Attachment S -- Information Sheet for Patient Observations

ATTACHMENT S

Information Sheet for Patient Observations

Research Study Title: Patient-Reported Health Information Technology and Workflow 

Principal Investigator: Pascale Carayon, PhD

How to contact the study staff: call Randi Cartmill (project manager) at 608-890-2185 or Andrea Hassol (project director) at 617-349-2488.

Who to call if you have questions about being a research subject: University of Wisconsin Hospital and Clinics Patient Relations Representative at 608-263-8009

This sheet provides key information you need to know about this research study. Taking part in a research study is voluntary. You can stop taking part in this study at any time without any penalty. Feel free to ask the researchers any questions you have about this study.

If you have any questions about your rights as a research subject or complaints about the research study that you could not resolve with the study team contact UWHC Patient Relations Representative at 608-263-8009 or the University of Wisconsin Medical Foundation Patient Relations Representative at 800-552-4255 or 608-821-4819.

Our health care team is participating in a research study today. The study is about how patients report information to the practice using computer technology. When we see you today, there may be someone with us who will be watching and taking notes on how we care for you. The observer will NOT be writing down anything about you, not even your name or your gender. The observers are just taking notes on what the doctor, nurse, or medical assistant does. They are learning about how patients use computer technology to report information to the clinic and how that information is used by the clinic.

If you don’t want the researcher to come in, just let your health care provider know when we come into the room, and we’ll tell the observer not to come in.

Please let us know if you are okay with the observer being there at first, but you change your mind. Or if you would like private time with the doctor without the researcher, just tell us.

Thank you!

[Name of Practice]