CRITICAL FORMS – Are Paper Business Forms Still Relevant?

Over the past couple of decades, paper business forms have almost disappeared from business. Most signatures today are captured on a pad, or with a PIN. Contracts and business agreements are more likely to be PDF’s than paper. Checks have largely been replaced by cards, chips and electronic transfers. In many cases, only mission critical forms remain, and many of those only for emergencies.

And for most people, and most industries, that’s just fine; the digital world has provided replacements that are faster, easier, more convenient and less expensive. And when they’re digital, the forms you need to capture and convey vital information are available all the time, to everyone, and from everywhere.

Except when they aren’t.

Last year alone four major US airlines suffered big, embarrassing, and expensive digital systems failures. Alaskan Air, American Airlines, Southwest Airlines and United Airlines each had a sustained network or data center failure that had them scrambling for alternatives – and all too often finding that none existed.

Although some paper forms survive at each of these companies, comprehensive strategies for doing business when vital digital systems fail appear to be absent. Fortunately each of these failures were in customer facing and business management systems, not air traffic control.

Frustrating and expensive, but not particularly dangerous.

The healthcare industry may be a little better prepared to work without digital systems than the airlines, partly because digital adoption in healthcare lags behind behind commercial aviation. Sometimes way behind. Were it not for the digital transformation being driven by the Affordable Care Act and it’s siblings, most medical records would still exist only on paper.

But these pressures have healthcare systems across the country scrambling to select and implement Electronic Medical Record (EMR), Electronic Health Record (EHR) and other digital records and management systems. And as they do, digital system failures in healthcare will become more common.

Failures that can be frustrating – or fatal.

Sometimes the difference is a humble piece of paper. The right piece of information recorded in the right place, at the right moment, and made available to the right next person, can save a life.

So when Hudson Printing was invited to help a large healthcare organization implement a Critical Forms project, as part of a huge EMR / EHR software project, we jumped at the opportunity.

The project started a couple of years before Hudson Printing became involved, when a team of doctors, nurses and clinical professionals, medical information and education content owners, and technology and logistics experts created a clear strategy for working through Planned and Unplanned Downtime Events.

As it became clear that paper forms would play a crucial role during system downtimes, a key challenge emerged: Deciding which of the 20,000 existing forms were to be tagged as Critical Forms, and included in the downtime resources.

Then, instead of just filling boxes or file cabinets or desk drawers with forms that might not be found when they are eventually needed, our client created a plan for Downtime Forms Kits. These kits would help to ensure that all of the most essential forms would always be available, in a known location, in every hospital and clinic in the system.

About 300 forms were identified as critical. These had been created across many years, and were being produced by multiple vendors. They included carbon-paper manifold forms, 2, 3, and even 4-part carbonless and NCR forms, and complex multi-page forms of odd sizes. And many of these would need multiple copies.

Any way you looked at it, this was going to require a lot of Print! And a tremendous amount hand-collating and assembly work. And even more planning and coordination and tracking…

The kits needed to be quick to create, easy to track, and simple to modify and update, as planned downtimes would reveal needed changes to existing and future kits.

So discrete units were created to populate each kit. Collections of Forms became Bricks. A plastic container with the appropriate Bricks and other items (pencils, paper, tape, ID tags and so on… ) became a Tub. And one or more Tubs comprise each Kit.

The client had originally intended to produce these Forms, Bricks, Tubs and Kits at their in-house print shop, as they rolled out the project at just a few facilities at once. But as the in-field deadline for the first group of facilities approached, it became clear that even producing the kits in small groups, there simply wasn’t enough print capacity or work space to do it internally.

That’s when they called Hudson.

We brought all of the work in process, and all of the inventoried forms into our 200,000 square foot facility, finished the printing necessary for this first batch, then scrambled a team to hand count, hand collate and package up all of the kits.

Working together with our client, we just barely made the first deadline.

A couple of days later we sat down with our client to talk about a better way to produce these critical forms and bricks and kits. Together, over the next few weeks, we built a data driven process for managing the entire project. We eliminated more than 90% of the inventoried forms. We simplified and standardized most of the manifold, multi-part and oversize forms so they could be printed and finished as one complete brick. We created a tabbed table of contents that visibly showed the title of each brick, it’s revision date, what forms and how many of each are included, and where in the brick they are located.




The data driven process also has reduced the lead time needed to make changes to any form, brick or kit from weeks to hours – and in some cases, minutes. And it has eliminated about 70% of the handwork that was required for assembly, serving to minimize the chances for errors, and reducing the cost of each brick, each kit.

We were also able to enable the clients desire for rapid replacement of any brick or any kit. We can now deliver replacements within 24 hours of an event. (We are still working on a plan to be able to replace every brick and every kit within 72 hours, in the event of a system-wide downtime – a huge challenge!)

We also moved most of the print production from Indigo and toner-based digital presses, to our HP T350 Pagewide inkjet press. This significantly reduced the printing time and the print costs.

Today we’re about half-way through the initial implementation, and our client is thrilled with the results of this critical forms project.

With each new round of the project, we are improving the processes and systems, making it more robust, more responsive and more effective at providing the critical paper backup necessary to continue taking care of patients – of people – in the event of a digital system failure.

We are thrilled to be of service with such a critical project. And we look forward to applying the unique knowledge and expertise we’ve gained on this project to helping other customers – and other industries exploit the advantages of data driven Critical Forms for emergency, backup and contingency planning.

Perhaps we’ll see you at the airport!

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