Electronically Signing Professional Physical Therapy Consent Template Made Easy

Electronically signing professional physical therapy consent template

hello / hello everyone and welcome to today's program automating informed consent moving from paper to electronic consent forms presented by forum fast and hosted by p SQ h my name is Michelle Clark and I'm the managing editor @ p SQ h and i'll be your host for today's webcast our program will be 60 minutes in length the first portion of the program is presentation followed by a question and answer set phase program is being recorded before we get started I'd like to take a moment to review the web conference clap first to ensure that you can see all of the content for the event these maximize your event window second be sure to adjust your computer volume settings and or pc speakers for optimal sound quality third at the bottom of your console or multiple widgets you can use to submit a question click on the Q&A widget it may be open already and appear on the left side of your screen you may submit questions at any time during the presentation however please note that it is likely that your questions will not be answered in doin a portion of the did you experience any technical difficulties during today's program and need assistance please click on the help widget which has a question mark icon and covers common technical issues we're very excited to offer this free educational opportunity we have formed fast and now I would like to introduce today's speakers first is Renee Martin a partner at dilworth Paxson LLP and next is Yancey stout a project manager at forum fast and finally before we get started a copy of today's presentation is available in the resource list which widget which is located in the lower left area of your screen please note that an on-demand version of this program will be available approximately one day after the completion of the event and can be accessed using the same login link that you use for live program with that I would now like to pass the program over to her well thank you very that's Michelle good afternoon everyone thank you so much for joining us I'm going to be discussing the legal elements of informed consent on the basis of the doctrine itself the elements that should be included in in the process of obtaining informed consent and then review how informed consent can result in malpractice actions against mostly physicians senses we'll find out as we go through the broadcast that responsibility for obtaining informed consent still largely and principally lies with physicians so I just want to go over informed consent and what it means generally and believe it or not the first time that the right to informed consent was recognized in the United States was in a Supreme Court case in 1771 authored by Justice Cardozo who was one of the esteemed Supreme Court justices of the United States Supreme Court and he noted in case where a woman had not consented to have and it's the under anesthesia have a tumor removed from her abdomen she brought suit against the doctor and he said informed consent doctrine is based upon the principle that every human being of adult years and of sound mind has a right to determine what shall be done to his or her own body so the doctrine of informed consent as you can see at least goes back to 1771 as being an important and basic foundation upon which patient care is is on based upon its based essentially on the patient's right to exercise control over his her own body and to be able to decide intelligently for himself or herself whether to submit to a particular procedure informed consent requires their position and again as I said it's all generally sits on the duty rests with the position to disclose to the patient the information that will enable that patient to knowledgeably evaluate the nature of your treatment that is being proposed what are the risks associated with it as well as what are the alternative options and the risks and the benefits associated with those options the likely outcomes of each and all of that should be discussed with the patient in a way that they can understand and comprehend on before the patient is actually subjected to the actual course of treatment why do we need I'm informed consent and why is it required well everyone has a right to be free from unwanted touching um and this results when a physician performs a medical procedure without the patient's consent and we'll see that that element of unwelcome or unwanted touching is one cause of action that can be brought under a failure to obtained informed consent the second important principle is that patients have the right to have autonomy on to make decisions regarding their own bodies and their own health now granted there are certain situations that will touch upon briefly in the cases of a minor or if someone likes on the mental capacity to make those decisions for themselves but as a general rule the patient is autonomous has the right to control on the decisions regarding their own health in their own bodies and they also have the right to make an informed refusal of treatment without position liability for the resulting harm to the patient for that non treatment so it gives cuts both ways they have the ability to UM say they want the treatment and if they're of sound mind they have the right to say they do not want the treatment on to Wyeth informed consent required well first of all because I'm sure we're all aware there's a special relationship that develops between the physician and the patient and the patient places this duty on the physician um that they will be kept informed of the risks and the alternatives of their of their care and their treatment so whenever a patient comes to see a physician or even a nurse or a physical therapist once that patient and practitioner relationship develops then under a negligence theory or under a malpractice theory that's the basis upon which any cause of action in negligence or malpractice would emanate from their negligence in the informed consent framework that that's the framework that's used in the majority of states negligence means that the patient needs to prove that there was a duty which we've discussed already between the provider in this case the physician and the patient that there was a breach of that duty that the