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Introduction
If you have been assigned to the Consultant role in ECWeb, your primary responsibilities will be to:
When you log into ECWeb as a Consultant, the first screen you will see is the Consultant's Main Menu. The following choices are available on the Main Menu:
Create New Consultation: Select Create New Consultation when you're ready to begin entering data for a new consultation record. List Consultations: To review or make changes to an existing consultation record, choose List Consultations. A list of all consultations at your facility will display, and you can filter or sort the list to find the consultation you want. List Attachments: ECWeb allows consultants to attach relevant files – such as journal articles, Word documents, and Excel spreadsheets – to consultation records. Select List Attachments to display a list of all files that have been attached to consultation records in your facility. You can filter or sort the list to locate the attachment you want. Search Consultations: To locate consultation records that contain a particular word or phrase by searching for that word or phrase, select Search Consultations. Generate Reports: Select Generate Reports to generate and view summary reports of all consultation activity at your facility. Resources: Select Resources to access pertinent resources available on the National Center for Ethics in Health Care web site. Help: Select Help to access supporting documents developed by the National Center for Ethics in Health Care, and to display contact information you can use to obtain technical assistance with ECWeb. Edit User Profile: Select Edit User Profile to change your ECWeb password, or to modify information about yourself in the ECWeb database, such as your credentials, email address and name. Exit System: Select Exit System when you are finished using ECWeb and are ready to log out.
Create a New Consultation
When you receive a new consultation request, the first thing you'll need to do is create a new consultation record in the ECWeb database. To do this, go to the Main Menu and click Create New Consultation.
ECWeb begins by asking you to classify the new record as either a Case or a Non-Case consultation. You should choose Case if the consultation pertains to an active clinical case. If it doesn't, choose Non-Case. Let's consider a few examples.
A Urology Nurse Practitioner at your facility is conflicted about whether she should treat a particular patient's erectile dysfunction considering that the patient also has a sexually transmissible disease. This request involves an active clinical case, so it should be entered into ECWeb as a Case.
The Associate Chief of Staff for Education has requested information about ethical concerns around resource allocation for a program he is planning for Trainees and Administrative Interns. This request does not pertain to an active clinical case. It should be classified as Non-Case.
Finally, the Methicillin-Resistant Staphylococcus Aureus (MRSA) program infection control nurse at your facility questions whether signature consent is required for MRSA screening. Again, this request does not explicitly refer to a specific active clinical case, so it should be classified as Non-Case.
Create a New Non-Case Consultation
The chief of the Cardiology Service at your facility recently came across some literature on the ethical implications of discontinuing the use of Automatic Implantable Cardiac Defibrillators (AICDs) after they have been implanted. The cardiologist has requested a consultation to discuss the ethical issues raised in the article. Since this request does not involve a specific active clinical case, you will enter it as a Non-Case record in ECWeb. To create a new Non-Case record:
Go to the Main Menu and click Create New Consultation. Click the Non-Case button on the Create New Consultation Record screen. ECWeb will ask you to confirm that you do in fact want to create a new Non-Case record. Confirm that you do by clicking the Next button. To begin a new record, enter the first and last name of the person who requested the consultation – in this case, the Chief of the Cardiology Service at your facility. You enter the rest of the data for a Non-Case record on the two tabs on the next screen. A few pieces of general information – most of which have already been filled in – appear across the top of the screen. ECWeb has already assigned a Consultation Number to the new record. Further down are two tabs: Requester Data and Consult Data. The Requester Data tab is initially selected. You'll need to enter data on both tabs to complete this record. Fields that have a red asterisk beside them must be completed by the time the consult is finished. Fields without an asterisk are optional. A good place to begin is by entering a brief description of this consultation request in the Nutshell field at the top of the screen. This is particularly useful because later, when you view a list of all the consultations at your facility, the nutshell description of each consult will display. Consults for which you've entered a nutshell description will be much easier to locate. The Requester Data tab
Next you should enter the required data on the Requester Data tab. This includes the Job Title and Role of the person making the request, as well as the Date of Request and and an indication of whether the request is urgent (Is request urgent?). There are two ways to move to the Consult Data tab to enter the rest of the required information. You can either click the Consult Data tab, or click the Save & Proceed button. The Consult Data tab
