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Informed Consent: Let Go of the Status Quo

Posted on October 1, 2018 I Written By

The following is a guest blog post by Shahid Shah.

We’ve all heard it before: “healthcare is slow to adopt new technologies.” In fact, we’ve heard it so many times that we just accept it as gospel and don’t give it much thought.

It’s not true though.

For example, I remember when the iPhone was first released, it was easily adopted by doctors because it gave them something they craved: increased freedom by having access to information on the go.

What’s probably true is that “healthcare institutions are slow to adopt new technologies that impact status quo.

Why is that?

Because the perceived cost of maintaining the status quo is smaller than the cost of the innovation (e.g. product or solution), even if that innovation is free.

When the cost of not doing something new is low, nothing will change: and bad leadership is often able to keep the cost of maintaining status quo very low. Poor leaders add hurdles, like requiring unknowable ROI analyses, for introducing innovation but don’t penalize maintenance of status quo. This means that it’s easier to not introduce anything new – because the cost of not innovating is low but the cost of innovating is high.

Let’s take a look at digital patient consent as an example of an innovation – obtaining patient consent to perform a healthcare service is something that no hospital can do without. Called “informed consent”, this is a document that patients are required to sign before any procedure or health service is delivered. You’d think that because this form is the initial and primary document before almost any other workflow is started, that it would be the first to be digitized and turned into an electronic document.

Unfortunately, it’s 2018 and informed consent documents remain on paper. Thus:

  • JAMA reports that two-thirds of procedures have missing consent forms
  • JAMA reports that missing consent forms cause 10% of procedures to be delayed, costing hospitals over $500k per year
  • Joint Commission reports over 500 organizations annually experience compliance issues because of missing consent forms. There’s almost a 1 in 4 chance that your own organization has this compliance problem.
  • A recent JAMA Surgery paper estimated that two thirds of malpractice cases cited lack of informed consent, which increases liability risk
  • Superfluous paperwork directly contributes to clinician burnout
  • Patients often don’t understand their procedures or aren’t properly educated about the service they’re about to use

Today, many healthcare institutions go without automation of consent documents – which I’m calling the status quo. Even though this document is essential, and its non-digital status quo creates many financial, clinician, and compliance burdens, it’s not high in the list of priorities for digitization or automation.

As I enter my third decade as a health IT architect, after having built dozens of solutions in the space that are used by thousands of people, I still find it difficult to explain why even something as simple as an informed consent isn’t prioritized for automation.

It’s not because solutions aren’t out there – for example, FormFast’s eConsent is a universally applicable, easy to deploy, and easy to use software package with a fairly rapid return on investment. With eConsent software, clinicians aren’t interrupted in their workflows, patients are more satisfied, compliance becomes almost guaranteed, and procedures aren’t delayed because of lost paperwork.

A senior network engineer at East Alabama Medical Center recently wrote “the comparison of creating a form in the EHR vs. an eForms platform? There is no comparison. We are saving thousands of dollars by using eForms technology and the form creation is simple.”

Why do you think even something essential like patient consent forms remain on paper? Drop us a line below and let us know why the status quo is so powerful and what’s keeping your organization from adopting electronic forms solutions.

Note: FormFast is a proud sponsor of Healthcare Scene.

Looking to Improve Patient Experience? Simple Options Can Yield Big Results.

Posted on September 18, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Improving patient experience is a top priority. Instead of grandiose new programs, hospitals and practices would see better results by focusing on simple options that have a big impact – like an eConsent solution. eConsent makes it easier for organizations to treat patients with respect and gets patients involved in their care.

Over the past several years more and more attention has been placed on improving the patient experience. This is partly due to a recognition by healthcare organizations that experiences could euphemistically be called less-than-ideal and partly because of changes to reimbursements that tie $$$ to patient satisfaction (specifically HCAHPS scores). From a patient and patient champion perspective this attention has been a welcome change.

There is a tendency, however, for healthcare organizations to gravitate towards large-scale projects to improve patient experience. Although projects like renovating patient suites and implementing AI chatbots can indeed have a positive impact, these initiatives are resource-intensive and can take a long time to yield results. Instead, hospitals and physician practices should focus on doing small things better and reap the benefits of improved patient experience sooner.

According to a study published by BMJ Open in 2016, positive patient experiences were “closely linked to effective patient-health professional interaction and logistics of the hospital processes”. The authors of the study also found that “positive aspects of the hospital experience were related to feeling well informed and consulted about their care”.

In 2014 a study found that delays in healthcare (wait times) impacted the perceived quality of care received. The longer the delay, the more that confidence in the care provider eroded. Having confidence in the care provider is a key factor in the online ratings patients give to healthcare organizations. Online ratings are the new real-time way to gauge patient satisfaction.

Taken in combination, these studies tie patient satisfaction/experience directly to (1) interactions between patients and their health professionals; and (2) smooth hospital processes.