breach of the duty was a direct direct cause of actual physical patient harm that resulted in compensable damages so under the negligence theory the position has a duty to the patient to keep the patient informed of the risks and the alternatives that are available for each significant medical procedure so unless the plaintiff if they're going to brown their theory against it if physician and negligence can prove all four of those elements they haven't proven that the physician has been negligent now there are two legal standards that have evolved over time considering what does the patient want to hear about and what does a physician believe that he or she must inform the impatient of so there are two legal standards as one revolves around the patient one is the patient need to know standard and in some states informed consent is what an individual would reasonably need to know to make an intelligent decision about the procedure that's being proposed to them now whenever you hear the word reasonable arm in a legal context that really means you're looking at an objective standard that the average person on the jury would agree with it is not what that individual has as a subjective standard it's an objective standard that everyone can pretty much agree upon arm so it's an objective standard that means some real new jewelry someone from the outside looking in to the discussion between the physician the patient would say this is what I would want to know if I was in that into individuals position um keep in mind though that in most cases doctors ordinarily are not required to give a detailed medical explanation that nawl probability the patient you know would not understand so no matter what we're talking about i think we all understand that what the patient needs to know i would want to know would be on the types of general information that the average person would need to know to make an informed decision the other standard that is used in other states looks at the informed consent that a physician believes or a reasonable medical practitioner believes would be responsible for providing to the patient under the same or similar circumstances so it's again it's an objective standard what would a physician let's say a cardiac surgeon be expected to inform a patient who's going to undergo cardiac bypass surgery what would they need to know about that procedure but what would a physician a cardiac thoracic surgeon from an objective standard on be required to tell the patient and it's an objective standard so that means it has to be something that is not subjective to the physician him or herself and this generally requires the use of an expert witness because the expert witness then would be called upon to testify in a negligence action on regarding whether or not that physician in that particular informed consent process met that objective standard now the other theory that can be used to bring a cause of action in against a physician for a lack of informed consent is that in medical battery and battery means several things first of all an unwanted touching so we've all heard about battery assault and battery being used in the criminal context but the basis of medical battery is sort of the same thing it rises from that same context historically where the patient is being touched in a way that they have not consented to the plaintiff has to establish either that they were unaware that the doctor was going to perform the procedure and they didn't consent to it or that the patient did not armed authorized the actual procedure that was being done for example in the medical battery where the patient did not consent to exactly what was done or agreed upon between them and the physician is there was a case where a dental case where a patient thought that he was going to only have a couple of teeth pulled while he was under arm anesthesia and the position actually pulled all of his teeth and on the patient had all those extractions done and then had to be hospitalized every after so he was able to bring a cause of action against the position for battery because the physician went beyond what he and the patient had discussed as what was going to be the course and the scope of the actual procedure the second time that informed consent can be a result in a battery is if the patient did not authorize the procedure itself this is the case where the doctor performs a surgery that has been discussed but the surgery is actually performed on the wrong body part they amputate the wrong limb surgery autumn extends beyond the field that the patient has agreed upon for example this is similar to the individual who had all the teeth extracted instead of the several teeth let's say there have been cases where women have gone in for hysterectomies and during the course of the hysterectomy the doctor or the surgeon believes while I'm in here I'll do an oophorectomy at the same time and I think in this day and age we can see that that would be on something that would be kind of egregious but in the past on physicians on I think we're a little bit more lenient in more paternalistic about how they are treated on patients and had more of a mindset that they knew what was best for the patient now the important thing to realize is the two cases that I've shown you here resulted in some kind of harm to the patient um loss of reproductive capability and then with the guy with his teeth out he had to be hospitalized but let's say the physician um does a procedure extends beyond that which the doctor said they were going to do in a common case of this is when surgeon will go in and do something on the colon and while they're in there they'll do an appendectomy well um having the appendectomy performed by the physician didn't actually cause any harm but perhaps that wasn't discussed between the surgeon and the patient before the on the informed consent and during the conformed consent process and there have been cases where on plaintiffs have sued because that actually they don't get too far because I think the average person on the jewelry that the damages are very limited I so the patient wasn't does it need to actually show harm and the other thing why and the other reason why this is chosen as a cause of action rather than bringing one under negligence is that you don't need expert testimony to establish