There are three new required fields on the Consult Data tab: Type of Assistance Desired, Summary of Request or Ethics Concern, and Summary of Response. You don't have to enter all of the data at the time that you create a new record. You can save the record anytime, and then return to work further. To leave the record in an unfinished state, save the data you've entered by clicking the Save button. Then navigate to somewhere else in ECWeb, or click Exit System to exit ECWeb entirely. Once you have responded to the request, summarize it in the Summary of Response field. Additional Commands
Finally, in the upper right-hand corner of the screen, you'll find a number of important commands:
reminders: Select reminders if there is something you need to remember to do for this consultation, and you want ECWeb to send you an email reminder. ECWeb will prompt you to enter the message text and the date the message should be sent. The message will be automatically sent to the email address specified in your user profile at 12:01 am of the day indicated. As you add reminders they will be tallied and the total number of reminders will display inside the parentheses. notepad: Select notepad to enter supplementary notes for the consultation. Use notes to keep a running log of activity related to this consultation, or for any information you gather that would not be entered in one of the database fields. All existing notes are listed in reverse chronological order in a popup window. You can add new notes; edit existing notes that you created; and review (but not modify) notes created by other consultants. As you add notes to the notepad they will be tallied and the total number of notes will display inside the parentheses. finish consult: When you have finished entering all of the information for this consultation, you need to select finish consult to change the record status from Open to another status (e.g., Pending Evaluation, or Finished).The process of finishing a consultation is covered in detail in the Finish a Consult topic. attachments: Select attachments to attach electronic copies of relevant documents to the database record for this consultation. Attach any items that you consider important, or that you would ordinarily place in a paper file – for example, policy documents, articles, references, photographs, a scanned statement or note written by a patient, etc. Any of the following file types can be used: Word documents (.DOC), Adobe Acrobat (PDF) files, Text files, Pictures (.gif, .jpg, or .tiff file formats), PowerPoint presentations (.PPT), or Excel spreadsheets (.XLS). As you'll see in the Create a New Case Consultation topic, ECWeb also allows you to export a summary of a consultation record to Word. When you do this, the resulting Word document is saved as an attachment to the consultation record, and can be viewed by selecting the attachments command. refer consult: If you wish to have someone else take primary responsibility for a consult, you should select refer consult. ECWeb will display a list of the other consultants at your facility. When you select the consultant you want, he or she will be sent an email announcing the reassignment, along with any further information or instruction you provide in the message. Note that the individual you select becomes the primary consultant for the consultation, and will be listed in the Referred to column on the List Consultations screen. print consult: Select print consult to print a hard copy of the current consultation record. main menu: Select main menu to return to the Main Menu screen. exit system: Select exit system to exit ECWeb entirely.
Create a New Case Consultation
The family of a critically ill patient at your facility has requested alternative therapy for the patient. The patient's primary physician, Dr. Sample, has requested an ethics consultation to help the treatment team decide whether to comply with the family's request. Since this involves an active clinical case, you need to create a new Case record in ECWeb. To do this:
On the Main Menu, click Create New Consultation. Click the Case button on the Create New Consultation Record screen. Next, enter the first and last name of the person who requested the consultation – in this case, Dr. Sample. You will capture data about a Case consultation on the next screen, which has five tabs – one for each step in the CASES approach. The Clarify tab (the first step in the CASES process) is selected by default. By structuring Case consultation information to reflect the CASES model, ECWeb provides a framework that will help guide your activities as you work to provide this Case with the careful and thorough analysis it deserves. Although ECWeb presents the steps in a linear fashion, we all know that ethics case consultation is often a fluid process. At times, you may need to repeat steps, or perform them in a different order. ECWeb is designed to accommodate this reality. Each of the five tabs contains several screens. The first screen briefly describes the purpose of the current step and sub-steps, and the data that should be entered into this tab. The data for the selected tab is entered on the second screen. Like most data entry screens on the Case record, the data on the Clarify tab extends below the display area. You can use the vertical scroll bar to scroll down the screen. But ECWeb also provides two shortcuts to help you quickly find the information you want.
First, you can click any of the labels below the row of tabs. This will jump you directly to one of the section headings on this screen. (For example, you could click Patient Data to jump to the Patient Data section further down on the Clarify tab.) At the far right of the screen you'll also find the floating Cases Navigation bar. You can click any of the labels on this bar to jump immediately to any section heading on any tab. (For example, you could click Formal Meeting to jump immediately to the Formal Meeting section on the Synthesize tab.) The advantage of the floating Cases Navigation bar is that it will follow along with you as you scroll down the screen.
