In the fast-paced world of outpatient surgery, what surgeon has the time to write out all the necessary aspects of each consent form? It's a long list that's gotten longer: benefits, risks, alternatives, expectations and patient education. Medicare's even added a requirement that the names of people other than the primary surgeon who'll perform important parts of the procedure appear alongside the surgeon's name on the consent form. One solution is automating the informed consent process, which can:

• provide a library of forms for procedures you host, letting you give patients clear, standardized, reproducible, procedure-specific consent forms;
• make it easier to capture consent and to educate patients about conditions, treatment alternatives, benefits and risks of a procedure; and
• better document informed consent encounters.

We talked to a few companies that specialize in informed consent technology to find out more.

iMedConsent
Dialog Medical says 160 hospitals and more than 4,000 physician practices use its iMedConsent software, which features a library of thousands of procedures for 29 medical specialties.

"The patient education is fantastic," says Neil Baum, MD, a clinical associate professor of urology at Tulane. "We access this program about 30 to 40 times a day. It provides drug, procedure and diagnostic information in addition to the consent form." Instead of purchasing expensive pre-printed procedure brochures, Dr. Baum's staff prints illustrated patient education material directly from the iMedConsent program, he says.

James E. Gottesman, MD, a Seattle-based urologist, likes the fact that he can access consent forms for more than 300 urological procedures at the touch of a few buttons, and that the consent forms contain procedure-specific detail. "Other informed consent software has excellent consent forms, but only for the most common procedures," says Dr. Gottesman. "If you only have consent forms for 20 out of the 300 procedures that you do, what do you do for the other procedures?"

You can integrate iMedConsent with a paperless electronic medical records system. Patients at the Atlanta VA Medical Center use an electronic signature pad to sign customized electronic consent forms. The patient's signed digital consent is linked to the patient's electronic medical record and then stored digitally on the VAMC's document imaging system.

The iMedConsent PE application license costs $695 per physician with a $295 annual maintenance fee that entitles the practice to unlimited updates and upgrades. IMedConsent Group is available for large group practices and outpatient surgery centers. For more information, visit writeOutLink("www.dialogmedical.com",1), call (800) 482-7963 or circle number 167 on your Reader Service Card.

EMMI
More than 800 surgeons use EMMI (Expectation Management Medical Information), Rightfield Solutions' interactive Web-based product that supports 11 specialties, including orthopedics, gastroenterology and plastic/general surgery.

"We're in the business of expectation management," says Jordan Dolin, CEO of Rightfield Solutions. "Rather than take the current process of informed consent and streamline it, we try to make it more meaningful. We facilitate dialogue between doctor and patient, and more appropriately manage expectations."

Patients use an access code to log on to EMMI, which walks patients through the entire surgical experience from pre-op to post-op, including risks and alternatives. As the patient interacts with the program, even asking questions and getting answers, each click is recorded to create a permanent record of everything the patient saw, heard and did while viewing the program. If necessary, the entire experience can be recreated for judge or jury in the event of a malpractice claim.

Users raved about this easy to use, visually stunning product. Ada Henderson of Laparoscopy Bariatrics and Surgery of Fort Worth, Texas, says that before they began using EMMI, patients (even those from out of town) were required to come into their office to attend an informational seminar. Even after the seminar, patients would have so many questions that the doctor spent hours in consultation answering them. Ms. Henderson says that using EMMI for the lap band and gastric bypass procedures has saved time for the surgeons and patients. Patients can view the half-hour or so presentation in the comfort of their home, print out questions and then consult with the surgeon.

Christy Pennington, the office manager for Gerald Pennington, DDS, an oral and maxillofacial surgeon, has been using EMMI to educate patients about wisdom tooth extraction, implant surgery and bone grafting surgery for the last two years. When asked about return on investment, she said that EMMI is considered an overhead cost, but it's well worth the money. "Protecting your practice is extremely valuable because there's always going to be someone who says they didn't get the information," she says.

For an annual price of $1,200 per physician, you get an unlimited number of access codes. For more information, visit writeOutLink("www.rightfield.net",1), call (312) 236-3650 or circle number 168 on your Reader Service Card.

VisionTree
The VisionTree Healthcare Online platform is a Web-based decision making portal that allows for patient-physician interaction during the consultation process. VisionTree is currently implemented at more than 30 sites across the country, including UCLA and Baylor College of Medicine.

The VisionTree system provides more than just informed consent - patient management and outcomes assessment are included as part of the informed consent process, says the company. Patients can review treatment options with the physician and decide on an appropriate treatment method. Physicians access the program from an Internet site, then review available treatment options with the patient. For a patient diagnosed with breast cancer, for instance, available treatment options may include lumpectomy with radiation therapy, total mastectomy with radiation and total mastectomy without radiation. The patient can view the treatment options, clinical resources and risks of each treatment before making a treatment decision. When the decision is made, a customized consent form can be printed then signed by the patient for insertion in the patient chart.

An initial setup for five physicians is $2,500; cost is $5 per patient. For $15,000 per year, you get unlimited physicians and patients; on-site training; Web and phone support; monthly product updates of the system; and a review of the evidence-based database from the VisionTree consortium of academic sites.

For more information, visit writeOutLink("www.visiontree.com",1), call (619) 295-2800 or circle number 169 on your Reader Service Card.

Satisfied patients, too
Computerized informed consent may also improve patient satisfaction. Patients ranked their satisfaction with informed consent software over traditional informed consent as 4.5 on a scale of 1 to 5 in a recent study presented by Chad Ritenour, MD, an assistant professor of urology at Emory University, at the 2005 Toward Electronic Patient Records Conference.