Project ECHO

As a Key Stakeholder in the Herefordshire & Worcestershire Monthly Palliative and End of Life ECHO Hub, I will:

• Participate in each Project ECHO learning session via Zoom.

• I grant permission for St Michael’s Hospice to manage my personal data safely in connection with Project ECHO®.

• I grant St Michael’s Hospice the permissions required to transfer my data to the U.S.

• I understand that my participation in Project ECHO is entirely voluntary and that I am free to withdraw at any time, without providing a reason or explanation.

I understand that:

• Project ECHO case consultations do not create or otherwise establish a provider‐patient relationship between any ECHO clinician and any patient whose case is being presented in an ECHO session.

• While the case consultations and ECHO sessions may offer recommendations regarding effective evaluation, care, and treatment options, these represent recommendations only. The patient’s treating provider retains sole responsibility for selecting and implementing the plan for evaluation, care, and treatment of the patient.

• My contact information will be shared with other members of this program’s cohort.

I agree and understand that data will be collected and held under the following restricted terms:

• In order to facilitate Project ECHO, St Michael’s Hospice will be recording each ECHO session. These recordings will be password protected and made accessible to Herefordshire & Worcestershire ECHO Hub members only.

• If you wish to participate in any way in the “ECHO®” movement, some information which comes within the GDPR definition of personal data is required by Project Echo in the United States. To ensure that the requirements of UK law are met, St Michael’s Hospice requires your permission to transfer and store your data within the US before you can participate in an “ECHO®” session or in any aspect of the ECHO® movement.

• Your data will be stored digitally within an application that tracks the growth, and activities, of the ECHO® movement.

• Data from participants is “aggregated” (i.e. anonymised, combined and measured in various ways for analysis).

• This data is used for reporting to funding and governmental entities, in public-facing mappings, visualisations, and directories of the movement, for research related to the movement, for data quality assurance activities, in communications and surveys related to the movement, and in decision-making related to new initiatives. UNMHSC will not use your data for any other purposes.