Finally, you'll find the same commands seen in the upper right-hand corner of the Non-Case record screens on the Case record screens as well. Let's begin entering data for the case of the patient whose family has requested alternative therapy. You would start by entering a brief description of the case has been entered in the Nutshell field. The Clarify Tab
The Clarify tab is where you enter data to define the concern at hand, and to identify the various parties that will be involved in the consultation. In the Requester Data section you enter data about the person who requested the consult (including his or her Name, Job Title, Role, the Date of Request, and an indication of whether the request is urgent). You also record the requester's description of the case. You identify the patient and the patient's situation in the Patient Data section, including the patient's name, the last four digits of his or her Social Security Number, the Care Setting, and the Clinical Service involved. The next section - Ethics Question - is where you identify the central ethics concern of the consultation, and shape it into a formal ethics question. ECWeb suggests two possible formulations for the question. In the last section of the Clarify tab you identify the individuals who will be involved as consultants in this case. You also identify the consultation model that will be used. Identify the Primary Consultant; it may be you. To identify additional consultants who will be involved, select the individuals you want and move their names to the Other consultants involved in this case list on the right. Finally, you need to specify which consultation model will be used in this case. The following guidelines may be helpful in deciding which consultation model to use:
Individual – The most efficient model, because it involves only a single consultant. However, because it requires a single individual to possess all of the necessary knowledge and skills, it is generally appropriate only for the most proficient ethics consultants, and for the most straightforward consultations. Team – The most commonly used model; in some ways the Team method is a "middle ground" between the Individual and Committee approaches. It allows tasks to be divided among a small group of individuals who can provide diverse knowledge and skills, yet still respond relatively quickly. Committee – The most efficient means of securing broad organizational input. However, because it requires the participation of a relatively stable group of 6 – 20 individuals, the Committee model requires a large amount of staff time, and is not well suited when a rapid response is needed.
The Assemble Tab
The first screen of the Assemble tab provides an overview of the Assemble step in the consultation process. This is where you gather and document the data that will be needed to analyze, deliberate, and propose recommendations for the case. You should click the Next button when you're ready to begin entering the data described here. You start by identifying the sources of the information that has been collected. Since two of the most important information-gathering tasks are reviewing the patient's health record and conducting a face-to-face visit with the patient, ECWeb begins by asking you whether these tasks were completed. Note that whenever you indicate that the patient's health record was not reviewed, ECWeb asks you to provide a reason. The same is true when you indicate that no face-to-face visit was held with the patient. The reasons entered here are stored in the ECWeb database, may be viewed in ECWeb reports, and used as part of your quality improvement program. Next you identify all individuals – including staff members, family members, friends, and other parties – who were contacted for information. Click either the Add Staff Member or Add Family/Friend button to enter information for an individual.
You should also identify all sources of ethics knowledge that were considered. Then, in the next section, you:
Document the patient's decision making capacity Identify the patient's surrogate Indicate whether the patient has an advance directive (if so, record information about the AD – for example, where the advance directive can be found – in the Comments field)
The Information Summary section is where you summarize all of the information that has been collected based on the type of information, including the Medical Facts, the Patient's Preferences and Interests, and Other Parties' Preferences and Interests. As with all fields, take care in how you enter information as the specific text in these fields will form the basis of health record notes that ECWeb generates. Finally, ECWeb redisplays the Ethics Question you entered earlier. This is so you'll have the opportunity to revise the question, if necessary, in light of the information collected during the Assemble step. The Synthesize Tab
The Synthesize tab is where you document the process by which recommendations and plans were reached. Here you:
Indicate whether a formal meeting was held with key participants Detail how the collected knowledge applies to this case (in the Ethical Analysis section) Identify the Ethically Appropriate Decision Maker, and explain why he or she is the appropriate person to make the decision Describe the options that were considered and why each one was or was not ethically justifiable (in the Moral Deliberation section) Indicate whether the parties involved reached an agreement. If they did, you should also describe the recommendations and plans that were agreed to (in the Recommendations/Plan section)
The Explain Tab
On the Explain tab, you indicate whether the synthesis was communicated to key participants and, if so, you document participants' responses. You can also generate a consultation summary note for the health record from the data entered in this consultation record. to generate a health record summary note as a separate Word document:
Click the Note button. (A separate window displaying all the data entered for the case appears.) You would scroll down to preview this information. If the information needs to be modified, click the Edit Note button. Note that any updates that you make in this window will be saved throughout the consultation record – as long as you click the Export Consultation Summary to Word button at either the top or the bottom of the window. Clicking the Export Consultation Summary to Word button will also save the entire contents of the record to a Word document, which ECWeb will automatically attach to the consultation record in the database. You can then open this document in Word and print it. Or you can copy and paste the document contents into CPRS to ensure that the consult is thoroughly documented and available to all staff members who need it.
