Why Paper is Completely Impractical

‍Lindsay McGuire: If I'm allowed one soap box in life, this topic may be the one that I choose eliminating paper, because it sucks. I have endless stories about the inefficiencies I've experienced as a customer of organizations who haven't moved past paper processes yet. And I know you probably have some too think about it. When was the last time you went to the doctor's office and didn't have to fill out some sort of paperwork, even if you've been a patient there for years or even decades, you know, some people like their doctors a lot. That's why I couldn't be more excited to have Denise Davis here with me. Denise is the corporate director of marketing technology and operations at Emory healthcare, a Georgia based healthcare system with 11 hospitals in more than 250 provider locations. One of Denise's largest efforts at Emory has been eliminating paper processes in order to improve the patient experience in this conversation. She's sharing exactly how her team is doing it, how you can start and why this is crucial for you to think about now, here's Denise. Tell me a little bit about your role at Emory healthcare. I know you've been there for nearly a decade. Now.

Denise Davis: I am the corporate director of marketing technology and operations. I am the first in the marketing department to hold this specific role. And I often refer to myself as the chief marketing mechanic, cuz it's a little easier for people to get their heads around. I have absorbed the web team and I also pull together budget operations and project management and CRM and have been weaving the ties between CRM and web and getting people to think about the interactivity that they are not two different sides of the house, but they are actually combined very powerful tools. So that's been a lot of the work that I've been doing over the past four years.

Lindsay McGuire: I really appreciate the breakdown of the marketing mechanic, cuz yeah, titles can be arbitrary and confusing and hard to understand. Why do you think Emory healthcare decided to have a role like this?

Denise Davis: I think in part they felt that CRM was the direction we needed to go to level up on marketing to start moving towards one to one personalization. But also I know for a fact that my boss, the vice president of marketing saw CRM as a way to really grab data. The marketing department did not have access to itself. We were usually reaching across aisles, usually to operational or clinical teams who are very busy and most healthcare organizations, they get it, but they don't quite appreciate the nuances and the subtle differences in marketing data versus clinical and operational data. The idea that we just asked the call center for call data is fine, but their tools are aligned to or built to measure service levels and volume. They're not built to track campaign tactics, driving those calls in. And so when you start to show people what you can capture through web forms and call tracking software and then match it up to patient records, you can start showing these really interesting stories, not only ROI and contribution margin, but how people are flowing in and how they're behaving. We would not be able to help the organization make better decisions about its marketing without showing them our data, not data siphoned and repurposed from other areas.

Lindsay McGuire: So I know Emory has done a lot to eliminate paper and make that a priority. So can you talk a little bit about why Emory has been on a mission to eliminate paper?

Denise Davis: Yeah. And extends well beyond marketing, it comes down to scale at a certain point, there just aren't enough human hands to lay on all the paper we could possibly produce and also data integrity. The transfer of that data just very time consuming it, uh, introduces opportunities for errors in the data to make it impossible to report off of because you have so many different ways. And we spent a ton of time normalizing our location addresses because straight spelled out versus St. Period, when you start pulling those into software, those are different locations unless you've got really, really superior AI software that can come through that. So it became again, a way for us to better serve our patients and our referring physicians. By freeing up the time our people spend letting them work at the top of their licenses. If they're doing data entry, then they're not nursing, right.

Or if they're doing data entry, then they're really not being that smiling face at the front desk can, can help the patients navigate their appointment or make them feel comfortable when they walk in the door, definitely in our call centers, if they have to re-key referral forms that are coming in from other physicians, there's a tremendous amount of downtime that produces in their agents and they can't facilitate the actual referral appointments. You know, the world got really big and we consolidated a lot of small practices into really big health systems. And it's just the sheer volume of data coming in is completely impractical on paper.

Lindsay McGuire: Yeah, that makes a lot of sense. And in our 2022 state of digital maturity report, we actually found that more than two thirds of organizations have an initiative to eliminate paper. Like you've said, it just causes so many issues both internally from like an employee experience standpoint, but also from a customer experience standpoint and causing those other issues that can trickle down into your business. Were there any, either really big trends you saw over across your different locations and organizations or was there just one instance where you're like, now's the time we need to do this? Was there a light bulb genius moment for you to be like, this is enough?

Denise Davis: Yeah. I will say COVID. So every piece of paper that was touched was a potential transfer, right. Even though they said that it was really not transferable, let's not leave it up to chance, but also in COVID our organization at least took the opportunity or made the decision to really enhance our electronic medical health record system. And that forced a commonization. We had a lot of deviation in the forms we were producing. We have like hundreds of pages on our website with PDF patient questionnaires and not one of 'em were the same. And they were all asking for the same information. And I think that was where we, as an organization said, okay, let's stop. And let's not make our patients fill out their name 15 times we know their name by now. So I think we hit a critical mass where we just had to make the shift and in becoming more patient centric and developing this sense that we know our patients to not repeat questions. We should already know the answer to, which is easier when you commonize forms digital or paper, but much easier in a digital format.

