How To Install eSign in Doctors

How to industry e sign doctors install

so with that being said I'm going to turn it over to cliff Babbitt who is joining us again to discuss e-signature today and once again cliff is our director of solutions architecture and we're glad to have them it's about electronic signature at a high level talking about some of the functionality that is some of you may have some some customers may not be familiar with with this feature set but we also will be going into a little bit deeper dive later Pam Landry will be talking about some more of the setup in the application for those users who might be a little bit more familiar using in their environment and may be interested in specific details but feel free to ask questions through the QA interface as we go along here and if they're more detailed we may table that for the in depth session later on but first we will talk in a about a couple of different aspects of electronic signature our applications that support capture on a number of different devices I'll highlight a couple of devices today but really the configuration of the electronic signature area where we're capturing those signatures is a big part of the decision process and the workflow behind capturing those signatures software is is a very powerful tool and we hope to enable the best workflow processes but a big part of that is how exactly is the patient going to be interacting with the registration user and the hardware there so first I wanted to give you a quick look at a standard or it's sort of our preferred or suggested installation for a typical registration area and this this may vary slightly depending on the size of the registration desk how much free space there is there how many signatures are going to be captured at any given point in time but as you can see in this photograph there's a registration user might even be a nurse in a in a unit that's doing them doing work on a PC that's facing away from the patient and we may want to capture signatures and allow the patient should interact with the the forum or forums that they're signing but not other content that the registration user is viewing so if they're in their registration system will there's meta tags and captain also scripts epic Siemens all of all of their work will be on that primary monitor facing a registration user and we can automatically launch the former forms for that that patient in context for their service financial code or financial class and language a number of different criteria that if you're familiar with staff sprint and are printing those documents out automatically today we can generate those on screen automatically for the patient in those same scenarios so the patient sees the documents she needs to sign here and there's an external device a USB Attached signature pad this is a 1 by 1 inch by 5 inch surface that's mapped on to the form wherever the signatures may need to be captured so maybe one signature or multiples as we go through this I'll talk a little bit more about how that's considered but has the patient's signs on that device it also shows up simultaneously on that secondary monitor facing the patient and for the registration user and again this is a this is a standard that if the real estate allows it at the registration area it's a very good solution because the patient can see real time what they're signing a number of other customers have deployed in areas where space is limited or budget is limited as have deployed pre printed versions of the forms have them laminated or just soft copies that are there for them to see otherwise the patient could could also see that on the primary monitor but that can can lead to workflow disruptions for the registration user um so again they'll capture the signature place it on the form and we can archive that into other document imaging or positive for the hospital I'll talk a little bit more about the specifics of how that works as we go through the presentation here another isn't just another view of that to give you a sense of well what hardware can do in in the configuration as you see here this this monitor is attached to an articulating arm that can swing out so if the patient is in a wheelchair or is less ambulatory we can orient that so the patient can see if they're taller or shorter that can be angled so it's you know it allows for the full viewing of that document and some monitors will also be have a limited viewing area I Rana CLE that some of the cheaper monitors on the market have a lower angle via viewing angle word as compared to some of the more expensive models which can actually be a bonus or benefit in registration areas where privacy is concerned we don't want to have other patients see patient information and so that being faced towards the patient can mitigate some of those concerns but some of our customers have also considered I'm not sure how much of this is in use but you can also use privacy screens 3m makes some that also wanted the viewing angle to only those who are directly in front of the monitor some other options we don't have depicted here there are a number of USB Attached monitors on the market there are also touchscreen devices so there's a wide range of devices and we'd be happy to consult with you based on experiences that we've had or other customers have had into pulling this technology and registration areas but one key to keep in mind is that this is not an all-or-nothing solution you can mix and match depending on areas of if you want to have articulating arms and three to five primary registration here is where you get a letter you get a lot of registration throughput that that can be a solution for one area where is another area might have different options for you you might have a USB Attached monitor or even laminated forms an outpatient or sameday surgery area where there's a little bit lower volume or limited desk space