the fact that the physician went beyond the scope of the surgery that he or she had discussed with the patient prior to the surgery okay so in order for negligence to be the cause of action to recover sort of a reiteration of what we described a little bit before but this is in more detail about actually what the duty of informed consent means in your negligence malpractice action and specifically number one the physician has a duty to disclose information including the material risks and alternative treatments including non treatment the patient they have a duty to disclose what a reasonable patient would consider material okay so this goes to the standard that most states use that you were looking at a reasonable physician standard and expert testimony would be brought to bear at the trial to show what a reasonable patient would be expected to hear you have to be able to show the position did not disclose required information that the failure to disclose the required information cause damage or injury to the patient and then the patient suffered some kind of harm or injury as a result as a direct result of the breach of complying with what was requisite information the patient needed in order for there to be an adequate and fully informed consent so sometimes all you need to show if the patient is emotional distress and that may be enough to have a claim for negligence under the negligent informed consent theory overwhelmingly it remains the physicians duty to and to be responsible for obtaining informed consent there are some nuances now that we have you know other health care practitioners and allied health care practitioners on providing certain services but most of these allied health professionals on physicians assistants and nurse practitioners or nurse midwives they either function collaboratively or they function under the supervision of a physician so it's still the ultimate responsibility still rests with the physician themselves in fact as in point of fact in Pennsylvania it's expressly stated in the statute regarding the physician supervision of a physician assistant that it's the strict liability of the physician for anything that is done or not done by the physician's assistant that could result in patient harm also in Pennsylvania and I'm just using this as an example says this is where I largely practice one of the things that came out of our state's attempt to reduce malpractice exposure for physicians was that mistake holders got together the plaintiffs bar the defense bar insurance companies etc and they actually statutorily dictated what needs to be included in an informed consent discussion and when informed consent is necessary so not all states do that but you should check your your statutes and your codes in your own state if you're subject to them to see what the informed consent elements are and if they're codified at all keep in mind also that the document and I'm sure that against you will talk about this even further but that document is nothing more than a document that ever the informed consent form that shows that the discussion took place and as a defense malpractice attorney which is what I do when I first graduated law school I can tell you that that consent form can easily be disregarded or um yet disregarded by plaintiff counsel is just saying well that's just what the paper says but that's not what the patient is saying they were informed about so informed consent generally the position still has to provide it there may be statutes within your own state that lists who else can obtain informed consent but one of the most important things and questions that I frequently get from nurses who are afraid to sign on the witness line on informed consent form the only thing the nurses is witnessing is the patient signing the document they are not signing the informed consent form to indicate in any manner whatsoever what was discussed between the physician and the patient nor to give any attestation that the adequate that the informed consent process was adequate the sole purpose of the witnessing of the on the consent form is to demonstrate that the patient signed the form okay two other concepts of concepts I'd like to discuss and move on to and I sort of alluded to them at the beginning are you know who can give consent and when when can an individual not give consent involved in this or are two separate concepts first one is competency and the second one is capacity we'll talk about capacity first capacity means you're able to consent to medical procedures and it's determined by the criteria of informed consent so what does the patient have the ability to do can they understand the medical procedures specifically understand a description of the procedures its risks its benefits its alternatives time he or she give consent is are they competent meaning does he or she have a guardian and that's when that we have to look at whether or not they have competency to do that are they able to reasonably understand the condition nuts to be treated the effect of the proposed treatment the risks the benefits and treatment and non treatment is the patient unable to understand the consequences of their decision that not patient is unable to give informed consent and is therefore on lacks capacity so therefore you would turn to then their personal representative or perhaps a legal guardian that is been appointed on their behalf now in many many cases the family members or the individual that is having a surgery has not gone to the point of having a judicial determination that they lack capacity to make their own medical decisions and that's why it's so important to understand and establish as early on as possible when you first have interaction with the patient who's their personal representative and who who do they want to make luckily for you if they have an advanced directive but who will make decisions for them and keep in mind that minors lack capacity to consent under most state law unless they're an emancipated minor in some states you have to file for that in actual court of law or in other states you become emancipated because you've got marriage of graduated high school you have been pregnant one time but generally there's an AIDS in each state that says when you are legally capable to make your own decisions to consent the surgery or to buy a