Conditions of Collaboration, Privacy Consent and Photo Release Waiver

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CONDITIONS OF COLLABORATION
between Sydney Local Health District ('the Hub') and Participating Spoke Provider ('the Spoke')

 

PURPOSE

Project ECHO Sydney Local Health District Australia is a project focused on supporting healthcare providers from diverse service settings to build capacity in the treatment and management of a range of complex conditions through weekly videoconferencing sessions.
The ECHO framework is a collaborative model of specialist health education.
The purpose of this CONDITIONS of COLLABORATION is to foster collaboration between the  ECHO SLHD and participating healthcare providers, by supporting the implementation of PROJECT ECHO SYDNEY LOCAL HEALTH DISTRICT. This conditions set out the roles, responsibilities and expectations of the Parties. Participants will not require a username or password to access this Conditions of Collaboration document.

DEFINITIONS

  • Hub:  ECHO Sydney Local Health District, Australia (ECHO SLHD)
  • Participant: Healthcare providers who participate in ECHO SLHD programs.
  • Session: A weekly video conferenced discussion between Hub presenters and participating clinicians including a brief presentation by expert specialists (Hub), in-depth case-based presentation(s) presented by Participant(s) and recommendations on cases provided to participants.

 

I. COMMITMENT TO COLLABORATION – THE HUB
   The Hub will:

  1. Offer weekly educative presentations at the Sessions via videoconference on a wide range of subjects relevant to a specific program that are pertinent to participants from a wide range of disciplines.
  2. Discuss de-identified cases presented by Participants during the Sessions.
  3. Provide timely written suggestions for care to Participants following the Sessions.
  4. Provide appropriate IT user support to facilitate connectivity and participation. 

 

II. COMMITMENT TO COLLABORATION – THE PARTICIPANT
     The Participant will:

  1. Participate in at least 60% of ECHO Sessions. Please see the “Participation Notice” below for further information.
  2. Provide comments and ask questions (we encourage participation by multi-level teams when possible).
  3. Present in-depth de-identified case presentations with patient consent. 
  4. Participate in periodic surveys and other evaluation activities to help the Hub improve its services to healthcare providers and other partners.

 

III. PATIENT RELATIONSHIP DISCLAIMER


ECHO SLHD de-identified patient case presentations do not create or otherwise establish a provider-patient/client relationship between any Hub clinician and any patient whose case is being presented in a Session.
The Participant understands that advice from Hub clinicians are recommendations only and do not in any way replace the diligence and professional expertise to be exercised by the Participant with respect to their patients. SLHD and Hub clinicians do not have any liability for any injury, loss or damage caused by use of the information provided during the Sessions.
The Hub may provide a Participant with information about referral options for a patient. However, if a Participant wishes to refer a particular patient to a specialist service that should be done outside of this project.

 

IV. DE-IDENTIFIED INFORMATION NOTICE AND CONFIDENTIALITY 
 

Please note that no patient identifiers are to be used within any Session document, and communication correspondence. Unique ECHO IDs will be assigned for each case presented at ECHO SLHD, but at no time shall any identifiable personal information or personal health information of patients be included in the documents or correspondence between the Hub and the Participant or as part of the Sessions.
If, for whatever reason, personal information or personal health information of a patient is inadvertently disclosed in a Session, the disclosing Participant clinician shall be responsible for ensuring that the privacy breach is addressed in accordance with the internal privacy policies and procedures of that Participant.
The parties understand and agree that any information (including, without limitation, case presentation forms and any other relevant documentation or information) received as part of the Sessions shall be kept confidential and only used in connection in the context of the ECHO SLHD collaboration and for the purposes described in this statement of collaboration.

 

V. PARTICIPATION NOTICE
 

The expectation is that Participants attend all Sessions in a given ECHO series. Individuals who attend at least 60% of Sessions within a given ECHO series will receive a Certificate of Attendance at the end of the series, indicating their participation in the program.
The HUB appreciates that Participants have important commitments, busy clinical days, and emergencies. Participants will inform Hub key staff as soon as possible if they are unable to attend a Session, or a series of Sessions. If a Participant’s attendance record has 3 consecutive absences without notice, they will be contacted by Hub staff to understand how the Hub can best support the Participant’s ongoing attendance. 
It is expected that Participants will adhere to the videoconference etiquette that is included in the ECHO SLHD participant guide. 