so low that can be mixed and matched depending on the requirements for the area again as the patient's signing on the device there is an option some of these devices are backlit and have an LCD panel as you see on the screen here that displays the signature as it's being applied so the patient can see not only on the device itself but on the screen simultaneously along with registration user their signature being applied to that field so it's very high confidence level for the patient and knowing that their signature is being applied to the form exactly where they've been told they can see it applied then after that signature that no document has been signed we can print out a copy for that patient on demand our default now is to limit that to win when it's requested so we're not printing out superfluous documentation and wasting paper unnecessarily but some of our customers have also mentioned that automatically printing out some of this patient information and giving it to patients even when they haven't asked for it can become a HIPAA concern or a patient information risk because the patient may then go put that in a trash can or dumpster and even though it's strictly not the hospital's responsibility for that it de facto can be become that because that that information is still on the campus or in the facility on even though the patient may have placed it there so as we're signing this it's becoming a part of the legal document here and it's a very robust legal signature I'll talk about some of those aspects here as we go through the functionality of the application so here we have a screenshot of what the registration user sees the interface here is I'll talk about in a moment but this can be launched directly from a number of hif systems so there this is a while it is a an application it is a very light application for those of you in an IT it's based on Microsoft's click once functionality that will automatically install this on the pc so there's not IT doesn't have to go out and install the application everywhere although the drivers for specific signature devices might sound I need to be in fouled on the machine but as they're registering some of the H is systems have the capability to automatically launch our application in context for that patient so as an example meditech or McKesson I registering a patient and click on an option to capture signatures it will launch this interface with the documents already prepared for that specific scenario so as an example if it's an english-speaking Medicare patient will generate the the normal consent that every patient gets but may also have Medicare documentation and and they even have some some forms that are specific to the patient type or service that's that's applicable to this specific patient and visit so as you see on the screen here there thumbnails along the left-hand side of the interface that show what needs to be signed for what can be signed for this specific patient scenarios these have already been prepared and are ready for for interaction and they also are color coded according to some configuration behind the scenes first of all we're embedding information from the registration process automatically on the forums and we're also making that decision process for what forms need to be generated but we also can designate whether certain fields are free text fields where we might capture some information that was not already captured during the registration process like a witness name or something along those lines we can pre text into that using a keyboard or as we talked about in the mobile usage of portion in a moment through the through the tablet pc or device like an iPad the the signature field I'll zoom in on us a little bit later when they have a little signature pad and a pen icon to designate that base I nabol feel and that can be interacted with an external device or touchscreen pc or an ipad so and there can also be checkboxes on the forum for those the color coding as you see here all of these fields are designated as optional or fields it can be filled out but are not required and those show up in the application as a blue icon to the end-user so they can see that there are fields that can be fine but they're not required before archiving that into the document imaging repository then green indicates that either all signatures have already been captured or that the document it has no signature fields on it at all it may be an informational form like a page of a consent that it doesn't have a signature on it it's just informational maybe we want to display that for the patient or allow them to request a copy of that but we don't actually need to capture any signatures on that and then hopefully this is intuitive as well the consents at the top has a red icon indicating that there's at least one required signature field on that that needs to be captured before we archive that and those the configuration is built entirely based on the hospital requirements and the build for their individual forms so this is customized for each customer as I mentioned we have fillable fields and signature fields that will display differently on the form the syllable field will be highlighted or filled in blue I can just click on that with a mouse and activate it with a keyboard signature field I can interact with in two different ways I can click on a button at the top of the screen that for signing all of those which will not sign them simultaneously but walk me through a one signature after another and we get it we often get questions about whether we can have a patient Stein in one space and apply that signature to multiple locations on a form or cross forms and the answer is technologically we you know we could enable that but legally that's that's not something that we we support in the application because we really in a healthcare environment we need the patient's be able to authenticate