car or to do any of those things and so you'd have to look in your own state to see what that age is now competency is illegal finding competency proceedings like I said include guardianships and were conservative ship hearings and they are conducted in a court of law on and the individual has a representative on that says that they lack competency to make decisions for themselves and they go before the judge and the judge on makes that determination now incompetency is the lack or the ability to discharge or understand either health care decisions or financial management decisions and sometimes you'll see a power of attorney that says the person is incompetent either to make health care decisions or to make financial decisions and most of the times you'll see one is combined on with both and that's the same thing as if you see an advance directive sometimes or a durable power of attorney you have to look at it and see whether or not it's for a health health care decisions or financial decisions or both and then if the Court finds of the individual likes competencies and they will appoint someone else to be able to make decisions for them arm in order to get a guardianship usually the standard is pretty high because I think as you can see from the case law that dates back to 1771 that there's a very strong belief that the individual lacks excuse me has capacity to make his around decisions absent a really good proof that they're incapable of doing so they can't take care of themselves they can't take care of their own necessity so you can't get there in two shelter and they're generally sort of naughty able to care for themselves and and unsafe for them to take care of themselves and they really need someone else to assume those responsibilities for them now so that's who can give consent who's responsible for giving consent what are the legal theories that can be brought against a physician who is proton predominantly still responsible for obtaining the consent so we've covered that so now let's look at what are some of the elements of the informed consent well first of all basically you have the physician has to describe what the procedure is and again there's a balance here that has to be achieved between giving sufficient informations that the patient understands what's going on giving information in a manner in which the patient can comprehend what they are being told and then on making sure that they're not giving so much information that you're inundated the patient and I know unfortunately this doesn't happen in practice but many times the patient might need you know several question-and-answer periods with the physician as I digested material and have additional questions for the the physician but you know it's pretty fast paced in in this world that we live in these days you know gone are the days when I was in nursing school when the patient was admitted the night before they were given a sedative you know they were they were at the wash and shower with their beta 9 scrub it sets or while they're in the hospital well that doesn't happen anymore the conformed consent you know it sometimes signed in the physician's office and the next left next time the patient sees the position they're in the waiting area to go in to have surgery and they might even already have gotten their pre-op medication but you want to make sure the patient understands the risks if the procedure is not performed to benefits if the procedure is performed what are the potential complications the usual ones and the rare ones and generally most patients when you hear well what's the percentage of the likelihood of a rare complication occurring again alternate treatments and risks and benefits of each alternative and then what are the residual effects going to be from the surgery what's expected on recovery time and this is what the average person um generally would like to UM understand and to know about the procedure that they're going to be engaged in or have performed on them and that's the information that most physicians I think provide to patients in various depths or in in pence 21 the amount of time they actually spend with the patient um because I said the consent form in and of itself is only there to document that the conversation took place any good risk manager would tell a physician that it's also good to document specific areas of concern or of interest to the patient in the progress note also so that it's another way for the physician to UM if the patient is going to bring in action in negligence to actually show what was discussed in what was um emphasized during the course of obtaining that patients informed consent the one of the problems with obtaining informed consent and what's the problem with the form itself while most procedures and treatment plans are really highly complex and they're difficult to understand and it's hard to get that all down on a piece of paper providers really are not always able to invest the proper amount of time and the face-to-face time that's required to translate all of the aspect of the procedure it really anymore with physicians being rushed on in the office visits um it's dawn and fast confessed and there's insufficient time and they've done Studies on this and I'm sure we'll continue to do this as time goes on but you know just as with any patient education you want to hear them recite back to you what they've just heard and that frequently is something that is not no time allotted for that also with any educational materials videos and those kinds of things can be provided that would also be a help because as I said the forum in and of itself does not get the job done the other problem with the forum is that um it's frequently that timely patient signatures are not obtained and I have already been involved as a risk manager in a hospital and even though we have pre-op checklists and you think that the patient wouldn't get to the ORV under anesthesia before someone realizes that the consent form has not been signed but I have had had had multiple instances of the surgeon and the anesthesiologist you know running to my office and I'm letting me know that on the patient's under and they haven't signed the consent form and the only real way to tackle that is to let the patient lighten up enough from anesthesia so that they can go ahead and sign