form is generally printed out for use.
  • Radio button: A radio button is usually seen in at least a pair and indicate a binary selection of a multiple-choice possibility. For example, you might see four radio buttons on a patient questionnaire, where you are expected to only select one of them based on patient feedback.
  • Checkbox/Tick box: A tick box is a control which will allow you to ‘tick’ it off to indicate a confirmation of the connected question or text. Can be used to select one or more item in a list of selectable choices.

Citations

This guide was inspired by BC's DTO Guide to forms and best practices.