Lindsay McGuire: When I'm trying to think about the scope of the work that Emory had to do, what was the first priority on your lists when you decided now is the time to digitize now is the time to rid ourselves of paper.

Denise Davis: I think the push started and it really started in the operational teams. Some of our chief clinical directors really, I think heard their patients a few years ago. I think we've been trying to do this for a while, but again, in our organization, the shift in our core software opened up an opportunity to say, no ma we're ending paper as much as possible is there's always gonna be an analog backup where you have people who can't do digital, but that opened a huge window of opportunity to get, I think, executive backing plus to empower the clinical teams to really enforce level of commonization, but also to really think through not just that, but really think through asking those questions because on paper, I think you could ask a question in a way that you can't in a digital, you gotta be very concise and you gotta let them click a button. You can't do a lot of free text, right. And open ended questions, which is what, where some of the arbitrary answers, or maybe the misinformation comes in and you can't report on these wide open, free text boxes or self as attestations. It really helps speed up the form if it's a yes, no, if it's a multi-select so not just making the forms digital, but streamlining what we're asking and really being judicious about how many questions we're confronting them with.

Lindsay McGuire: Yeah. That has been a common theme. This season really narrowing down what data is crucial to your systems and processes and customer, but I'm interested in when you started realizing, oh, now is the time to not only go digital, but beyond that, when you started thinking about how can we streamline these, how can we make them more efficient, make it so that we're asking only what we need, who was in on those decisions? How did you decide what data was relevant and what really was unnecessary?

Denise Davis: Again, I'll give huge props to the clinical directors in our physicians group practice and in the hospital systems, as they, I think they suffered through the pain and had to hear it firsthand from the patients, what they were frustrated with. We have a patient family advisor group who regularly gives us feedback based on here's what my experience was in your health system. Here's what I think you should change. But I think it was just enough data that they went out and learned from others who went ahead of them. This whole idea of at least 60% of the people who are gonna complete your firm are gonna do it on an iPhone or on some mobile device. And how easy is it to complete that form on a phone versus at a desktop with full keyboard. So I have to give them a lot of credit for listening to the patients doing due diligence, really looking across the universe of the other health systems and getting best practices and just leaning into good UX design. They just pulled the right people together, a lot of cross functional teams together. So it's been a labor of love over a number of months and years, but I think it's really gonna pay off for everybody involved.

Lindsay McGuire: That's a really powerful story. And I think a really strategic way to go about that. And I also really love that you brought up the idea of standardizing questions because especially with larger healthcare organizations, you can have one chain here, one branch here, one location here. And if that standard of care varies across those locations and those nurses and doctors and frontline staff that can cause some churn. And if you have an unsatisfactory or a different experience at one location compared to another being able to have some control over that. And I think in a way that probably a lot of people might not be thinking of the impact of just standardizing something as simple as a form can have a huge impact. Would you agree with that?

Denise Davis: Absolutely. We're an academic medical system. So there's a lot of data we want to capture to analyze and help inform the next generation of treatments in healthcare and clinical trials. And if those forms, if that intake is not consistent, we lose the opportunity to really look across the population we treat. And again, population health and healthcare is a big deal. And again, data hygiene is huge. And it's also, when you look at the cost of healthcare, the cost of opportunities lost in data that isn't clean and the cost of rework or additional work because the data isn't there in an accessible format that all adds up. And again, the customer experience, if I don't have to answer that question five times, I'm a happier person. We get closer to, we hope a Hilton or Delta experience where it really feels like we know them. We should know them, we should know this stuff about them.

Lindsay McGuire: So how have you kept momentum either on your team, your department, across your organization, as you've done some of these bigger digital transformation projects?

Denise Davis: I think I've watched on our clinical teams that as they've been going through their transformation, the realization of how much bandaid bubble gum and bailing wire, they have put in place to accomplish a thing versus making the change. And they're starting to see like, oh my God, this could be easier for everybody. That is a nice thing for them to see on the horizon, every change introduces hiccups, headaches, hearts, and hernias. But the reality is that these changes are probably a renewing, a lot of painful practices. We just kind of coped with my team. It was, I think, now that we're able to tell these great data stories, and I think that will happen too elsewhere in the organization. Let's clean up one more time. Let's see what else we can shift into this so that we can do more, better, bigger, better in this direction.

