IntegratedEthics™
Improvement Forum Call
Introducing IEWeb and Recording of Clinical Visits by Patients
May 22, 2017
Slide 1 - Welcome to Ethics Consultation Coordinators
This is David Alfandre. I am a Health Care Ethicist at the National Center for Ethics in Health Care and I will be moderating today’s IE Ethics Consultation Improvement Forum call. Thank you for joining us today. Our topic today is: Introducing IEWeb and Recording of Clinical Visits by Patients
If you did not receive a reminder email for this EC Improvement Forum call, it is possible you are not signed up for the IE mailing list. You can do so easily by going to the National Center’s website and under the Integrated Ethics portion of the website you will find it. The link will be available in the minutes:
http://vaww.ethics.va.gov/integratedethics/regindex.asp
The call schedule and summary notes are posted on the IntegratedEthics website at: http://vaww.ethics.va.gov/integratedethics/TA.asp
Before I continue I want to mention that other staff from the Ethics Center typically join the call and you may be hearing from them.
Presentation shown on the call:
Slide 2 - This meeting is a multimedia presentation requiring both audio and visual access.
· Audio will be available through VANTS: 800-767-1750 Access: 89506# and Online Meeting
· Visuals will be accessed through the Lync online meeting:
Join online meeting
Please call the usual VANTS line AND join the Lync online meeting.
If you are having technical difficulties, please contact your local IT department to assist you.
Slide 3 - Ground Rules –
I need to briefly review the overall ground rules for these calls:
· PLEASE do not put the call on hold.
· We ask that when you speak, you please begin by telling us your name, location and title so we can continue to get to know each other better.
· As you may know the Ethics Center does not audiotape these calls; instead, we provide minutes. In the field some VHA facilities are audiotaping the calls to make it possible for their colleagues to hear the full text of the discussion. As a result, this is not the venue for reporting violations, talking about individual case information, or disclosing identifiable patient information.
Slide 4 – Announcements
Upcoming Virtual EC Beyond the Basics
• June 23 from 2:00 – 4:00 pm ET – Managing Common Misconceptions about the Role of an Ethics Consultant – (Module 1) TMS # 33107
• July 28 from 1:00 – 3:00 pm ET – Formulating the Ethics Question – (Module 2) – TMS # 33718
Slide 5 – Focus Topic Introducing IEWeb and Recording of Clinical Visits by Patients
IEWeb Project – An Introduction
Welcome all. Today I aim to achieve 3 objectives in my presentation:
1. Introduce ethics consultants and other IE staff on the call to IEWeb
2. Provide an overview of what facility ethics consultation services need to do to prepare for the transition from ECWeb to IEWeb.
3. Solicit nominees to work with our office to perform usability testing on IEWeb
Slide 6 - Setting the Stage
Let’s start with a reminder about why was IE created?
The NCEHC developed the IntegratedEthics (IE) initiative to establish a standardized, comprehensive, systematic, integrated approach to ethics in health care. (IE), was rolled out VHA-wide in 2007 and was named as one of the top 25 innovative government programs in 2011 through the Harvard-Ash Innovations in American Government Award. This national education and organizational change initiative was based on established criteria for performance excellence in health care organizations and methods of continuous quality improvement. IE provides structures and standards that promote and improve ethical practices in health care. Through the years we have developed and offered practical, user-friendly tools to help health care leaders and staff perform all three IE functions. That is, respond to ethical questions at the level of actions and decisions through ethics consultation; address ethics quality gaps at the level of systems and processes by applying a quality improvement approach in preventive ethics; foster a strong ethical environment and culture through ethical leadership. The goal of IE is to support, maintain, and improve ethics quality while emphasizing a values-oriented approach to ethics that looks beyond rules to inspire excellence.
Now let’s look at the history of ECWeb. When and why was ECWeb developed?
In 2001, NCEHC developed an information technology solution called Electronic Tracking of Consultations (ETC) to support and document our office’s national ethics consultation (EC) activities. With the development of the CASES approach to ethics consultation in the early 2000’s, the ETC system - called Ethics Consultation Web (ECWeb) - was modified for use by field-based EC services, and its use was mandated throughout VHA with the implementation of IE.