each field that individually they need to be able to determine whether they're signing each field and so we walk that through individually the registration user the other option is to enable field individually so if we have a witness that needs to sign and she's available now whereas the patient is not available as getting some emergency treatment or if it isn't available at the moment we may do that in a different order depending on the patient scenario we also have the option for enabling checkboxes on the form that can be again interacted with a mouse or through a touchscreen and those checkboxes will be active before signatures are applied on the form as has our free text fields so I can have options in this example to say the individual refused to sign or there is an emergency situation and the patient was unconscious or as a minor all of those again are the is customized for facility requirements and then required fields will be highlighted in red and are immediately apparent to the registration user that those need to be filled out that can also be a check box on the form a belief Pam will go through some more of the details about how this is configured and some tips and tricks about using this in your environment later on in their music group meeting there's also now an opt-in in the past year and a half or two that we have tied into the users login credentials and can self find that so the registration clerk rather than needing to sign or touch the same devices that the patient is using across the table column potentially creating an infection control risk but also a workflow risk now the registration user is signed then we know that it's is that it's Betty who's who's logged into this machine and she can simply right click on this field and self find that and what that will do is it will place a digital signature on the form that tells the software it's was electronically signed or digitally signed and it will embed some of that date and time stamp information on the form and as you see the the checkbox is now flattened out this applies the check box to the form and it cannot be changed by subsequent user so once a signature has been applied to the form we remove the ability to interact with us with those free text fields and checkboxes for legal reasons again so that if a patient has signed something and has acknowledged the content of the form a subsequent signer cannot change that we can clear that form and update the content but that removes the signatures for all the previous signers and and then if a legally robust document everybody is confident that their signature applies to all the content on the form as they saw it at the time the individual signatures as we talked about before can be mapped onto the field so as they sign that it will be dynamically displayed on on the device in on the screen as well now one thing that that is also relatively new for us is sports app for mobile devices we came out with mobile e-cig recently and have expanded our support beyond just you know some of the windows divided compatible devices to the iPad platform and the Android as well as Windows tablet PCs and the like but this these are some screenshots of the way it looks on an iPad so similar interface to our normal application we can select a form that needs to be signed select a patient and open forum and interact with it on and iPad or Android device this is we also had some questions around this today this is a essentially an html5 application that is compatible across a number of different browsers which allows us to use that in an Android and an iPad environment there is not a Google or Android app for an ipad iOS app at this at this point in time but that can be done through the browser and stored on the on the iPad or Android device has a hyperlink to get into the application design forms through here so one one constraint of this as we potentially lose some integration capabilities that you have in the registration in a typical registration desk where we may be automatically launching our annotation clients but we can now take this right up to the patient's bedside using a device that maybe the nurses the physicians already have on on units so again this this is a discussion point that is very important to determining what's what's rolled out in a facility and we don't necessarily want to introduce a new device for capturing signatures we want to be be able to plug into a device that's already in use in an area an this is one of the reasons why we enable the the iPad because we know that a lot of clinicians are whether whether the hospitals are necessarily embracing that initially physicians are or more commonly using iPads and a lot of lot of our customers have strategies or plans to adopt specific technology so if there are devices in use in clinical units that page that the nurses or physicians are already taking up to a patient's bedside we can use those without having additional devices and place just for our signatures one slight difference also on the mobile technology is that as I click on a signature signature line it will display in resumed in for the full screen on an iPad so I can interact with it if it's stylist or even with my finger so the patient signature may not look as as nice as it would on a signature pad like the Topaz but it will allow the patient to do that right at their bedside we embed that on the form just we do with the other signatures and now that's available to be sent to the document imaging repository so with that one of the things I haven't touched on in much detail yet is orc iving that form really one of the biggest benefits of this process is that we eliminate the need to scan these documents in rather than now having a printed copy of warm with a patient sweat signature on that that needs to be scanned we have all that of the data metadata for that form that allows us to automatically send that into the