Healthcare IT News - February 2009 - (Page 9) www.HealthcareITNews.com February 2009 ■ Healthcare IT News O M M N T r y informed consent key THE JOINT COMMISSION recently announced changes to the Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery, underscoring the vital role that informed consent plays in patient safety quality improvement. In fact, the Universal Protocol now requires that informed consent documents be available in the preprocedure area during the verification process and in the procedure area during the time-out process immediately prior to the start of the procedure. This added emphasis has prompted leaders at healthcare facilities to step back and evaluate their approaches to informed consent. Many have come to the conclusion that, when viewed as model for shared decision-making between provider and patient, informed consent can serve as the ultimate patient safety tool. By recognizing the importance of ongoing dialogue, facilities acknowledge how vital it is that patients are truly “informed” as they provide their consent for tests and treatments. To be successful, however, these organizations must transform both their thinking and their workflow processes. In terms of thinking, many progressive healthcare facilities and providers are borrowing the time-out revised Universal Protocol, may prove helpful. Armed with an understanding of the patient’s capacities, communication preferences, and limitations, informed consent discussions may and should begin as soon as diagnostic and therapeutic options are introduced, and follow the patient throughout care delivery. Paper-based consent documentation becomes unwieldy in this scenario and, increasingly, facilities are turning to automated applications. Best-of-breed systems offer comprehensive libraries of procedure-specific consent documents – which are customized on a case-by-case basis to identify surgical site and other information that is pertinent to a patient’s unique circumstances. Because the documents are electronic they are easily accessible to all members of the care team whether in the office, testing facility, or operative suite. These applications offer additional teaching tools including images and diagrams that address the needs of FAy patients who best respond to visual Rozovsky discussions of their conditions and Rozovsky planned procedures. Likewise, autoGroup mation facilitates the use of teachback techniques which allow staff to evaluate comprehension, uncover misunderstandings, and confirm decisions. An example of the value automated informed consent can offer is found with the Veteran’s Administration, which has deployed a tool called iMedConsent. Use of a software application to assist with chronicling informed consent, coupled with the VA’s comprehensive electronic medical record, makes treatment and patient-specific documentation immediately accessible in pre-procedure areas and during preoperative time-out for use in verification processes that serve to minimize the risk of error. Healthcare organizations would be well advised to evaluate their current practices, and begin to implement changes to ensure informed consent processes include both a “consent time-out” as well as ready access to documents throughout the continuum of care. Fay A. Rozovsky, JD, MPH, is president of the Rozovsky Group and a recognized authority on healthcare risk management and informed consent. Newsmaker iNterview What is the biggest change for 2009 TEPR+, Feb. 1-5? TEPr+ 2009 has changed from a conference that mainly addressed the selection and implementation of electronic medical record systems to an event that focuses on the emerging changes in healthcare. What prompted the first TEPR event? Twenty-five years ago, there was a vision to create continuity of care in healthcare through longitudinal electronic patient records. This was an overwhelming, unrealistic expectation not accepted by many. Enterprise-wide solutions thus became the focus, and we take credit for promoting EMrs and EHrs more than any other organization during the subsequent 25 years. C. Peter Waegemann CeO, medical records institute, Boston, which launched tePr (toward and electronic Patient record) 25 years ago Director of the Center for Cell Phone applications in Healthcare (C-PaHC) “ Informed consent can serve as the ultimate patient safety tool.” process employed prior to a surgical procedure and are applying a similar process of checks and assessments immediately prior to the informed consent discussion. A “consent time out” evaluates the capacity of the patient to participate in the informed consent process. Auditory, visual, physical, speech, and cognitive capacities are assessed. In addition, an effective “consent time-out” will also consider the patient’s health literacy, cultural, language, and family participation needs. Many effective healthcare providers intuitively perform many of the assessments that comprise a “consent time-out”. For providers who have a limited history with their patients, use of a checklist approach to the “consent time-out,” similar to the checklist mandated in the What inspires your staying power after 25 years? While we promoted EMr systems all this time, others came onto the scene. Today, EMr systems are a topic across numerous healthcare conferences. Therefore, true to our vision, we are taking on and will drive the next big wave that many are not yet aware of or attending to. It is the mHealth revolution. We believe that mobile technologies will change healthcare even more than the vision of electronic patient records. We are, and will be, the center of this movement. How might TEPR change? It will more than today focus on the disruptive changes that technologies will bring to healthcare. There is a need for standards, an ecosystem description for interoperability, a blueprint for mHealth, and more. These changes may be painful for some but offer opportunities for others. Our future events will explore these and show that change cannot be avoided. What are you reading? My current books are “Hot, Flat, and Crowded, “and “Wikinomics.” I’m particularly interested in the power of consumers and patients to transform medicine. MoRe at HealthcareITNews.com e Connect: WaegeMaNN 0209 ● leTTeRs Continued from page 8 Readers split on social networking YES The ability to share from a “patient peer” perspective provides additional empowerment to patients, specifically in light of reduced time available to spend with physicians during the diagnosis and subsequent care process.” - Anonymous thrown out, there will not be broad based adoption.” – Giri Iyer GE Healthcare IT “In summary, TLCHC embraces the integration of dental care into its medical model. As oral health parallels the broadened meaning of health — ‘a complete state of physical, mental and social well-being’ one cannot be healthy without oral health.” I think HL7’s leadership should visit Ashland, Wis., to get up to date info on how standards should be formulated, also Marshfield, Wis. If HL7 did not integrate medical and dental care and data, shame on HL7! I hope you find I am wrong. Valerie J H Powell university professor, computer and information systems Chair, education and training, WG, WorldVistA Robert Morris University Moon Township, Pa. MoRe at HealthcareITNews.com e Connect: letteRs 0209 HEaltHcarE It NEwSmONItOr NEwS mONitOr NO “Patients won’t take time to participate.” – Anonymous Q 80% 60% 40% 20% 0% are social networking web sites such as patientslikeme.com and americanwell.com of value to patients and healthcare providers? 69 reader responses “More objective information should allow for better customization of care to individual patients, instead of the typical try multiple options and see what works for you approach.” – Anonymous “Yes in theory. Unless GINA goes into play and pre-existing conditions gets EDITOR’S NOTE: A new study from PricewaterhouseCoopers predicts that technology will empower patients in new ways in 2009. PwC anticipates growing patient-to-patient interaction over social networking platforms and Web sites in the future. 54% 46% YES NO ● To take future surveys, subscribe to our enewsletter, HealthcareITNewsWeek, or visit us daily on the Web at HealthcareITNews.com. http://www.HealthcareITNews.com http://www.healthcareitnews.com/news/informed-consent-key http://www.HealthcareITNews.com http://www.healthcareitnews.com/news/newsmaker-interview-3 http://www.patientslikeme.com http://www.americanwell.com http://www.HealthcareITNews.com http://www.HealthcareITNews.com http://www.healthcareitnews.com/news/new-standard-dead-arrival
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