The Support Tab
The information you can enter on the Support tab includes:
A follow up plan Your self assessment of the consultation Any system issues learned about during this consultation that might warrant attention by the Preventive Ethics team, or other appropriate resource.
When you've actually finished entering the data, you'll be ready to finish the consult. You'll learn how to do this later, in the Finish a Consult topic.
List Consultations
You can display a list of all the consultations that have been conducted at your facility by clicking List Consultations on the Main Menu. This is one way to locate an existing consultation record that you want to modify, view or finish.I t's also useful for locating other consultations that may have previously addressed ethics concerns similar to one currently underway.
Initially, the Consultation List displays in reverse chronological order. You can tell from the Consult No column. This is the number that ECWeb automatically assigns to each new consultation record. It is in the format: Facility Number, followed by Fiscal Year, followed by Consult Number. (The first record within a fiscal year is Consult Number 001, the second Consult Number 002, and so on.) Since the first item in the Consultation List has the highest Consult Number, it is the most recent record. You can sort the list in a different order by clicking any of the column headings.
In addition to sorting the list, you can also filter the list to reduce the number of records that will display. Initially, All is selected beneath Select the consultations you would like to list. This indicates that all consultation records are currently displayed, regardless of their status. A consultatiion record will pass throug a number of different statuses during its life cycle.
Records are in Open status while the consultation process is ongoing. Once the primary consultant finishes his or her work, the status changes to either Finished or Pending Evaluation. Finally, the Evaluator changes the status to either Evaluated or No Evaluation Response once the evaluation is over.
You can display only those records that are in a particular status by selecting the status you want from Select the consultations you would like to list, and then clicking the Display List button.
You can open any consultation record that is in an Open status to update, view, or finish it. (You can also open records in any of the other statuses for viewing, but it is not possible to make changes to their content except for adding an addendum in the notepad area.) To open a consultation record, you just click the underlined number in the Consult No column.
There is another way you can customize the Consultation List. At the head of the three right-hand columns in the list are dropdown lists. If you would prefer to display other data in any of these columns, you can make a different selection from any of these dropdowns.
One last thing you should know is that it is possible to delete consultation records, but this can only be done by special request to consultation staff at the National Center for Ethics in Health Care.
Finish a Consultation
Once you've entered all of the data required for a consultation record, the final step is to finish the consult. Finishing a consult effectively closes the consultation record. Once the record has been closed, you can no longer make changes to it except for adding addenda, but more about that later. If you request an evaluation of the consultation, the finish a consult process will also notify the evaluator(s) that the record is ready to be evaluated.
To finish either a Case or Non-Case consultation record:
Use List Consultations or Search Consultations to locate the consultation record you want. Open the record, and click the finish consult command.
ECWeb first verifies that you have completed all the required fields in this consultation record. Any required fields that are not complete are listed near the top of the screen. Entering data into incomplete fields like this is easy. Just click the field name to jump directly to the field.
Once all required fields have been completed, the first task is to assign this consultation to a Domain and Topic. This information is used to categorize the types of ethics concerns being addressed by your consultation service. You select a Domain by clicking the appropriate tab. Then click the checkbox beside the most appropriate Topic within that Domain.
Next, ECWeb redisplays the Ethics Question entered earlier so it can be updated, if necessary. Then you're asked to enter an estimate of the total time spent by all ethics staff members on this consult, e.g., each consultant's time contribution plus time spent on research and documentation. This information is used to track staff workload and should be comprehensive.
Next, confirm which individuals contributed to this consultation. (ECWeb will pre-populate both the Consultant and Other Consultants fields with the information entered earlier on the Clarify tab.) And, last, indicate whether or not this consultation should be evaluated. You'll want to follow your facility's guidelines for determining which consultations should be evaluated.
Clicking the Finish button will close the Finish Consult Page. If you indicated that the consultation will be evaluated, it will also cause the status of this consultation record to be changed from Open to Pending Evaluation. If you had indicated that this record should not be evaluated, the status would be changed from Open to Finished.
List Attachments
ECWeb also allows you to view any of the supplementary documentation attached to consultation records from your facility. To do this, your just click List Attachments on the Main Menu.
The Attachment List initially displays in reverse chronological order, sorted by Consultation Number. The attachments can also be sorted in the order they were added to ECWeb by clicking the icon in the Attachment Number column heading. (The higher the attachment number, the more recently it was added to ECWeb.) To open an attachment, just click its Attachment Number. You can also open any of the consultation records by clicking in the Consultation Number column.
