Transitioning to digital consent being 'business as usual' (BAU)
The transition to business as usual (BAU) sees Concentric use within an organisation transition to a steady state requiring minimal day-to-day project support after completing the implementation activities and phases outlined in our delivery playbook.
This guide outlines the steps and considerations for that process, which will be amended to your local context. For some elements, the transition is a checkpoint to ensure that the right processes have been put in place, whilst others tend to require a change in process for BAU.
We are on hand to support the process, with the experience of helping many organisations through the transition to BAU.
Are we ready for BAU?
At the end of deployment phase 3, Concentric should have been introduced into all in-scope clinical areas. Following a stabilisation period of a few weeks after the last clinical go-lives, the organisations should be able to transition to BAU.
As a guide, BAU transition can often be considered when digital consent represents around 80% of the in-scope consent processes. The process can act as a nudge for remaining clinicians or specialties to transition from traditional paper processes.
It is in both our and the healthcare organisation’s interests to ensure that digital consent is the default process by the point of BAU so we can offer specific clinical engagement support for any late or reluctant adopters.
BAU considerations and actions
This section outlines the different elements, sharing our experience regarding best practices. Local contexts can be significantly different, so we are happy to discuss the best approach for you collaboratively.
Removal of paper consent forms from general circulation
In phase 3 of deployment, the delivery playbook advises the removal of paper consent forms from general circulation (i.e. not kept in clinical areas except in ‘downtime folders’ or similar) as clinical areas go live with Concentric. Due to clinical areas often not mapping directly to specialty go-lives, it is appropriate during the transition to BAU to ensure that paper consent forms have been removed from general circulation, including any modification to paper consent form ordering, contracts, and printing processes, with appropriate BCP downtime provisions and processes in place.
Our experience demonstrates that organisations that do not effectively remove paper consent forms from general circulation observe an extended or indefinite period of parallel paper and digital consent processes, leading to confusion, delays, and errors.
For clinical areas with easily accessible paper consent forms on entering a BAU transition period, we would advise communicating to the relevant teams a 4-week window during which replenishing will stop, with the removal of remaining paper consent forms at the end of the 4-week window.
Some clinical areas may be out of scope for a Concentric deployment, such as consent for fertility treatment; communication and processes may need to consider these scenarios.
User management, training, and first-line support
Depending on the processes adopted during deployment phase 3, there may be adaptations to user management, training, and support during the transition to BAU; this section describes the recommended state by point of BAU.
User management, i.e. starters and leavers, should be managed as part of the usual process for clinical applications, and the process for both should be reviewed during the transition to BAU. Different processes may be required for permanent and rotating staff (e.g. resident doctors). An organisation-specific how-to guide for user setup is often useful given that Concentric is different from some other applications; a user account needs to be created within Concentric, which then links to the organisation’s single sign-on (SSO) process. Depending on the organisation’s configuration, the guide may need to cover details such as adding users to certain SSO user groups.
For users that should be assigned admin privileges, the process is outlined in our admin application guide. For information governance reasons, we only enable admin privileges if the request has come from an approved individual; please ensure that we are informed of who these approved individuals are as part of the BAU transition. Before BAU – given that processes, responsibilities, and teams involved often change during the transition – it’s advisable to review the admin accounts for any required additions or removals.
Clinicians’ general support queries will usually be managed via the organisation’s service desk function from the transition to BAU. In some cases, these are managed by the digital consent project team before BAU, therefore requiring a change of process. As part of the transition to BAU, the flowchart for support request resolution and escalation (internally and to the Concentric support team) should be reviewed, and any guides/FAQs maintained for the support team should be reviewed and updated with any learnings from during deployment. As Concentric’s support email is a support route clinicians use, please share service desk details with us, including any structure or minimum dataset requirements.
User training: As most existing staff will be familiar with, and already using, Concentric by the time of the BAU transition, the primary training consideration will be subsequent new starters. From BAU, this will need to be managed without the project team, who will often have supported training processes during phase 3. In most cases, Concentric training at BAU is handled via a combination of an onboarding guide with written and video content (as per pre-BAU) and training alongside other clinical application (e.g. EPR) training during induction. Training processes for rotating and permanent staff should be documented and shared with Concentric to aid in responding to direct queries we receive from your users. As part of preparations for the transition to BAU, it is advised that the onboarding guide is reviewed and that the responsibility for managing required updates to the guide is defined. Train-the-trainer update sessions can be run at the volume and cadence stated in the contract; in some cases, these haven’t been fully utilised during deployment due to project team involvement, meaning that a train-the-trainer session can be run as part of BAU transition.