the form even though they might be under the effects of anesthesia the idea is the discussion and means formed consent was actually obtained before the patient got to the lr table and based upon that rationale it's okay to have the patience signed the form at that time there's also a lack of consistency in completing the forms missing and consent forms are always a frequently a problem patient signatures may be eligible and actually the PA q h actually did a study that examined the completeness of 540 consent forms from about 150 seven hospitals and nationwide and of these only 26 point four percent included all for the basic elements of informed consent the risks the benefits the alternatives and the nature of the procedure eighty-seven percent noted the general possibility of a risk but less than half provided any specific information on what their more fine-tuned and expected and/or rare expected side effects could be from the operation or procedure being performed alternatives to the procedure were only listed in 59 fifty six point nine percent of the forms and the benefits of having the procedure appeared in only about thirty seven percent of those on forms and both of them were just general references and no real specific information being provided so the risk of paper informed consent really um has shortcomings for patient safety in two ways number one wrong wrong site wrong body part even though you know jayco has during commission has this the patient marking the site that's to be operated on unfortunately mistakes are still made on the quality of the care risks are not frequently provided to the patient the selection of inappropriate therapies or that's not mentioned does a risk there's increased patient anxiety perhaps they're not really listening to adequately what's being said to them and then poor compliance with poor post operative procedures so the automated informed consent forms um can actually create a centralized control repository for procedure specific forms um and certain Ganci will address this in more detail but it actually does improve patient information management it reduces the risk of litigation because patients are much less likely to sue if their patients communicate effectively to them it reduces transcription errors and staff time that's required for transcription it actually improves reimbursement it reduces delays in the operating room due to lost paperwork as I said preoperative checklists are often very insufficient tools and it achieved the heightened compliance with accreditation and regulatory agencies it allows the consent for the procedure to be done by one provider in one facility and it can mirror the consent forms for identical procedures prepared in sister facility so let's say you have an ambulatory surgery center and you have operating center and the consent can be the same across the healthcare system so everybody is familiar with it it ensures the entire document is legible it allows for risks to be uniformly included so it's not left to the individual physician or surgeon to include them in there but yet it does provide some flexibility to customize the form for that patient specific needs providers can access treatment information and answer patient questions about the surgical site location to diagnosis or in our case specific considerations described between the patient and the position the anesthesia etc it also allows a progress note detailing the informed consent to be also simultaneously automatically posted to the patient's chart it allows for the form to be easily translated into different languages and we all know that cultural competency is an issue that CMS looks at for their conditions of participation of hospitals of skilled nursing facilities and even of ambulatory surgical centers and that all of that eases and allows more time for discussions um the significance of all of this is not just patient safety and good physician-patient relationship and that patients are not harmed and they're kept safe but it also goes towards accreditation standards because during Commission specifies that an institution has to have an established policy for informed consent it has to determine what procedures require informed consent establish the process for collecting informed consent and then they have to spend to hospital or the facility has to specify had that consent is going to be documented so the automatic automated consent form does all that the other thing to pay people might not be aware of is that the state operations manual which the state surveyors use for CMS has expanded the definition of informed consent has given explicit detail concerning on what the form is to contain what the description of the procedure has to be listed in there the risks the benefits etc so it has consequences for the patient for the physician and certainly for the facility based upon that I am going to pass this on to Ganci and let her begin her portion of the presentation Thank You Renee that was a excellent presentation and I think that gave us a great idea of the all the legal aspects and the what should be on that form form content I'm just going to touch briefly on a few numbers a few of the logistical challenges that occur in the process so as a Renee mentioned the conversation is so important between the physician and the patient but in addition to that there is a whole process that works around all of that that uh makes everything happen and from obtaining the form to then all the way to the forum actually being available to the care team so I do want to be brief so we can there's some excellent questions out there and I want to want to try to get some moves answered because that's really good stuff and Renee can provide some good answers that but first a quick look and Renee mentioned some great numbers with the form content also uh this is a study done on missing document so document content wants that never made it to the system and couldn't be located afterwards we're just very disconcerting but I mean pretty big numbers for to consider you know what may be happening at your facilities is this an issue a legal concern that as a risk manager or director of nursing I really need to consider and how can I make this better so as I mentioned the process everything is is workflow so how does this all fit together you have to