Interactions with Patients

So what can hospitals do to improve interactions between health professionals and patients? They could implement new communication tools (like real-time chat). They could renovate offices so that patients and clinicians can look at screens together. They could even hire navigators to help patients interact with health professionals. All of these are fantastic initiatives, but all of them will take time and in some cases, a lot of resources.

There are, however, a number of simple things that hospitals could do that do not require significant investments of time or dollars. One would be to train clinicians to ask patients: “Is there anything we have covered today that I can help clarify or that you have questions about” rather than the standard “Do you have any questions?”. Another would be to implement electronic forms during the intake process so that patients only have to enter their information once. There is nothing more annoying than having each department ask for the same information over and over again.

Along these lines, an often overlooked yet quick-hit improvement area, is the informed consent process. The American Medical Association defines it as follows.

“The process of informed consent occurs when communication between a patient and physician results in the patient’s authorization or agreement to undergo a specific medical intervention. In seeking a patient’s informed consent (or the consent of the patient’s surrogate if the patient lacks decision-making capacity or declines to participate in making decisions), physicians should:

(a) Assess the patient’s ability to understand relevant medical information and the implications of treatment alternatives and to make an independent, voluntary decision.

(b) Present relevant information accurately and sensitively, in keeping with the patient’s preferences for receiving medical information. The physician should include information about:

  • The diagnosis (when known)
  • The nature and purpose of recommended interventions
  • The burdens, risks, and expected benefits of all options, including forgoing treatment

(c) Document the informed consent conversation and the patient’s (or surrogate’s) decision in the medical record in some manner. When the patient/surrogate has provided specific written consent, the consent form should be included in the record.”

The informed consent process is a golden opportunity for hospitals to improve the patient experience. It is a chance for health professionals to engage patients in their care. This engagement has numerous benefits including:

  1. Reducing the anxiety patients have about the upcoming procedure, which in turn helps improve patient outcomes. This study published in the British Journal of Surgery, shows patient who are less anxious have fewer post-procedure wound complications.
  2. Demonstrating that the health professional (and by extension the hospital) care about the patient as a person.
  3. Mitigating the risk of malpractice. Lack of communication and feeling like clinicians didn’t care about them are common reasons cited by patients who decide to sue for malpractice. This New York Times article has an excellent summary of various studies into this phenomenon.

A simple way to improve the informed consent process is to move away from paper-based consent forms, which can be lost and are often confusing to patients, to electronic consent forms (commonly referred to as eConsent).

According to Robin McKee, Director of Clinical Solutions at FormFast, which offers an eConsent solution, “It’s the right time to be having the conversation about the costly risks associated with a paper-based process. Over 500 organizations recently experienced compliance issues due to missing informed consent forms according to the Joint Commission). Adopting an electronic solution is an easy and quick way to offer a better patient experience during the consent process.”

With an eConsent solution like FormFast’s, hospitals would be able to:

  • Have patients fill out forms on a user-friendly tablet
  • Pre-populate information on the forms with EHR data
  • Link to educational material that explains the procedure and risks in more detail
  • Quickly recall consent forms prior to the procedure by scanning the patient’s wristband
  • Provide a copy of the consent form (and links to the educational material) to patients

Smooth Hospital Processes

Feeling respected as an individual is key to a good patient experience. In fact, a 2015 Consumer Reports Survey found that patients who said they did not feel respected by the medical staff were 2.5 times as likely to experience a medical error versus those who felt they were treated well.  One of the easiest ways to show respect for patients is to value their time and prevent long delays during their hospital stay.

For patients, it is a horrible feeling to show up at the appointed time for a procedure, only to be carted to a waiting area in nothing but a flimsy robe and left to wait with no explanation. Now imagine how it would feel after 20 minutes of waiting to have a member of staff come and ask you to fill out another set of consent forms because your originals had been lost. Of course, while the patient is filling out the form, the staff member must review all the risks and implications of the procedure before you can sign the forms again. I know I would be about as calm as a palm tree in a hurricane.

This situation is referred to as “gurney consent” and is something that many hospitals are trying to eliminate. The National Center for Ethics in Health Care has a special guideline that prohibits gurney consent – VHA Handbook 1004.01 – Informed Consent for Clinical Treatments and Procedures. That handbook states that “Patients must not, as part of the routine practice of obtaining informed consent, be asked to sign consent forms ‘on the gurney’ or after they have been sedated in preparation for a procedure.” This clause was meant to ensure the consent does not occur “so late in the process that the patient feels pressed or forced to consent or is deprived of a meaningful choice because he or she is in a compromised position.”

Sadly, gurney consents are an all too common occurrence in hospitals that use paper-based consent forms. JAMA reports that missing consent forms cause 10% of procedures to be delayed, costing each hospital over $500K each year. This of course does not count the emotional toll it takes on patients.

It would be remiss not to point out that members of staff equally hate the need to have patients re-sign consent forms. It’s not comfortable to be the bearer of bad news and stand there while an upset patient vocalizes their displeasure. After all, the staff member is not the one that lost the form. Medscape’s recent National Physician Burnout & Depression Report found that the top contributor to physician burnout was excessive administrative tasks. Asking for another consent form from a patient certainly qualifies as an excessive administrative task.