Lindsay McGuire: Sometimes it can be hard to visualize if you can't see it or demo it or even feel it depending on what situation you're trying to achieve or solution you're coming up with. But I will say you should copyright that bubble gum phrase, cuz that was genius. I loved that. I don't know if that's a common phrase or not, but like yes, yes. That is a great way to talk about going back to this idea of these paper systems that I think people get comfortable in them because they're the way we've done them for forever. We know they work quote unquote, but they don't necessarily work well. But a lot of the times we just don't take the time to consider how could it work better? How could we reimagine this? What is wrong with the system that worked for 20, 30, 40 however many decades and years. So going back to that, how have you seen paper processes get in the way of efficiency?

Denise Davis: Oh, it comes down to data entry, right? And it comes down to, it's really hired over an institution of 28,000 people to commonize a thing like we're gonna write straight out or we're going to abbreviate at St. Period, or we're gonna abbreviate suite ASTE. And when it's left up to physically writing this out on paper or even typing it into a interactive PDF form, which are great, they're lovely. They really are, but they're still almost an intermediary between paper and the actual digital form. You just get so much unclean data and inconsistency. The beautiful thing about these form builders is that they can enforce some of those data entry standardizations. And that just takes the noise out of what you're collecting and what you're trying to analyze. I'll give you an example in locations, when we're setting up our practice locations, we'd have all kinds of different variations of how those locations were entered in. So when we tried to create a automated system that pulled those locations in, from a database, they had been entered into that database. So many different ways that we went from 250 locations to like 2000 locations because there were that many variations in the spelling of street avenue, suite, a Atlanta GA versus a Atlanta capital GA <laugh>. You know, so that was the cost. That was the cost of not being able to automate because data was keyed in or entered in, in a non-standardized way often because a piece of paper was filled out first.

Lindsay McGuire: That is absolute insanity. I will start off with. And I don't know how you went through it and survived and are here talking with me right now. <laugh> but I think it's those small things that you just don't think about in the context of how will this have an impact on this process or system, but once it's started and begun, it can spin out into this huge issue. And I mean, that is so much cleanup on the backend. So being able to put those processes in place that can act as guardrails and for the paper advocates, I don't know if there are any out there and if you're listening and you are a paper advocate, just have a conversation with me, please tell me your case. But for the paper part of it, you can try to put as many rules and steps and directions as possible in that paper. But a lot of the time, these situations, people are late or they don't really want to read all of these things on this piece of paper. So they're just gonna put down the data they think you want, and you're still not gonna be able to control it. But as you said, having those instances through digital processes and systems and tools where you can actually state yes, it has to be this way and control it to only be that way. That's so powerful.

Denise Davis: I will say that the software manufacturers have come a long way in making this type of digitization and this move away from paper easier for people who were reluctant to do it. My team never liked building forms. And now we get into our tool and we're like, oh my God, this is fun. Let's play in here. And so it really makes us think about how we can use that tool to even solve other business problems that aren't even just forms, but are a way to programmatically trigger a thing through a web interaction. So we talk about getting away from paperless forms, but the form is pretty powerful interface tool in a digital experience platform, which is what we're really building now with websites.

Lindsay McGuire: So first off I wanna point out, she said, form building can be fun. So everyone pay attention. It can be fun. You do bring up a really funny point, which is the, probably some listeners might not even know any of this backstory, but Formstack was founded more than 15 years ago because our founder Aday realized that people had such miserable experiences building forms. It was tedious. It was time consuming. It was not fun. And so he way back before no code quote was even an idea or a topic had the idea to make a no code form builder. So it's interesting to see how far we've come since that point in time. But yet that still is the crux of a lot of organizations making the switch away from paper and coming to a tool maybe somewhat like form stack because it does relieve so many of those other barriers to entry, like you said.

Denise Davis: Yeah. Even when we did printed forms, no graphic designer loved to build forms, right? <laugh> so translate that to the web world and nobody really loved to build forms, but I will say that these tools allow you to think more about the problem you're solving and less about haven't code. Every little thing I like to say marketing is business and we are in the business of solving business hurdles. And these types of tools really empower us to help solve things that we haven't been able to do in the past easily.

Lindsay McGuire: And I wanna dig into that just a little bit, because I think one thing that we talk a lot about is this idea of how can you innovate and truly innovate. And especially in healthcare, I think we see a lot of innovation as far as what you can do in surgeries and recovery, but then when you go into that customer experience, the patient experience, there's still a lot of realms that I think organizations can innovate. So how has Emory been able to innovate by moving away from paper and into a more digital front door environment?

