Great Ormond Street Hospital
Leading pediatric hospital streamlines clinical workflows to improve the patient experience by digitizing consent forms, signature capture and use of clinical guidelines.
The challenge
Paper consent forms prove problematic, wasteful
It’s more than five years since Great Ormond Street Hospital (GOSH) — one of the world’s leading children’s hospitals – decided to go paperless as part of its ongoing digital innovation journey.
Specifically, it wanted to replace the paper consent forms that are critical to its work with patients. But staff at the hospital knew that any move to replace paper had to go hand-in-hand with a robust e-consent solution. What’s more, GOSH needed a solution that would satisfy very specific consent form needs.
“One of the challenges of being a leading pediatric hospital is that we, by nature of our organization, require up to six versions of consent forms for procedures,” said Joanna Tucker, ICT programme manager at GOSH.
UK law stipulates that pediatric hospitals like GOSH have to collect individual consent forms for patients under 16 years old, 16- and 17-year-olds — and patients who are 18 years and older. It is also incumbent upon staff to collect consent forms associated with a patient’s religion, mostly to ensure proper use of blood products based on individual belief systems.
Ensuring regulatory and ethical compliance around these criteria resulted in an extraordinary amount of essential paperwork.
According to Chris Jephson, ENT consultant at GOSH, the hospital needed to manage as many as six sets of six-page consent forms for every procedure. And any e-consent solution would need to capture multiple signatures on one document.
“Sometimes the number of signatures we need to capture on one form is huge,” said Jephson. “The parent needs to sign, the child and clinician need to sign, and we may need an interpreter, social services or secondary clinician to sign.”
GOSH also required additional forms for photography, MRI requests and other clinical paperwork. The result was a confusing paper trail that could lead to misplaced documents, omissions and confusion. At any time, staff might be circulating multiple paper versions of these documents around the hospital.
The solution
Hyland delivers multiple-signature capture form
Faced with such complexity, GOSH decided to design its own dynamic e-consent form tailored to its exact requirements. The hospital already leveraged PACSgear for medical images, and OnBase — Hyland’s enterprise content management and process management software platform — in other areas of the hospital. And it was also actively using Hyland’s integration with the Epic electronic patient record (EPR) system.
As a result, Hyland was included along with other vendors in the discovery process for an e-consent solution.
Most vendors we met with could only show us how to electronically capture a single signature. We mentioned this to Hyland. Within days, they came back to us with a multiple-signature capture form. A developer at Hyland custom-created this application for us in a matter of days. That really impressed us.
— Joanna Tucker, ICT Programme Manager, GOSH
Tucker went on: “We now have one form, and the form changes dynamically based on the age and religious beliefs of the patient. It’s hard to fill out the wrong form now.”
The shift from a paper-based process to a digitally dynamic electronic form has transformed this important part of the patient care process. It is also infinitely safer and more secure in terms of protecting patient information.
“Having it linked into the encounter makes it impossible to lose the consent form,” said Jephson.
Accessing, filling out and submitting the form is simple. And it all takes place through OnBase and within the patient record.
To begin, staff and clinicians simply create a new form, linking it to the encounter from Epic.
Once OnBase generates the form, it automatically populates fields with demographic data from the Epic record. Then staff enter fields not pre-populated electronically.
Once this is complete, patient, guardian and clinician signatures are captured digitally using a touchscreen device.
What’s more, because the form is added to the team’s overall task list, it automatically tells the healthcare team when a patient is ready to enter the operating theater. Via Epic flight boards — which track and provide case status in the Operating Room and provide timeout documentation for intra-operation teams — clinicians are informed when pre-op is complete, when the consent form is signed, and when the checklist is complete.
“With a paper consent form, this wasn’t automatic,” said Jephson.
e-consents improve the clinician and patient experience
The adoption of a paperless system has proved so successful that staff have requested modified forms for different departments and specific procedures. For example, one team has requested a metals questionnaire and consent form for patients requiring an MRI.
The e-consent form also provides a better patient experience. If a patient must undergo the same procedure multiple times, they no longer need to fill out all of their information in a new form each time. The Hyland solution saves the information provided in the original consent form, simply removing the signatures for resigning.
A chemotherapy patient undergoing six courses of treatment, for example, no longer needs to fill out a consent form for each course. Instead, signatures are added to the bottom of the pre-existing form, saving time for clinicians and allowing the patient to focus on their treatment rather than paperwork.