document imaging repository whether it's mcKesson's patient folder meh detects scanning and archiving for Cerner's document imaging or some other platform like story and EDM you have work with almost every document imaging vendor on the market and have specifications to output those files in a format that will be automatically indexed into your document emission repository so it will then be essentially viewable real-time by anybody that has authority to view that patients documents within within your legal or document imaging repository with that I believe I'm I'm post up on time on on the electronic signature component are there any questions that have come in through QA or chat that we can address we do we have a few questions here so the first question is do you have any customers using tablets to capture a signature would form fast and a patient registration environment if so how do you handle the security of the tablet device that's a great question I I don't so specifically in registration environment that has not been widely deployed this is it's kind of a difficult area that our customers have haven't necessarily found a good solution for for things like that and registration area is one of our customers recently was looking at deploying iPads so we're looking into allowing that in those areas but for supporting the rollout of devices like iPads or tablet PCs and registration areas but there are number of concerns they go around that that are sort of implicit in that question the the cost of the device how are we going to make sure that it doesn't get damaged or taken from the facility we at four fest you don't don't sell the devices or have any really real stake in the specific devices that are deployed but we we have some ideas around what options can be deployed there some of some devices have some security built-in that will allow tracking that if it does get taken outside of the facility there are also options for having those tethered you know a lot of lockdown certain certain pcs or tablets can be locked and have have the ability to keep those near the registration desk but that then limits the the usefulness of having it as a as a tablet pc that the patient could take back to to their area really i think the ipad and similar devices will roll out more flexibility in that realm so we'd be happy to talk through some of those considerations with with you offline and see what would be a good fit for your environment ok the next question is how do we get the paper forms on to the tablet so maybe you could give a little preview of what Luke will show on the form design side absolutely that's a great question and as Sharon says it says that's really there's a two part process to that and because of the restructuring of the breakout sessions now you'll be able to see both of those components later in the day I'm going to try and share form designer with you here one second while I bring up a form that's assignable calm but they're the first part of that is the design of the form so you can scan in a paper form or convert a and existing soft copy of that in PDF or Excel Word into our form design application and just checking to see if I got a good form that I can share with you here and I are going to put you on the spot there if we need to to save that for Luke's section next and we can do that yeah I may try and share that in a moment but essentially we take that and build it in our form design application and it will look very similar to your paper today will will work with our customers to optimize or configure a template so that the information is standardized across the forms we have a bar code for the document type and a layout that complies with ehh IM standards for for space around the edge of the form for the margins and revision numbers and all those details and then there's a second part that Pam will be discussing to her portion a little bit taking that form after it's been designed and building in an hour in our application so it's ready for electronic signature and that's really placing where is the signature going to be applied if it's going to use a topaz 1 by 5 device that sort of thing get into that a little bit high and go to those sessions okay another question that came through the chat is launching the ecig capture screen and McKesson specific to launching from the quezon star or H bill HB f I le we're going to be launched either one oh that's there are a couple of different ways we've launched it from mckesson i know that we we do with a lot of our customers launch that through io e le has the ability to have that patient context i'm not sure if the about star without highly installed we may follow up with some with them offline and look into that to be sure but i believe tarragon also has an option to do that directly now so there there are a lot of different ways that we've done that with with McKesson customers but Iowa is the one that we've done the most frequently and really is a standard offering that um and the kevin has excellent i see also question about highland and if we worked with Highland on base before and that is that that is something we've done before we've output two on days and they along with many of the other vendors like perspectives image now have a very standard way of if they play in a sandbox very well with most document imaging systems do that they accept documents in a standard format with some indexing information and that's we've worked with them before and absolutely have that functionality available okay that looks like that's all the questions we have at this time as I mentioned Pam Landry be speaking on e-signature and some of the best practices for working with dead in a bit so if you have more questions then then you can ask pam we can ask cliff as well if you have a question specifically for him whether this a point I'm going to segue into the form designer portion of the presentation