Denise Davis: Well, in this predated form stack, and of course there are a lot of form intake systems that aren't form stack that are used on the clinical system, just to be fair in transparent. But we in developing the CRM through form building helped with the COVID vaccination efforts at Emory teaming up with our clinical teams and our patient access team, that ability to build forms quickly that could send data in and we could match people up and get people appointments. And we're using the forms also in areas like population help, gap closure. And again, it's as simple as capturing the level of interest. Yes. Please call me back about this. The interesting thing is you can schedule online, but sometimes online scheduling doesn't allow you to ask the questions you need to ask. So request, appointment form is still necessary. So there are a lot of, I don't even think we think through things all the time.

Denise Davis: I think we are now working with a couple of clinical teams to figure out how to build forms, to help them fit patients who need availability in certain programs and help them guide them better. So they're not playing a long game of phone tag with the system. It's interesting. When I came into healthcare marketing and the call centers didn't talk much, but now this ability to capture interest either in leads or I'd like to talk to somebody of an appointment, starts to bring us together to create this connected digital experience that didn't exist. It's pretty mind blowing for people coming in from outside of healthcare, but it's been a relatively recent effort in a lot of healthcare systems to merge these two business units together.

Lindsay McGuire: Yeah. Uniting those two areas can have such an impact, not only internally with how you are able to have that data access, and they're able to see how you are communicating and interacting with patients. But also just thinking from, if I were to call my customer service line at my doctor's office and them being able to connect the dots across my patient journey, that can be a huge game changer, whether it's a healthcare organization or any other industry or vertical for an organization that is trying to eliminate paper is early in their process of eliminating paper. Or maybe even hasn't started, cuz there's a lot out there. How would you guide that organization and getting started

Denise Davis: Sometimes it's as easy as we've got a real near term problem we have to solve. And you start with that near term problem, or you have an opportunity to sit down and take an inventory or do a value stream analysis of how much time you're spending doing it in a paper format. And then you can look at tools out there like form stack that can help make it far easier to take your work streams out of paper. But I think it's really listening kind of like when we say listen to your body, you start to know when something's not right. You can sort of stop and listen to your processes and know there's a better way to do this. It really shouldn't take this long. I often tell people like, if it feels like it should take 20, 30 minutes and it's taking two to four hours, then stop and examine the process.

Denise Davis: Right. But then do your due diligence on your tools. What tools are gonna be the best fit for you and your organization in terms of ease of use and cost of entry and total cost of ownership and very important. I mean, one of the reasons why we went with form stack is its interoperability with our CRM and the ability to write a lot of hooks into other systems. So even if you're building a form that spits into an Excel file, that Excel file has to go somewhere, right? So you really have to think about how you connect your data and what your connection points really need to be. Look for what we call the, the minimum viable product. Don't try to boil the ocean, but look for your use cases that you can most easily take down, but then make a significant impact. If you could just carve out space to make that change. What you will free up over time is going to be huge. You're gonna get such benefit out of it.

Lindsay McGuire: And how do you make that more of a habit? I think that's something you need to train yourself to do. And a lot of people probably struggle with,

Denise Davis: We do a lot of continuous improvement. I don't think everything needs a fish bone analysis or a value stream analysis. I mean, you can make those incremental improvements, but I do think we stop and say what's working well, what isn't and try to build in time to one, really assess the problem and think through what are the simple tweaks we can make. Sometimes it's really easy. Sometimes it's the paperclip solution. Sometimes it just requires people outside of buzz. And that's where you have to start doing your cross functional negotiations. And socializations we look at probably on a weekly to monthly basis. And especially at the end of every project, what worked, what didn't work? What could we do better? What do we need to train people on? Hey, we keep having this QA problem. What can we do to prevent that problem from happening? It's as much a routine of you don't wanna be in a constant change state because then that's destabilizing as well. But you do want to have an open mind and be constantly curious is what I would say. And I will say my team is extremely good at that. I made them be good. I hired them to be here <laugh>

Lindsay McGuire: And it means you're a good hiring manager as well. And the curiosity fuels optimization, I believe. And on that note, that relates back really to this idea of practically genius and that there are people all throughout organizations who have these maybe tiny sparks of ingenuity. And then they're able to go and figure out a way to implement that throughout either their team, their department, their whole entire org. What do you think drives those people? What do you think enables them to have these practically genius moments?

Denise Davis: I think it's the drive to have an impact. And some people just love to problem solve. Some people like to stay in the pattern, but some people just really like to, they look for those opportunities to find a better way. And if you're looking to initiate these kinds of changes, you wanna make sure you do have people like that on your team, or find people who you can bring onto your team who just wanna innovate and who wanna see if they can push it further.

Lindsay McGuire: Thank you so much for joining us for this great conversation with Denise. If you wanna keep the conversation going, join me and my co-host Ryan for next week's episode of practically speaking, where we'll be diving in with some data-driven insights around why the most optimized organizations are limiting paper. And as always, you can find your next practically genius idea at formstack.com/practically-genius.

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