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#CCIOHomeSchool day 2... Lets have a think about #digitalconsent. Why would we do this?
- legibility
- reducing the variation in information provided and recorded
- avoiding delays in care due to loss of documents
Anything else?
- legibility
- reducing the variation in information provided and recorded
- avoiding delays in care due to loss of documents
Anything else?
The key policy document here is probably everybody's favourite bedtime read, the Health and Social Care Act which recognised expressed, verbal and written forms of consent
https://www.legislation.gov.uk/ukpga/2012/7/contents/enacted
https://www.legislation.gov.uk/ukpga/2012/7/contents/enacted
Interestingly there are only limited examples of where written consent is legally required e.g. fertility treatment. However this is seem as best practice where interventions are complex, carry significant risk / consequence or include aspects not related to direct care
The @gmcuk updated guidance for taking consent doesn't add much detail here
https://www.gmc-uk.org/-/media/documents/gmc-guidance-for-doctors---decision-making-and-consent-english_pdf-84191055.pdf?la=en&hash=BE327A1C584627D12BC51F66E790443F0E0651DA
https://www.gmc-uk.org/-/media/documents/gmc-guidance-for-doctors---decision-making-and-consent-english_pdf-84191055.pdf?la=en&hash=BE327A1C584627D12BC51F66E790443F0E0651DA
So where does digital fit? Obvious options include electronic documentation and signatures to help standardise information provision, aid legibility, and stop forms being misplaced. This is ok, but is essentially digital substitution
Still, it's harder than we imagine. Advanced electronic signatures have the following characteristics:
- biometric elements associated with production
- certainty of reliability
- able to authenticate the document and its relationship with the signatory
https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=uriserv%3AOJ.L_.2014.257.01.0073.01.ENG
- biometric elements associated with production
- certainty of reliability
- able to authenticate the document and its relationship with the signatory
https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=uriserv%3AOJ.L_.2014.257.01.0073.01.ENG
At some point, a national digital identify might help with a lot of this, but it's not exactly fast progress... https://www.gov.uk/government/news/next-steps-outlined-for-uks-use-of-digital-identity
Where could we add value now? Creation and curation of information for patients could be delivered nationally, with local EPR data leveraged to provide accurate, personalised measures of risk
This could extend to information about things that matter other than procedural issues like length of stay, time to results...
More interestingly is how in a pandemic scenario we can deliver remote or visualised consent. can we substitute qualified certificates in place of an advanced electronic signature?
Could we adopt and agree a pragmatic standard in place of an advanced electronic signature by developing something similar to email opt in lists backed up by 2FA with wet ink confirmation on arrival?
Ultimately the power needs to be in the hands of the patient and change needs to meet their needs, not just address our perceived problems