What is the current state?
Ethics Consultation Web (ECWeb), must now be replaced, as the current underlying technology is not scalable, outdated and slow, and unable to support the goals of the IE initiative as a whole. IntegratedEthics Web (IEWeb) focuses on the first two elements of the IE initiative: ethics consultation (EC) and preventive ethics (PE). The program will also enable the documentation and tracking of other important ethics-related activities.
ECWeb is currently being used by approximately 2,300 users (as of 5/22/17 – 433 administrator consultants; 1548 consultants; 347 evaluators) across 141 VA health care facilities. It is currently hosted on by VA WebOps on servers in Falling Waters, WV. The program enables ethics consultants at the national and local level to monitor their ethics consultations, adhere to guidance about best practices for ethics consultation (i.e., NCEHC’s CASES approach), and generate various types of reports. IEWeb will incorporate the functions of the current ECWeb system.
Use of the ECWeb program is mandated in VHA Handbook 1004.06, IntegratedEthics (http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2932). Promoting ethics quality in health care is an essential aspect of health care quality and it requires a systematic and programmatic approach. Because health care ethics programs are relied upon to help resolve sensitive problems that are often matters of life-and-death (e.g., decisions to continue or withdraw life-sustaining treatment), rigorous measurement and control of quality are essential. The currently-deployed system, ECWeb, was custom-built for NCEHC, and is based on proprietary technology (ColdFusion and SQL Server). ECWeb's performance problems and inability to adapt to changing requirements, make it essential to develop and deploy a replacement system. A new system is needed to fully support VHA's robust health care ethics activities and mitigate the concerns regarding the current system's (ECWeb) stability and sustainability.
To help PE teams document and report ethics quality improvement activities within facilities and across Networks, NCEHC will develop a Preventive Ethics Web (PEWeb) track in IEWeb. PEWeb will promote adherence to best practices for PE activities and increase sharing of ethics-related quality improvement efforts throughout VHA.
IEWeb will enable NCEHC to rapidly identify needs, risks and trends, and address them in an efficient, effective and timely manner. A strong corporate ethics culture can improve not only employee morale but also performance, and help to improve an organization’s efficiency and productivity. An effective ethics program also makes it easier to recruit and retain quality staff.
Slide 7 - Goals of IEWeb
There are three main goals/objectives of the IEWeb initiative.
GOAL 1: Improve the quality of ethics consultation activities across VHA
GOAL 2: Address ethics quality gaps throughout VHA through continuous quality improvement.
GOAL 3: Manage, document and track other ethics activities at the IE staff, facility and network levels.
Slide 8 - Desired Impact
What are we trying to achieve? The desired impact of these goals is three-fold:
· Better ethics quality in VA health care
· Improve efficiency of ethics activities and programs
· Enable NCEHC to be accountable for and provide oversight of VHA IE Programs. If we know what everyone is doing we can provide targeted support and fight for resources.
Let’s look at the each goal and its desired impact:
Slide 9 - GOAL 1: Improve the quality of ethics consultation activities across the VHA system.
DESIRED OUTCOME: IEWeb will be used consistently by ethics consultation services throughout VHA to do their work more efficiently and better. It will make it easier to document and track ethics consultation activities, and will allow NCEHC to monitor, support and improve ethics consultation throughout VHA.
Slide 10 - GOAL 2: Address ethics quality gaps throughout VHA through continuous quality improvement.
DESIRED OUTCOME: IEWeb will be used consistently by PE teams throughout VHA to do their work more efficiently and better. IEWeb will make it easier to complete PE cycles, enable sharing of strong practices throughout VHA, and will allow NCEHC to monitor, support and improve preventive ethics throughout VHA.
Slide 11 - GOAL 3: Manage, document and track other ethics activities at IE staff, facility and network levels
DESIRED OUTCOME: IEWeb will enable users to document other ethics activities (e.g., ethics education, requests that are referred elsewhere) to track workload and provide a resource for future reference, and will allow NCEHC to monitor, support and improve other ethics activities throughout VHA. Enhanced IEWeb reporting functionality will make it easier to support quality improvement and inform decision making.
