Online Forms and Consents in U.S. Healthcare
Our U.S. healthcare system continues to use inefficient paper-based processes for patient forms, particularly for consents and assessments, despite advances in care delivery.
TLDR: this analyzes the transition from paper-based to online forms in healthcare, examining current challenges, three available solutions, implementation strategies, measurement strategies.
Current Challenges with Paper Forms
Research from UCSD demonstrates that surgical paper consent forms have a 32% error rate versus 1% for electronic forms. These errors—ranging from missing signatures to illegible handwriting—lead to delays in care and increased legal exposure.exposure. Beyond compliance risks, paper-based surgical consent forms do not promote informed consent and shared decision making, which has been a cornerstone of modern medicine since Salgo v. Leland Stanford Jr. University Board of Trustees (1957).
In pediatrics, paper-based assessment forms can take up to 20 minutes per consult—not including the administrative time spent on scoring, storage, or tracking. Translated versions, if needed, are often unavailable or difficult to coordinate.
Yet, 80% of clinical forms in the U.S. are still on paper despite widespread adoptions of electronic health records (EHRs).
With waiting times to see a healthcare provider getting longer, it is paramount that we find ways to improve healthcare efficiency.
Current Options for Providers
1. Continue with current paper-based processes
Choosing this method, though least resistance, is most costly long-term. Here are some considerations for continuing with the paper-based processes:
Ongoing consent form errors and omission rates will continue to keep a high medical-legal risks
No improvements in quicker delivery of care: as assessment forms can remain unscored delaying referrals and operations continue to be delayed from missing or erroneous forms
Audit processes remain manual and time-consuming, requiring on-site teams to locate physical documentation
Telehealth adoption remains difficult, as paper forms are not conducive to remote exchange of information and signatures
With widespread adoption of EHRs, workflows often still require manual scanning and uploading of forms, increasing admin time
2. Use or develop in-house online forms
This method include using internal tools to build custom applications or leveraging basic form modules in currently available EHRs (such as eConsent in Epic).
Developing an internal application provides full control but requires significant capital investment for software development and clinical content creation. According to publicly available data, it takes 1–2 years and costs $500,000+ (2–3 full-time engineers), plus ongoing maintenance of $200,000+ annually. Additionally, organizations face uncertainty about having the necessary technical and clinical expertise to deliver the product.
Adopting extensions of currently available EHRs comes with limitations in functionality. For example, Epic's eConsent simply captures an electronic signature without improving compliance, enhancing patient understanding, or enabling remote access. Most leading EHRs do not offer remote completion of assessment forms such as ASQ or MCHAT. Implementation typically requires an on-site EHR technician and potentially a consultant—costing over $200,000—before factoring in staff training and maintenance costs.
For short-term and medium-term wins, in-house solutions have difficulty proving ROI due to high upfront investments, uncertainty revolving around development, delivery and timeframes.
3. Procure an external forms solutions
This involves procuring an external solution that is fits the clinical, operations, and compliance needs of your organization. Online third-party applications are very popular with mature offerings on the market.
Though it requires stakeholder engagement and some IT involvement for deployment, third-party solutions are typically faster to implement and easier to maintain.
Research shows that while year-one costs may break even, medium- to long-term ROI is often strong—with cost savings from reduced admin time, printing, scanning, and legal exposure.
At Standard Form, we fit within this category. Our goal is to support your full transition from paper to digital—securely, efficiently, and without disrupting your clinical workflow.
Measurement Strategy
Digitizing forms is only valuable if we can measure its impact. Here are suggested metrics to track clinical, legal, and operational outcomes:
Consent form accuracy: Track error and omission rates before and after implementation
Patient throughput: Measure the number of patients seen per day, pre- and post-implementation
Referral timelines: Monitor the lag time from assessment to referral before and after automation
Legal risk reduction: Review complaint volumes and legal cases related to informed consent annually
Time saved per consult: Quantify clinical time recovered in each appointment
Staff feedback: Survey clinicians on their confidence in the consent and assessment process
Risks of Online Forms
Online forms aren’t risk-free, and thoughtful implementation is essential.
Rolling out across an entire organization typically requires a phased approach. Many institutions begin with a pilot in a single department before expanding — a process that can lead to parallel workflows (paper + online) in the interim. In this case, it would be helpful for management to be flexible.
Another risk is failing to support shared decision-making if surgical consent forms are not distributed ahead of time or are completed too close to the procedure. Organizations must ensure patients have time to understand, ask questions, and consent meaningfully.
As for technological and regulatory concerns, Standard Form addresses these head-on. For a detailed breakdown of our security protocols and HIPAA compliance, visit our Security & HIPAA Compliance page.
Summary
Paper-based forms have long been accepted as standard — but they now pose serious risks and inefficiencies for modern healthcare delivery. Errors, delays, legal exposure, and administrative cost are the consequences of staying paper-bound in a digital age.
Online forms and consents, when thoughtfully implemented, can reduce medical-legal risk, improve efficiency, support shared decision-making, and ultimately reduce cost.
At Standard Form, we help healthcare teams modernize their form workflows without disruption — supporting better care, clearer communication, and stronger compliance from day one.