Generate Reports
One or more individuals – usually those with supervisory responsibilities – will be able to generate and view summary reports of all consultation activity at your facility. The following reports can be created in ECWeb:
A Standard report – summarizes the numbers and types of consultations conducted at the facility A Process report – displays statistics on how the consultation process was followed and documented An Evaluation report – provides statistics on participant satisfaction with the consultation service A Custom report – contains whichever data elements the reporter selects
Standard Report
The Standard report contains summary statistics of consultation requests, such as:
Process Report
The Process report provides summary answers to questions regarding the consultation process, such as:
Was the attending physician notified? Was an ethics question formulated? Was the patient's health record reviewed? Did a face-to-face visit with the patient take place? Were medical facts recorded? Were the patient's preferences and interests recorded? Were other people's preferences and interests recorded? Was a surrogate identified and, if so, was the surrogate interviewed? Was the patient's advance directive reviewed? Were sources of ethics knowledge identified? Was a summary of ethics knowledge provided? Did formal meetings take place? Was an ethically appropriate decision maker identified? Were other options considered? Were the recommendations followed? Were underlying systems identified?
Evaluation Report
The Evaluation report contains summary feedback on items such as:
Perceived timeliness of response Overall helpfulness Clarifying the ethics concern Providing practical information and resources
If you have been granted permission to generate reports, the Generate Reports option will appear on your Main Menu. Selecting Generate Reports will launch a wizard that will walk you through the three-step process of creating a report.
The process of generating a report is identical for each type of report.
In Step 1, the wizard asks you to indicate the range of dates to include in the report. In Step 2, you select which types of records to include in the report. Finally, you select the type of report you want (Standard, Process, Evaluation, or Custom) in Step 3.
The reports initially display the data in tables but some of the views can be modified using the commands on the screens.
Search Consultations
You can use ECWeb's full-text search to quickly find the consultation record you're looking for. To do this, from the Main Menu, click Search Consultations.
Just enter the word or phrase you want to locate. When you click the Search button, ECWeb will search your facility's consultation records looking for a match in any field.
ECWeb returns a list of all of your facility's consultations that include the text you specified somewhere in the consultation record. This list closely resembles the list that displays when you select List Consultations from the Main Menu. As with the Consultation List, you can sort this list by clicking the icon in the heading of any column. And you can choose to display different data in the last three columns by making a different selection from the dropdown menus. See the List Consultations topic for specific descriptions of how to sort and customize this list.
Resources
You can access a set of helpful resources available on the National Center for Ethics in Health Care's web site by clicking Resources on the Main Menu.
Help
If you're having difficulty using ECWeb and need technical assistance, you can select Help from the Main Menu to display contact information for the National Center for Ethics in Health Care. Staff there will be happy to assist you. You can also access a number of useful supporting documents developed by the National Center for Ethics in Health Care under Help.
For technical assistance using ECWeb, you can contact any of the individuals listed at the bottom of the Help page.
You can also access the following supporting documents from the Help screen:
Ethics Consultation: Responding to Ethics Questions in Health Care: Select this link to view an electronic copy of the Ethics Consultation Primer. Blank Ethics Case Consultation Summary Template: If you're a Consultant who prefers to conduct your consultation "off-line," use this form to collect the data. Then enter the data into ECWeb when you're finished. Ethics Consultation Feedback Tool for Staff: This is a printable form to solicit responses from VA staff members who participated in an ethics consultation. Evaluators could print and mail the form, or send an electronic copy as an email attachment so staff members can complete it. Ethics Consultation Feedback Tool for Patients: Evaluators should use this form to solicit feedback from patients and other non-staff who participated in an ethics consultation. Evaluators could print and mail or bring the form to the patient or family member so that they can complete it.
Edit User Profile
Like everyone else who uses ECWeb, you have a user profile that includes key information about you, such as your ECWeb username and password. You can make changes to your ECWeb user profile – including changing your password – by selecting Edit User Profile from the Main Menu.
You can change the following fields in your user profile: password, first and last name, credentials, and email address. Every field – except Credentials – is required. If you add your credentials, they will appear after your name on the health record summary note.
NT Username is the only field that you may not change. Your username will be entered by the Administrator Consultant and must EXACTLY match the username you use to log into your computer.
Your ECWeb Password must be a "strong" password at least 8 characters long, and must include:
Once you've made all the change(s) that you want to your user profile, you'll need to click the Save button to apply the change(s) to your user profile. Clicking the Back button will return you to the Main Menu without saving the change(s).
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