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Digital Health Care | Mar 2017

Enhanced Consent

Automated informed consent boosts patients’ satisfaction.

Ask any lawyer, and he or she will tell you that informed consent is a process rather than a document. Today’s refractive cataract surgery patients expect much more than a procedure without complications. Many expect perfect vision despite comorbidities like dry eye disease, surface irregularity from previous refractive surgery, and maculopathy. Patients therefore need a thorough explanation of all the possible sources of disappointment so that their expectations are realistic.


According to educators, verbal communication alone works best for only about one-third of the population,1 so a single consent discussion is unlikely to be sufficient. Two-thirds of the population learns best through visual clues, so presenting information in a multimedia format enhances understanding.1

In my practice, we cater to different types of learners. When a patient is scheduled for surgery, the surgery counselor triggers MDbackline, an automated, cloud-based system that sends the patient an email that links to videos and/or text-based learning material on what to expect before and after cataract surgery as well as how to take eye drops.

The system also offers modules (questionnaires and learning materials) with automated coaching on dry eye disease, glaucoma, and other conditions that can affect the results of surgery. This information can be delivered before the procedure to educate patients about what to expect. We find that the material is well received because it reiterates much of what the patient has already heard from the office visit, but it also provides detail on important topics that we do not have time to cover in person.


For each module transmitted to a patient, designated staff members get a report that summarizes what content has been viewed, along with a verification from the patient that the viewed material was understood. This feedback is filed automatically in the electronic health record. For patients who need further attention, our staff can take additional steps. Our staff now saves 30% of the time they used to spend on phone calls, because the system automatically answers about 90% of patients’ questions.

1. Busan AM. Learning styles of medical students—implications in education. Curr Health Sci J. 2014; 40(2):104-110.

John A. Hovanesian, MD
John A. Hovanesian, MD
  • private practice, Harvard Eye Associates, Laguna Hills, California
  • clinical instructor, Jules Stein Eye Institute, University of California, Los Angeles
  • (949) 951-2020; jhovanesian@mdbackline.com; Twitter @DrHovanesian
  • financial disclosure: founder of MDbackline
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