Part 1 of 5: Pre-registration & Telehealth Consent Strategy
As hospitals look towards the “post COVID-19” future, they are shifting their focus to increase operational efficiencies and rapidly create additional cost and workflow opportunities. The old proverb “necessity is the mother of invention” holds true now more than ever.
Patient care preference, dictated by necessary safety measures, has obligated hospital leaders to completely recalibrate how they approach healthcare visits, pushing mobile-based solutions such as Telehealth, Home Monitoring, Virtual Waiting Rooms and Virtual Visits; the list goes on and on…
As rapid innovation and “trail-blazing” have become the new normal for hospital Information Technology departments, we here at Access wish to help by providing useful information that can guide healthcare strategies and efforts in this new era.
In Part 1 of this blog series, we will be providing information about forms and consents that may be considered for a “virtual waiting room” or telehealth visit initiative, answering common questions, and providing you the necessary resources to help you navigate this journey. We’ll also address some of antiquated differences between rural telehealth initiatives that do not translate to hospitals, as well as provide solutions to increase workflow capabilities around EHR integrated consents.Your Hospital Telehealth Informed Consent Resource Guide
What is “Virtual Visit” and “Telehealth Informed consent”?
Simply put, a virtual visit informed consent form obtains consent, explains what telehealth is, lays out expectations, benefits, and patient rights; and addresses security measures and risks for the patient. Some variations also include more detail on as billing, trainee observation, prescribing policies, scope of service, communication, and follow-up. While informed consent is not always required by law for telehealth or virtual visits, from a security and compliance standpoint, it is always a best practice. Surprisingly, virtual visit consents have largely been a “scan in and manual archive paper process” due to widespread use in smaller clinics and rural communities; however, necessity and technological advances have paved the way for electronic EHR integrated consent forms to quickly become the preferred method of consent.
Do you need to obtain virtual telehealth consent?
That's an important question to ask, and it can easily be broken into two parts: “Should you?” and “Is it required?”
From a compliance and risk standpoint, it is ALWAYS a best practice to require consent for your telehealth and “virtual waiting room” visits whenever possible, even if it is not required by law. According to Elizabeth Krupinski, Ph.D., Associate Director of Evaluation for the Arizona Telemedicine Program and Director of the SWTRC, “even if your state doesn’t have specific rules on informed consent for telemedicine, keep in mind that informed consent not only informs and protects the patient, but also, according the MedPro Group, protects the provider from the risk of facing consent-based negligence claims.”
Legal requirements vary from state to state. Some states do not require consent, while others require written or even verbal consent. Consent requirements could also be a condition of payment, depending on the payer.
So where do I go to find out? Center of Health Connect Policy has created an easy to use Telehealth Policy Resource Map to help identify current state laws and reimbursement policies, which you can find HERE. Simply click the link and choose your state. You can further filter by category, topic, and keyword.
What should your consent form look like?
First and foremost, you should check current laws and policies for telemedicine through ATA, your regional Telehealth Resource Center, or CCHP for specific guidance on what MUST be included. These organizations can also be a valuable resource in providing sample telehealth informed consent forms. Also, keep in mind to include any additional billing or scheduling policies that your hospital may have regarding telehealth visits.
Southwest Telehealth Resource Center suggests following these guidelines:
- Inform patients of their rights, including the right to stop or refuse treatment
- Inform them of their own responsibilities for the Virtual Visit
- Include a formal complaint process to resolve potential issues that might come up
- Describe potential benefits, constraints, and risks, including privacy and security
- Inform patients of what will happen in the event of a technology or equipment failure during the virtual visit, and state a contingency plan
- Inform and obtain their consent when students or trainees are present
- Obtain consent before recording a virtual visit; make it known that any recording made will be available upon request and that the recording release will require written patient authorization or court order
- Adhere to all applicable laws and regional and local practices as to Patient Informed Consents & Disclaimers
- Set appropriate expectations regarding Virtual Visit to include proscribing procedures, communication, follow-up, and scope of service.
- Have a process in place for those who refuse to sign the consent forms or receive virtual care
Form Types and Samples:
Sample Consent Forms
- General Patient Consent
- Consent to Treatment & Release (Kentucky Telecare)
- Sample Informed Consent for Telemedicine Services
- Authorization and Consent to Participate in Telemedicine Consultation
Prioritize EHR Integration for Telehealth Consent
In speaking about a post-pandemic approach to healthcare IT, Randy Davis, Vice President and CIO of CGH Medical Center, says, “The need for access to records has now been 100 percent verified.”
At present, the virtual visit sector is dominated by paper forms that must be scanned in by the patient from home or dropped off at the hospital. This completely defeats the purpose of any total telehealth or virtual visit narrative, causing unease and dissatisfaction for patients. In addition, hospital staff then must scan a re-printed form or manually archive the form into the corresponding patient record within the EHR, delaying access and increasing unnecessary workload, not to mention wasting paper. No matter how you slice it, paper-based consents stand in stark contrast to the priorities of a proper Telehealth strategy. Paper-free “contactless” check-in is the goal, but an electronic forms solution must be consistent with the following:
- Patient convenience – Are patients required to print and scan in the consent form, or can they access it through their mobile device?
- Patient experience - Is the consent simple, quick, intuitive, and fully informing?
- Patient safety – Are patients required to come into the hospital to fill out the initial consents or drop them off? Do they have to spend an extended period of time in the waiting room?
- Automatic EHR integration workflow – Does your HIM staff have to manually retrieve and archive the form into the EHR patient chart?
- Immediate clinical access to patient records – Are there any delays caused by manual processes such as scanning and archiving?
- Ease of use for clinicians – Can staff easily access, update, and send forms to recipients? Can clinicians easily customize the form with relevant content?
Keep Workflow in Mind for Your Telehealth Consents
While the COVID-19 pandemic has changed the demand for virtual care from "nice-to-have" to "must-have," the telehealth playbook for clinics does not fully translate to hospitals. Standard paper consent processes, which work for small rural clinics, do not necessarily align with current hospital initiatives to increase operational efficiencies and to rapidly create additional cost or workflow opportunities.
A complete telehealth strategy for hospitals must include EHR-integrated solutions, like Access eForms’ “Impression,” which paves the way for a paperless and contactless check-in process as part of a “virtual waiting room” experience for patients who must visit the hospital.