Content requests and non-Concentric consent information
Concentric content continues to evolve following the transition to BAU, led by the Concentric clinical content team. A key consideration during this transition is whether any changes are needed to how content update requests are made and, where relevant, how updates to the organisation’s patient information library are communicated to the Concentric content team.
Details on submitting content requests can be found on our Concentric Ontology requests process page. During the transition to BAU, it’s important to confirm and communicate organisational decisions, such as the level of approval required for organisation-specific changes, so that appropriate logic can be applied on our side.
Transition to BAU is also an appropriate point to review the consistency and cost-effectiveness of non-Concentric consent information used across the treatment pathway – such as printed or digital patient information leaflets (PILs) provided by third parties or curated locally. In most cases, organisations discontinue non-Concentric third-party consent information services around the time of transition to BAU if not done before this.
Where local libraries of patient information are maintained, clinical scenarios covered by Concentric typically mean that such resources can either be removed or simplified to focus only on organisation-specific details (e.g. attendance locations or contact details). This avoids unnecessary duplication and reduces the risk of presenting conflicting information to patients.
Where organisations have embedded local patient information links within Concentric, reviewing the process for informing the Concentric content team of updates may be appropriate – depending on the approach taken above. If locally maintained resources are retained and linked within the application, a mechanism for communicating updates should be agreed upon. Options for managing this are outlined on our patient information leaflets process page.
Integration alerting and communication
Whilst little technical input is usually required following technical go-live, there are some scenarios where IT and integration team input is needed during the transition to BAU and afterwards:
During the transition, it should be ensured that the technical/integration architecture documentation is complete and accurate. This documentation is crucial as post-BAU – without the project team in place – organisational project memory and context are often lost, meaning that technical or integration problems can become much more challenging to resolve, particularly if some of the original technical team have by then left the organisation. If there are any updates, please send the updated documentation to your Concentric project manager.
During BAU, as is the case during deployment phase 3, integration issues visible to the Concentric technical team will be alerted to the organisation. The process and contact details for alerting should be reviewed as the transition to BAU often involves a move from alerting the project team to a service desk email address; updates should be communicated to us. In some cases, different communication and escalation routes need to be considered for in-hours and out-of-hours alerts, urgent vs routine communications, as well as different communication routes for the various integration elements; for example, connectivity (particularly for those running our Cloud Connector), demographic and document integration, and SSO configuration. Concentric alerts can only be sent to the organisation via email. They should be sent to centrally managed inboxes, not individuals’ accounts.
Planned and unplanned Concentric downtime communication
Unplanned Concentric downtime: While rare, there are occasional instances of unplanned Concentric unavailability, for example, due to an issue with our cloud provider. Downtime and resolution updates are communicated via the Concentric statuspage, and automated update alerts can be subscribed to.
Planned Concentric downtime: Concentric planned downtime is infrequent and conducted when Concentric usage is low (e.g. late at night). Per our contractual obligations, we provide 10 working days’ notice of any such downtime via the Concentric statuspage, and automated update alerts can be subscribed to. Concentric will also display an announcement banner within Concentric on the planned downtime day.
We recommend that the relevant team members ensure they are subscribed to updates as part of the BAU transition. A list of required subscribers’ email addresses can be shared with us to cross-reference with the subscriber list. The organisation’s digital consent business continuity plan (BCP) should be reviewed to ensure the process for communicating both planned and unplanned Concentric downtime to clinician users is robust and up-to-date.
Service review meetings
At the transition to BAU, we will move away from regularly scheduled project meetings to 6-monthly service review meetings, alongside ad-hoc support as required. Service review meetings can benefit both sides; they provide dedicated time to review usage and quality metrics, allow sharing feedback on the product or process, allow discussion of evolving or emerging needs, and are a mechanism to share and discuss product roadmap updates. The meetings will also review upcoming needs like contract renewal, integration changes, or DPIA / consent policy / clinical safety case reviews.
During the transition to BAU, it is recommended that a decision is made regarding which stakeholders/job roles should be involved in the service review meetings. Before each service review meeting, we will prepare and circulate a data pack, including usage and quality metrics.
Our preference is to do the first 6-monthly meeting around the time of transition to BAU, which can be a valuable summary of the journey with Concentric to date (taking into account that those responsible for BAU management may differ from the project team and may not be familiar with digital consent), and ensures that key stakeholders are aligned at this critical stage.
Conclusion and support
There are several considerations when planning the move to digital consent being ‘business as usual’. We hope this guide is a valuable starting point, alongside conversations with your Concentric project team. Get in touch if you have any questions.