 

VI. DATA USE NOTICE
The Participant understands that participation information will be collected for reporting purposes as follows:

  1. In order to support quality improvement and quality assurance, the Hub collects participation information for each ECHO program. This information allows the Hub to measure, analyse, evaluate and report on the movement’s reach. The Participant’s participation information will be used in reports for quality improvement and quality assurance purposes. The information you provide will be treated in a confidential manner. Only the ECHO SLHD team will have access to your contact details. Any reporting of the participation data for research, conference presentations, or publication purposes will be prepared in a de-identified way.  
  2. In order to meet our Ministry of Health funding deliverables, the Hub collects participant data for quarterly and annual reports. Any public dissemination outside of the Ministry of Health is anonymised. If shared for use outside of Ministry of Health reporting, participant names will be removed but the name of the participant's organisation may be included.
  3. In order to support the growth of the ECHO model, the ECHO Institute at the University of New Mexico collects participation information for each ECHO program globally, including ECHO SLHD. This information allows the ECHO Institute to measure, analyse, and report on the reach and impact of the program internationally. Participant’s participation information will be used in reports, for data quality assurance activities, and for decision-making related to new initiatives. If you would like to opt-out of this, please contact a member of the Hub. 

 

VII. RECORDING, PHOTOGRAPHS, AND GUESTS
 

The Participant understands Sessions may be video recorded by the Hub for educational and/or evaluation purposes. The Participant agrees to ensure that all discussions regarding any cases and individuals are carried out in a manner that ensures anonymity and protection of privacy for the subjects of such discussions. In the event that any personal information or personal health information is inadvertently disclosed as part of a Session, this information will be edited out of any recording. In addition, the Participant understands that it shall not be permitted to record any Sessions. If you would like any further information about the research endeavours currently taking place, please contact a member of our team.
The Participant understands that from time to time the Sessions may be photographed, and such photos may be used by the Hub internally, or may be shared externally on websites or with media outlets for the purposes of describing or otherwise promoting or profiling the work of this project. Please read the ‘Photo Release Waiver’ and indicate your preference on your registration. Those who do not provide consent on this waiver will have their photographs blurred in group photographs before they shared externally.
From time to time guests may join an ECHO Session provided that it is agreed upon in advance by the Session participants. If a guest attends more than one Session, the person will be contacted by a member of our team and asked to fully complete our registration process. 

PRIVACY CONSENT

DEFINITIONS

  • Hub:  ECHO Sydney Local Health District, Australia (ECHO SLHD)
  • Participant: Healthcare providers who participate in ECHO SLHD programs.
  • Session: A weekly video conferenced discussions between Hub presenters and participating clinicians including a brief presentation by expert specialists (Hub), in-depth case-based presentation(s) presented by participants and recommendations on cases provided to participants.

I have read the information in this Statement of Collaboration and consent to the Hub:

  1. collecting my participation information, including my personal information in order to evaluate the program and for quality assurance purposes. I understand that any reporting of the participation data for research, conference presentations, or publication purposes will be prepared in a de-identified way.
  2. providing my participation information to the NSW Ministry of Health. I understand that my name will be removed from this information if it is to be used or disseminated by the Ministry of Health, but that the name of my organisation will be included. 
  3. providing my participation information to the Project ECHO Institute at the University of New Mexico for evaluation and quality assurance purposes. I understand my participation information may be used in reports, for data quality assurance activities, and for decision-making related to new initiatives. 

PHOTO RELEASE WAIVER

 DEFINITIONS

  • Hub:  ECHO Sydney Local Health District, Australia (ECHO SLHD)
  • Participant: Healthcare providers who participate in ECHO SLHD programs.
  • Session: A weekly video conferenced discussion between Hub presenters and participating clinicians including a brief presentation by expert specialists (Hub), in-depth case-based presentation(s) presented by participants and recommendations on cases provided to participants.

I understand and agree that:

  1. the Sessions may be photographed/videorecorded, and such photos/videos may be used by the Hub internally, or may be shared externally on websites or with media outlets for the purposes of describing or otherwise promoting or profiling the work of the ECHO SLHD initiative.
  2. if photographs/videos are shared externally, the Hub may no longer be able to exercise control over their further use or distribution.
  3. the Hub does not have to notify me when it uses or shares the photographs/videos as agreed to above, and I do not have the right to approve the photograph before it is used or shared for the purposes listed on this form.

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For general enquiries, please email:

SLHD-ECHO@health.nsw.gov.au 

Project ECHO Sydney Local Health District is a collaboration between 

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