obtain deform initially and if this life cycle preprint very hard to manage and make sure that all the forms and all the different units and departments are fully updated so you have to concern that a clinician may grab a form that is not today and not approve it's an out-of-date form and that could could cause some serious issues down the line when that form gets cold back and is needed for legal purposes once that form is obtained then in a pre-printed form situation on paper a label has to be applied to that with patient information make sure it's indexed and archived in the with that patient record in right aight often that that doesn't happen exactly how we plan it because there's a human element to that we add the potential for human error so with an electronic process takes away a lot of that human error prevents problems and potential problems the availability of the completed form it with the patient records for the rest of the carotene Renee touched on this and this is this is a serious issue in talking with lots of healthcare organizations where not only does it take the time of the ORS staff and nursing staff physicians to keep looking for that or search that form out but it it causes cynical it can cause cancellations and that that causes everybody time as well as is there's a financial cost to that and so the immediate availability of the consent forms is really crucial and then as far as exposure to liability and compliance issues I think Renee covers this beautifully really an electronic form process ensures that the forms are completed the way that they should be there's no changes or bath dating happening for the integrity of the form as is kept and then the form is always there it's always available because there was no human element and to make sure that the form was picked up from the folder on the unit made it all the way to h IM perhaps where it was to be scanned and in with scanned and index and archives in the right place there's a lot of room for error there so kind of process in disaster really quick just think about the your process it reflects on what your process looks like today so if your facility is having some of these issues or considering some of these aspects then you may have a really amazing opportunity to improve that process protect your patient as well as your physicians nurses and organizations and make their experience significantly better certainly there is a to producing in electronic manner informed consent has kind of lags in the in the push to make that electronic I think organizations are realizing that that's the next area they need to focus so just briefly I'd like to go through if you're considering switching to an electronic and consent process one of the requirements you should be looking for what are some of the things you could should consider you know what capabilities are important so first as far as the actual forms management and Renee really made this point with this central repository of forms that makes consistency and accessibility so much better so you want a solution that's going to provide a way for you to scale that if you have more than 10 forms if you're doing a form per procedure which is is very common with health care organizations you may have two kinds of forms you need a solution that Senate provides the capability for you to create those forms an electronic format quickly and easily and revise them unnecessary because as as remain note the content is so important even though that's not the conversation the right content does need to be on the form to help that conversation is long and it should be it should eliminate or reduce certainly the cost of pre-printed forms that you're paying storage of those forms there's a lot of different implications and positive benefits you can have from getting away from that paper and then as far as is the informed consent process at the bedside in the conversation that happens the electronic form can help in many ways that Renee mentioned certainly we've found in setting this that readability of the form you can make it larger with an electronic device or paper you don't really have that option so if if the patient really is a visual person and wants to review and view all of that information we want to make that azz legible as we can for them and then want to make it more convenient for your staff again as I mentioned making the patient and clinician experience better is a key driver of why you will change your process make it more convenient safe in pine and give them a little peace of mind that they know immediately when they push that button the form is in the right place and the care team has accessible heed to that so as far as looking at at the benefits we've talked a lot about this and this slide just really recaps all the different benefits that is that the process can provide over in the the resources you'll see a link to learn more about mobilgas I can send it with with electronic process please click on that link and you can learn more we're going to have some questions in a minute hopefully would get get additional answers there but the the benefit are you know what we need to focus on but really it's more about you reflecting on your process and figuring out what what parts the process do you want to really resolve where are the trouble spots for your organization and make sure that whatever solution that you select meets those needs as effectively as as you need it to as far as a signature collection there is certainly and importance to compatibility across hardware platforms and you know whatever you hardware platforms tablets mobile devices that your organization is using make sure that's in consideration if you're already if your physicians are already using mobile devices that needs to be part of the consideration the requirements that the software solution that's going to pair with them is going to work beautifully obviously it's got to be able to collect multiple signatures and collect them in an eloquent fashion so and really be able to provide that experience for both the patients and the clinician and then the right forms for the patient so this is really important talking about patient safety so here when the wheat for medication and many of the services that were providing patients in on inpatient situation we're checking and confirming