“By modernizing document workflows, FormFast gives patients, their family member and clinicians the information they need, when they need it,” says Rob Harding, CEO of FormFast. “Digitizing the informed consent process helps ensure procedures go according to plan – no one is running around trying to find a paper document or asking for forms to be filled out yet again. A frictionless workflow makes for smooth operation which helps both patients and health professionals. eConsent is really a win-win.”

Conclusion

There are a myriad of ways to improve the patient experience. Big, bold initiatives and small, simple changes to existing processes. Although it is not an either-or situation, in the current economic and regulatory environment, hospitals should look for “small wins”, like eConsent, as an affordable and pragmatic way to improve the overall patient experience. As an added bonus, clinicians and administrators will also reap the benefits of lower stress and smoother workflows.

No matter what initiative, a hospital takes, ANY effort made to improve patient experience is a step in the right direction.

FormFast is a proud sponsor of Healthcare Scene.

The Evolution of Forms in Healthcare – Working to Empower the Patient

Posted on July 31, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I recently had a chance to see a demo of the new FormFast Connect product which empowers the patient to complete all their healthcare forms at home or wherever they may be.  Talking with FormFast was really informative since they are the experts at healthcare forms with over 1100 customers using their technology to handle the sometimes messy job of healthcare forms management.

It’s worth taking a second to look at the evolution of forms in healthcare.  Everyone remembers the stack of pre-printed forms at registration and the nursing station.  Then, over time, FormFast and others started creating bar coded forms that could easily be scanned and integrated into your IT systems using document workflow management software.  Shortly after that we started to see forms generated on demand with patient information printed dynamically.  Then, we moved to electronic forms and eSignature capabilities which converted the analog paper form model into a digital one.  The natural next step in the evolution of forms is to push the forms out to the patient outside of the four walls of the hospital.  That’s what FormFast Connect does and is a great evolution of the FormFast product.

We all know that filling out forms in the doctor’s office or hospital registration area is suboptimal.  Many patients don’t have the information with them to fill the forms out completely and the waiting room or registration desk often create a rushed environment to complete the forms.  In fact, many organizations have resorted to making time consuming, expensive phone calls to patients in order to collect the pre-registration paper work they need from the patient.

This is why an online form solution, like FormFast Connect, that is completed by the patient before the visit is going to be an important tool for every hospital.  The reality is that patients are starting to expect the same kind of online conveniences they experience in their normal life in healthcare.  Filling out forms electronically before a patient visit is one area where healthcare can provide a much improved online experience that mirrors the conveniences provided by other industries.

The real question is why has it taken so long for healthcare to create and adopt these solutions?  Many EHR vendors offer some half baked form options in their patient portal, but that’s exactly the problem.  A half baked form option in your patient portal doesn’t really address the issue.  Forms management is a challenging problem and most EHR vendors have been too busy worrying about regulations and other requirements that they haven’t created a high quality forms management solution.

For example, we know that the majority of patients now have some sort of cell phone or mobile device that they would like to use when filling out pre-registration forms.  Any form solution that pushes to the patient outside of the hospital needs to provide a mobile optimized option for the patient or it will likely fail to engage the patient in completing the forms.  Most EHR vendor forms aren’t mobile optimized and thus fail to achieve the desired outcome.  Plus, it’s not enough for the form to be mobile optimized for the patient.  The form must also create an output that is legally structured for the provider and the legal medical record.  Sounds easy, but I assure you it is not and EHR vendors haven’t executed across all these areas in the forms they offer.

One exciting part of a mobile optimized form solution is it opens up a number of opportunities that were a challenge previously.  For example, mobile devices can easily snap a picture of the patient’s insurance card as part of the form completion process.  The same goes for an electronic signature which is easily captured on a mobile device thanks to all the great touch screen technology found in all our mobile devices these days.  I’m also interested to see how smart form technology continues to evolve and improve as data becomes more liquid in healthcare and certain portions of the form can auto complete for you.

It’s great that we’re finally pushing form completion out to the patient where they can do it in a convenient, comfortable environment.  This is valuable to the patient who enjoys a better experience and for the hospital who receives better quality information.  Plus, even if the patient elects not to fill out the forms before the visit, this is one more opportunity for the hospital to build a relationship with the patient outside of the hospital.  That relationship is going to be key in the new world of value based reimbursement.

FormFast is a proud sponsor of Healthcare Scene. 

With 25 years exclusively focused on healthcare needs and over 1100 hospital clients, FormFast is recognized as the industry leader in electronic forms and document workflow technology. FormFast’s enterprise software platform integrates with EHRs and other core systems to automate required documents, capturing data and accelerating workflows associated with them. By using FormFast, healthcare organizations achieve new levels of standardization and operational efficiency, allowing them to focus on their core mission – delivering quality care. Learn more about FormFast at formfast.com.