Slide 12 - About IEWeb – EC Function
What are some of the features of the system that we are seeking to achieve for Ethics Consultation:
· State-of- the art security for PII
· Single sign on
· New interface to streamline data entry
· Enhanced progress note functionality
· Enhanced reporting functionality
· Adaptability for the new VISN and regional structures in VHA
Slide 13 - About IEWeb – EC Function (continued)
Possible Features:
· Automating and aggregating the Ethics Consultation Proficiency Assessment (ECPAT) and Ethics Consultation Service Proficiency Assessment (ECSPAT) tools will promote professional development for ethics consultants and service-wide competency for ethics consultation services.
· Enhance QI in ethics consultation by automating and storing data from ethics consultation quality reviews using the NCEHC-developed Ethics Consultation Quality Assessment Tool (ECQAT)
· Reference Library of vetted Ethics Consultation Records
· Flexibility to include non-VA facilities and/or health care systems (e.g., strong interest in the past from DoD (Navy), academic centers (e.g., Harvard Ethics Consortium), and health care systems (e.g., Kaiser) in using the system). This would be a tremendous feather in VHA’s cap and would be doing a great service to the field of bioethics. It would help Veterans by improving quality in ethics consultation in both VHA and the non-VA settings where they receive care.
· Flexibility to include non-VA facilities and/or health care systems
· Possible automated request for EC via the Inter- or Intranet
· Automatic data entry for feedback
Slide 14 - About IEWeb – PE and IE Function
There will be much more to say about PE and the general IE functions of IEWeb in other settings. For today you should know that:
· PEWeb will create a means to electronically promote adherence to best practices for PE activities and enhance sharing of ethics-related quality improvement efforts within facilities and across Networks
· IE Facility Workbook – Automating and aggregating the IEFW will enable benchmarking within VHA and promote QI efforts
Slide 15 - IEWeb Project Timeline
So how did this all come about? Well we’ve been at it for a really long time.
· Design – FY 2013 – FY 2016 – Based on feedback from the field, our assessment of the current functionality, and enhanced capabilities based on changes in technology over the past 15+ years
· Contract development – FY 2016 – We were not able to get funding through traditional IT routes but were successful when we applied to the ???? IT Innovations process.
· Development – FY 2017 – IEWeb is being developed using Salesforce which is an American cloud computing company that is developing and hosting a number of VA projects.
· Testing – Summer 2017
· Rollout – Anticipated in FY 17
Slide 16 - What facilities need to do to prepare?
There are 3 thinks that the ECC need to do to prepare for the data migration of ECWeb to IEWeb:
1. Update your ECWeb User List - Inactivate any person not currently on your service to ensure accuracy of records and security of the system
2. Complete consults in “Pending evaluation” status or they will be administratively finished before the data migration
3. Complete open consults – Reminder VHA Handbook 1004.08 sets a standard that ECWeb records be completed within of 7 days after the consultation has been completed
Slide 17 - Seeking Testers!
We are seeking active ethics consultants to test the newly developed system.
· The contractor will prepare “scripts” or step-by step instructions for testing the usability of the system.
· Testing is planned for the week of June 12
· Anticipated commitment – 8-10 hours
· Contact
Slide 18 – Questions? Below are the questions and answers.
Q: Will the consults in the current ECWeb transfer to IEWeb?
A: Yes, the old data will be mapped to the new system!
Q: Will the link to IEWeb beat home page or internet?
A: The system will be accessed on the Intranet. That is, from workstations already logged onto the VHA network.
Q: Please adviseif requestors would be able to generate online EC requests which would feed directly into IEWEB to get a request started?
A: Hopefully, yes! That is on the list of desired features to add after the core system is rolled out.
Q: Can you send us directions to inactivate users?
A: Yes, (Plus demonstrated at the end of the call)
Q: Will there be any mechanism to highlight ongoing national issues that impact most facilities? For example, informedconsent and occupational exposure?
A: Interesting question…perhaps through library of ethics consultations.
Q: What is the projected date for activating IE Web?
A: October 1, 2017, BUT there is a lot to do to get the system ready!
Q: If our site is willing to volunteer to do testing, do we contact Ms. Chanko?
A: Yes, please contact
Q: Will there be any features for doing research on related articles to a given ethics topic?