their bar code before anything is administered this forms should apply as well so electronic information is going to be pulled on to that form and it needs to be the right electronic information so a barcode scanning application can certainly provide that insurance that it's the right patient instant archival for increased visibility so this is this is the final piece so the rest of your care team and euro our team and everyone that's supporting that procedures it's going to be performed or that whatever that consent form is for needs to be able to access these signs consent form to verify the right body part what's been authorized and and that it's been signed by all the appropriate people before the person is preferably before they're put under anesthesia but certainly before any in more care is provided so I'm going to pass it over to Michelle Ford Asset question-and-answer period and hopefully this is this is provided some benefit to you so Michelle I'll hand it over to you great thank you so much Renee and Nancy this brings us to the Q&A portion of the program so we would now like to invite you to ask live questions of our speakers submit a question click on the Q&A widget at the bottom of your screen it may be open already and appear on the left side of your screen please note that your questions will remain anonymous and will not be viewable by other audience member so our first question and I think this one is for Renee is do you have to provide a patient with a copy of the signed consent I don't know if it's customary but yes you would have to provide a copy of them if they are requested it that would actually be part of the HIPAA requirements great thank you mm-hmm Yancey this one might be for you how does this technology integrate with our eh with our EHR absolutely that's a great question the there's several different ways that we can actually integrate we can create links out of your EHR and on the front end so when you're on the patient record then we can create links into into the form and we can also based on hl7 messages or in order messages we can receive those and generate forms for patients and that way that again a link could could navigate you over we also have an interface that you can access forms on demand so if you're walking around the unit and in on the tablet device that's not necessarily going to be directly from your EHR but you may have a few consent forms to fill out you can log into our software very easily and pull the forms that need for the patients that you you need them for and on the back end so we seamlessly integrate with your most of the major content management systems that soars all of those images that are then available within the EHR on that patient record so once you hit submit based on the information that's already been pulled into that form it indexes that image appropriately with the patient records in real time and so the rest of the care team access to the EHR just as they normally would and the document will be there in the images great thank you Renee this is another question for you actually this is a very popular question we've had several people ask if a witness to the signature is always required for the consent form no and actually just I think there's no legal requirement for the witness that goes back I think to the witnessing of a will and I think it just harkens back to an earlier time than a custom that has just been perpetuated until present day but now I technically it doesn't even really need to be witnessed it's just a policy and procedure to follow though if it's part of your institution okay another question is are completed forms I'm so sorry I looked at the wrong question I apologize I I skipped ahead is informed consent necessary for low-risk office procedures such as joint injections yes and I say that because whenever you are touching a patient and doing something to the patient certainly injecting a joint is touching a patient as it also involves a procedure so it does require some form of informed consent you know what would be the expectations of the benefits of having the injection what would be the benefits of not having the injection where the expected results where the expected or unexpected complications all of those things I think are warranted whenever you are injecting a joint or something like that obviously not an intramuscular injection that that's the worse of a different color um you know you'll say this might hurt a little bit i'm going to inject it into your this goes into your muscle etc so i think but any time you're going to touch patient and inject them with a sharp object it's probably good idea to get some form of consent from the patient great thank you so much the next question we have is our completed forms sent back to the EHR as a PDF and what hl7 mechanism is is used for that typically we're actually using cold feed but certainly in some circumstances we have sims NHL's message to to archive that back so it really depends them assume that you're on and how we we decide to configure it that's going to work best for you we can do it either way but we we typically don't do PDF and so again we can talk about the needs their most often we found that TIFF work really well for archiving to document management systems across the board it again we would just need to discuss your needs as organization and what you want to happen and see how we can meet those great thank you so much so unfortunately we have run out of time for questions in closing we want you to know that your feedback is very important to us and that the conclusion of the program a link for the evaluation will appear in the slide window and it can also be found in the program evaluation widget at the bottom of your screen we would greatly appreciate your thoughts on our program today for further information and resources on this topic please visit you'll see the URL on your screen if you could just click right there it'll take you right to the two more information at this time I would like to thank our speakers again for joining us today and sharing their knowledge on this topic and to our listeners thank you all for putting aside so much valuable time to listen to our program we hope you found it informative ladies and gentlemen this concludes our program thank you again for joining us and have a wonderful day