Getting started with Concentric
Before we start, if you're using Concentric at a large healthcare organisation there may be a specific getting started guide, including local integration and support details here.
Welcome! As a small team solely focused on improving the consent process we're here to support you and hope you enjoy the move over to digital consent.
Most healthcare software is difficult to use, slow, and gets in the way. We hope you soon agree that using Concentric feels pretty different. This is a light-touch guide, supported by a video walkthrough, and should be more than enough to get you comfortable with using Concentric within 10 minutes or so.
To start, watch this 3 minute video
Why introduce digital consent?
After using Concentric, the vast majority of clinicians state that they prefer digital consent to the traditional paper process, that the quality of the consent process is improved, and that their time is better utilised.
Patients report improved shared decision making quality, appreciate that their consent information is increasingly accessible and clearly presented, and allows them to revisit the information in their own time.
Read more about the impact of introducing digital consent here.
When your account was set up you’ll have received an email from Concentric with some initial instructions regarding activating your account. Depending on how you’ll login to Concentric this will have either told you which single sign-on provider to use or will have asked you to set your password.
You can then access Concentric at app.concentric.health, or if you’ve been given demo access to Concentric, this is at demo.concentric.health. Concentric can be accessed anywhere, on any web-enabled device. The integrations with other systems work the same regardless of where you are accessing Concentric from.
To get comfortable with using Concentric, most clinicians try it out with a test patient record for a few minutes. Each Concentric deployment has some test patients set up, usually you can search for ‘test-patient’ in the search bar but if that doesn’t work email email@example.com and we’ll direct you to your test patient records.
How is Concentric used?
Using Concentric is simple, and most clinicians take only a few minutes to get accustomed to how it works. The process is that the consent information is prepared for the patient, and then that personalised information is shared with the patient. The 3 minute video in the section above is the first thing to watch if you haven't done so yet.
Concentric can be used in all three main consent scenarios: adults with capacity (consent form 1), agreement to treatment from an individual with parental responsibility (consent form 2), and treatment in the best interests of an adult without capacity (consent form 4). You can read more about the specific workflows here: consent form 2, consent form 4.
Finding a patient record
In most cases Concentric is integrated with patient demographics, meaning that to find a patient record simply search using their identification number (depending on your deployment of Concentric this might be a hospital number, clinic number or national identifier such as an NHS number).
On selecting a patient, ensure that it is the correct patient so that no consent information is assigned to the incorrect patient.
If your deployment is not integrated with patient demographics there are some additional details about creating patient records here.
Preparing consent information
Clicking 'new episode' in the patient banner takes you to the treatment search page where you can select the appropriate content template. As you start to use Concentric your most commonly selected templates will show as a quick-select option on this page.
This video shows how treatment search works, how combinations can be selected, and modifications such as setting +/- or giving a treatment a custom name can be done. If there are no appropriate templates consent information can be prepared from a blank template.
The consent elements are then presented in the 'clinician view' page. The 'responsible clinician' is the senior clinician with overall responsibility for the patient’s care, who will most often be the consultant in charge of the patient. This must be assigned correctly as the information is used in communications to patients and is often used for other purposes (integration, dashboards etc.).
For each of the elements - such as indications, alternatives, risks, patient information (external signposted resources) - clinical concepts / resources can be added. This is supported by template concepts and resources, except in the case of blank templates.
Whilst information can be walked through or shared at any point, in order for consent to be given there are some 'required for consent' fields that must be completed. Once these are done, the action bar at the bottom of the page will say 'ready for consent'.
Sharing with patients and giving consent
There are two key elements to the consent process within Concentric from the patient's perspective, the consent information and the consent flow. The consent information is the information selected by the clinician in clinician view, and the consent flow includes the consent statements, additional consents, and documenting of a signature.
Where possible, a consent conversation including the sharing consent information through Concentric should occur prior to the day of treatment, during a face-to-face or remote consultation. However, where this is not possible such as in emergency surgery scenarios, Concentric can still be used.
To walk through the consent information most clinicians use 'consult view' - a patient-facing version of the information selected. Consult view can help structure the conversation, ensuring discussion through the different elements, and also presents the information in the same way as patients will have access to it in their patient app. After viewing the different sections in consult view you will see a page titled 'Are you ready to consent?' - this is the start of the consent flow. Some clinicians prefer to talk through the information without using Consult view.
Information can be translated into another language using in-browser translation tools. However, if the patient cannot speak English professional interpretation services must also be used.
Sharing with patients
Patients should be provided access to their consent information so that they can consider it in their own time. Consent information can be shared with patients from a number of different places within the application. Most patients receive this digitally via email/SMS, but if the patient does not have digital access, printed consent information should be provided. Read more about sharing information with patients here.
