Fillable PDFs have emerged as a low-budget alternative to paper-based mandatory reports and forensic medical examinations, however this comes with a host of additional issues and compliance headaches:

• No Chain of Custody: there is insufficient chain of custody associated with individual paper or pdf files. There is no change log to determine which healthcare provider created the report or made changes. 
• Lack Accounting of Disclosures: there is no ability to document an accounting of disclosures as required by HIPAA. 
• Unnecessarily Long Exams: paper reports require completion of every form field, which increases the amount a patient must be retraumatized. 
• Loss of Data: reports data saved in a pdf can easily be lost or corrupted. Use of different versions of Adobe creates challenges in using each device. Many of our partners have reported issues where a nearly-complete report was lost.
• Pain of Maintaining Installed Software: software installed on each device increases the footprint on hospital devices, which must be regularly patched and updated to maintain adequate security. If you are outside of the IT infrastructure of a major hospital, this creates significant challenges in protecting against ransomware and meeting the HIPAA compliance requirements.
• No Public Health Value: it is challenging to aggregate data from paper documents pdf reports without manual duplicate entry, so there is an immense opportunity lost for understanding the public health implications and aggregating the number of cases. 
• No Outcomes Data: there is no outcomes data available when the process ends at the completion of a forensic examination. Tracking outcomes becomes a complex exercise in integrating data sets that regularly do not match. 
• Less Connection With Patients: most pdfs are completed on desktop computers, which creates barriers when interacting with patients. Use of tablets can allow for more focus on the patient. 
• More Understandable Documentation & Body Maps: documenting injuries on a body map is often difficult for Law Enforcement to understand when written in small font and there is extensive use of medical jargon. 
• Empty Fields: missing responses and errors can be problematic when a forensic examination report is scrutinized in court. Forms should include validation and enable a streamlined quality assurance (QA) process.

We have spent years developing and validating our approach that leverages web-based systems that are easy to adopt and maintain, and offers the opportunity to better serve survivors of interpersonal violence.