For years we’d talk about the “paperless office” that would be created by the adoption of EHR software. Years later, that paperless office still doesn’t exist. One of the big reasons this hasn’t come to fruition is because EHRs can print massive reams of paper with the click of the button. Another reason the paperless office still alludes us is paper-based consents.
For years, there wasn’t a good way to replace paper-based consents with eConsents. However, that’s not the case today. To help us move towards the paperless office and to learn about adoption of eConsents in healthcare, I interviewed Robin McKee, MS, RN, Director of Clinical Informatics Solutions at FormFast. In this interview, Robin offers a lot of great insights into consents in healthcare and the value of healthcare organizations moving towards eConsents.
What are the main reasons people are still doing paper-based consents?
I see two big reasons for this. First, it’s a case of “it’s what we’ve always done.” When EHRs were first implemented, mobile was not a part of the strategy. This meant that getting a consent in front of a patient still meant paper and a clipboard. Today, the informed consent workflow is difficult if you don’t have a mobile solution.
Another reason is the sheer magnitude of the project. Over the years, each department, even each surgeon, may have their own version of a paper form, adding up to hundreds of variations of paper consent forms stuck in drawers of offices and nurse’s stations. It is a daunting task to try and tackle the conversion, standardization, and consolidation of the plethora of paper consents without a concrete path forward.
FormFast addressed both of those issues with our mobile eConsent solution. We digitize all of the organization’s consent forms and make them available in an online eForms library. The forms are delivered at the point-of-care on a mobile tablet for the patient to review and sign. Once completed, they’re automatically archived in the EHR. It’s a much more streamlined process.
Are electronic consent forms as legally binding and effective as paper-based consents?
Yes. When you take the stylus and sign your name and submit it, an eConsent electronically dates and time stamps your signature. It also locks the content on the form to prevent it from being modified post signature.
Are there ways that electronic consents are more effective than paper-based consents?
Definitely. In addition to the benefits I mentioned in the previous question, there are several more to add.
From a maintenance standpoint, you have one form to modify and it is instantly available to all staff. Templates can be created to ensure standardized statements on all consents and provide the means to add procedure specific content. Clinicians cannot submit consent forms that have required fields left incomplete. This helps guide the process and ensure consents are completed.
Our eConsent forms also allow for links to your organization’s educational content, right on the form, so it’s easy to link out to approved content for further education while having the informed consent discussion.
What are the biggest misconceptions around electronic consents?
What I have seen most often with our customers has been the idea that the consent is not modifiable, that it is a fixed document. We provide dynamic content based on procedure selection, or editable fields, as well as areas to add content via free text or speech recognition.
Our customers appreciate having a combination of standardized, dynamic, and free text content. Every patient is unique; providers must be able to account for the specific risks, benefits, and alternatives of any procedure for each patient.
What are the costs and savings associated with implementing eConsent?
We see both direct and indirect impact on B organization’s financial landscape. The direct impact is, of course, the savings from eliminating paper. We’ve seen estimates from $3 – 6 per page due to the following factors:
- Supplies – paper, ink, etc.
- Materials – copiers, scanners, faxes as well as maintenance on the hardware
- Staff – to perform printing scanning and indexing functions
- Storage of paper records
- Secure shredding of scanned documents
More indirect costs include the loss of productivity of procedures or operating rooms, due to the delays caused by missing or incomplete paper consent forms. A JAMA Surgery article estimated over $500K per year is lost simply on this factor. Also, while less common, malpractice claims that site a lack of informed consent comprise 2/3 of total claims, opening organizations to costly legal proceedings.
One also needs to consider the value of better forms, workflow and communication via eConsent which improves both patient and clinician satisfaction.
Many of the consents are needed in the EHR. What’s the process for integrating eConsent into the EHR?
Electronic consent forms are superior to paper in this regard. While paper consents get lost or have to be carried around in a paper chart until they are scanned into the EHR, eConsent forms are instantly archived into the EHR. This ensures the document is archived correctly every time. Plus it is easy to access the form in pre-op, as well as confirm in the OR during timeout. We utilize a variety of methods, including HL7 and FHIR, to integrate with any EHR or document management system.
Are eConsent forms secure and trusted? Could a digital signature be inappropriately replicated?
There are a couple of ways we prevent signatures from being inappropriately or inaccurately added.
When a clinician chooses to digitally sign a consent form, the login user’s name is applied. Additionally, our solution provides audit logs to track who has been in the system.
We also require that the patient sign each signature field. This helps ensure that their informed consent is accurately documented.
What are you looking at next when it comes to eConsent?
FormFast recently introduced a great feature that launches and pre-populates the right consent form for the patient by scanning the patient’s wristband. It’s another way that we’ve tried to make the consent process more streamlined.
We continue to refine our eConsent solution based on customer feedback. No one knows better than the end users what a successful solution should look like, what it should contain, and what makes for an optimal workflow.
We look toward updates, such as enhanced notification processes, more OS compatibility, and further improving the user interface, that will continue to improve clinician and patient satisfaction.
With over 25 years exclusively focused on healthcare needs and 1100+ hospital clients, FormFast is recognized as the industry leader in electronic forms, eSignature, 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 at formfast.com.
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