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using an automated informed consent application (AICA) called iMedConsent from Dialog Medical. As its new Pensacola surgical service began to come on line, GCVHCS took the opportunity to evaluate its methods for offering pre-procedure instructions. During a few brainstorming meetings, staff asked, “Why not use the consent application to additionally automate pre- procedure instructions?”

Three distinct motivations guided the decision to provide pre-procedure instructions via the AICA. They were the desire to: 1. Offer patients more detailed, personalized pre- procedure instructions;

2. Best document that patients received the correct pre-procedure instructions; and

3. Verify receipt of instructions via patient signature.

Using templates to personalize instructions GCVHCS’ Biloxi and Pensacola staff worked together to develop an automated process aimed at educating pa- tients to be fully knowledgeable about, and prepared for, their procedures. Templates proved to be the answer to personalizing information, and initial template creation focused on the procedures most commonly performed

at GCVHCS: colonoscopy, bronchoscopy and esoph- agogastroduodenoscopy (EGD). Starting with the most commonly performed procedure, new sets of instructions were rolled out one at a time. About seven unique sets now are in daily use.

Here is how the process currently works: Instructions typically are prepared for patients by a nurse during pre-operative clinic visits. After the patient watches a short movie about the scheduled procedure, the nurse discusses it further and asks the patient to verbalize – in repeat-back fashion – what he or she understands. At that point, providers open the AICA from within the EHR and select the “patient signature forms” option. They then choose the desired set of instructions from a list presented on the screen. For example, they might click “joint ambulatory care center (JACC) pre-op in- structions.” A check box allows them to mark the correct procedure (e.g., bronchoscopy, colonoscopy, dilatation, EGD, sigmoidoscopy) and enter personalized details in specifi c fi elds that include: • The date of the procedure; • The date to expect a confi rmation call; • Medications to take on the morning of the procedure;

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