More importantly, I feel that parents and their children like the experience of signing the electronic form. I think it helps them to feel like they’re taking part in the process of their care as opposed to just watching us type things into the computer.
— Chris Jephson, ENT Consultant, GOSH
As the hospital’s digital transformation evolves, clinicians continue to discover new and innovative ways to make patient care simpler for staff and clinicians through OnBase. For example, as Epic replaces certain legacy systems, OnBase is serving as a secure and accessible repository for historical data that GOSH must retain from those systems.
Another innovation allows doctors to use their own devices to capture clinical photography while working with patients. By law, clinicians cannot possess patient-identifiable material on personal devices. However, the Haiku/Canto method of capturing consent — employing Epic's electronic health record secure apps — allows users to capture an image and upload it directly into OnBase, bypassing the personal device altogether.
It eliminates clinician risk and enhances patient care since doctors no longer need to send a patient to another department for image capture.
Launch of Mind Palace streamlines clinicians’ access to clinical guidelines and protocols
In 2023, GOSH took another step forward in its collaboration with Hyland by creating Mind Palace, which is designed to capture and manage clinical guidelines, policies and procedures that integrate with Hyland’s OnBase platform.
It addresses one of the most challenging aspects of patient administrative support. How can clinicians search for — and locate — multiple documents in a hospital’s ever-growing digital footprint? More importantly, how can this be achieved when real-time access is needed?
The solution — Mind Palace — serves as a knowledge base for staff that addresses these problems with faceted navigation, conversational search, natural language support and other intuitive features to enhance clinical productivity and patient outcomes.
It means staff no longer have to ’make do’ with time-consuming legacy document viewing systems that don’t quite fit their clinical workflow.
Instead, Mind Palace is a dedicated tool that’s always-on and accessible from anywhere with seamless system integration to support organization-wide clinical teams.
Dr Shankar Sridharan, chief clinical information officer at GOSH, is clear about the impact this new solution has made.
At GOSH, we care for children and young people with the most complex and serious health conditions and their care can span across many specialty areas. For our staff to deliver gold-standard care, we need secure, easy and rapid access to information within vast clinical guidelines. The Mind Palace knowledge base acts as a complementary force to our electronic health record and will enable us to deliver better care.
— Dr. Shankar Sridharan, Chief Clinical Information Officer, GOSH
The difference
The roll-out of the paperless e-consent form solution — and the more recent Mind Palace technology — underscores the close professional relationship between GOSH and Hyland. It means that GOSH can continue its digital innovation safe in the knowledge that Hyland is an established long-term partner focused on patient care.
To date, both projects have:
Eliminated paper, saved time: Prior to implementing its e-consent form solution, GOSH, with its traditional EPR-generated consent form, would print out the form, have it signed, scan it back into the computer and then shred the paper. With a dynamic e-consent form, staff and clinicians can pre-fill forms by uploading patient data stored in Epic. Patient data is always up-to-date, and consent forms take less time to complete.
Provided quick and easy access to forms: Users have a single, easy-to-use interface to complete, sign or print pre-populated form packets on demand. Administrators pre-define form packets based on custom business rules, ensuring caregivers confidently produce the right forms, every time.
Customized solution streamlines access: The bespoke Mind Palace solution provides a single, federated search interface for staff to find information and documents from a variety of sources across GOSH’s large digital footprint. The solution features faceted navigation, conversational search, natural language support and other intuitive elements that enhance clinical productivity and patient outcomes.
Enhanced patient experience: Rather than juggle as many as six sets of six-page paper consent forms, GOSH’s dynamic e-consent form allows staff and clinicians to focus more on patients rather than paper. The interactivity of the form is also a boon for parents and patients, who feel like they are taking part in the process of their care.
About Hyland Healthcare
Hyland Healthcare provides connected healthcare solutions that harness unstructured content at all corners of the enterprise and link it to core clinical and business applications such as electronic health records (EHR) and enterprise resource planning (ERP) systems. Hyland Healthcare offers a full suite of content services and enterprise imaging tools, bringing documents, medical images and other clinically rich data to the healthcare stakeholders that need it most. This comprehensive view of patient information accelerates business processes, streamlines clinical workflows and improves clinical decision-making.