Whenever consent information is being shared (as long as the sections marked 'required for consent' have been completed in clinician view) there is an option to enable remote consent if appropriate.
- Following review of the consent information in consult view (and stating that consent is not to be given at the time) there is an option to share information with the patient.
- Consent information can be shared directly from clinician view by clicking 'Share with patient'
The consent flow can be completed in person with the clinician or remotely, and patients should be comfortable that they have had time to consider the consent information prior to completing the consent flow.
The consent flow is accessed in one of three ways:
- Following the consent information in consult view if the 'required for consent' section have been completed then the page 'Are you ready to consent?' will show, this is the start of the consent flow.
- At the bottom of the patient app page is the option to proceed into the consent flow if remote consent has been enabled.
- The consent flow can be directly accessed from clinician view by clicking 'Skip to consent' (only visible if the 'required for consent' section have been completed) in the episode bar.
The consent flow goes through the consent statements, any additional consents, and records a patient signature (clinician is automatically electronically signing). If using a touchscreen device the patient can simply sign on screen. If using a device without a touchscreen then a QR code will appear - follow the instructions on screen with any touchscreen device to add the patient signature, before continuing on the original device.
Confirmation of consent
Where consent has been given prior to the day of treatment then consent should be confirmed on the day of treatment. This can be done by clicking 'Confirm consent' and any discussion or questions raised can be documented.
WHO Surgical Safety Checklist
On the day of treatment completed consent episode details are usually viewed on screen and do not need to be printed out. Depending on whether your deployment is integrated with other systems, this is either viewed within Concentric by clicking the ‘View consent form PDF’ button, or within the main electronic health record.
Important clinical safety considerations
As part of using the Concentric application you confirm that you have read, understood, and agree to the following statements:
- As a clinician you maintain the clinical responsibility for the consent interaction and the appropriateness, at an individual patient level, of consent information being selected, documented, and shared.
- Information provided within Concentric should be consistent with, and supplementary to a consent conversation between clinician and patient. Information shared as part of the Concentric process sits alongside but does not replace the need for a consent conversation.
- As a clinician it is your responsibility to read and adhere to the professional responsibilities and standards set out by the General Medical Council in their guidance, Decision Making and Consent.
- When delegating consent, you must ensure that the practitioner has the relevant training and knowledge to undertake this and if not, make alternative arrangements which may include training and direct supervision.
- When the process of obtaining consent has been delegated to you, you should only undertake this if you have the appropriate training and knowledge. You must let your colleague know if you are not able to meet this standard, and ask for support. You must not practice outside your area of competence.
- Where the clinician and patient do not share a spoken language professional interpretation services should be used to facilitate the consent conversation. Translated Concentric information can be used alongside, but should not be used instead of an interpreter.
- It is important that patients have access to their consent information. Whilst most patients will receive this digitally it is important that consent information is printed and shared with patients when digital access is not possible.
- To ensure the security of patient health data and reliability of the audit trail you must log out following clinical use, and you must not share access credentials. All interactions within Concentric are associated with your name and clinical practice registration.
- When needing to enter patient contact details you should ensure accurate data entry so that information is successfully received and not inappropriately shared with a different individual.
- Following departmental transitioning to digital consent it is important to only use digital consent (outside of some business continuity plan scenarios) in order to minimise confusion and potential errors within the healthcare system.
Clinician consent statements
To simplify the Concentric process, the clinician receiving the patient's consent automatically adds an electronic signature to the consent form PDF as part of being logged in and going through the consent flow with the patient (consult view), or by enabling remote consent.
The electronic signature is associated with the following two statements, added to the 'Statement of health professional' section on the consent form PDF:
- I have explained the procedure, including the intended benefits and serious- or frequently occurring risks described in this document to the patient.
- I have also discussed what the procedure is likely to involve, the benefits and risks of any alternative treatment (including no treatment), and any particular concerns of the patient.
You should ensure that you are comfortable that the above is true prior to progressing through the consent flow in consult view or enabling remote consent.
Frequently asked questions
You can explore our knowledge bank for answers to frequently asked questions (FAQ's) from clinicians and deploying teams.
Support and contact details
If you are having any issues getting started with Concentric, a problem arises, or you need an account set up, please let us know so we can quickly get things sorted for you.
This information is only relevant to some users, and is linked to from the relevant sections above.
Creating a patient record
If your deployment is not integrated with patient demographics then a patient record needs to be created within Concentric before a first episode is created. You’ll know this is the case if you’re offered the option to ‘Add a new patient with this number’ after search for a patient. Creating a new patient record involves adding some basic demographics:
In this non-integrated scenario you should ensure that all the patient demographic fields are correct prior to creating the patient record as errors are associated with clinical risk and may mean that it is difficult to find the record in future, and may mean that consent episodes associated to the patient record cannot be used to confirm that consent has been given (for example in theatre).