Advance Care Planning (ACP) document storage and integration is useless if the documents are useless

There are several healthcare IT companies that provide a document storage service for advance care planning documents (living wills, MOST, POLST, HCPOA, Advance Directives, etc.).  

There is plenty of research showing these forms are ineffective:

·       The Hidden Dangers in Living Wills - https://www.pbs.org/now/shows/541/living-will-dangers.html

·       The Problem with POLST – Physician Orders for Life-Sustaining Treatment - The Problem with POLST – Physician Orders for Life-Sustaining Treatment

·       Problems with Advance Directives - https://www.healthinaging.org/age-friendly-healthcare-you/care-what-matters-most/advance-directives

These ACP healthcare IT companies are also investing in integration with EMRs and other software to provide access. This is a good start, an exercise to creating a technical interface, similar to Google Cloud teams up with Deloitte, KPMG to launch healthcare interoperability program for providers and payers

Reality check - You can sign up your customers using one of these ACP document storage apps and you might get significant “adoption.” But you do not solve the problem that only 7% want full code and 80% still get it because access to a bad document does not eliminate the confusion.  Significant “effectiveness” is the goal, not significant access by just filling out forms that may not even comply with state laws.

The goal is to provide an Advance Care Planning (ACP) service that assures individual’s wishes for medical care are followed when they are unable to communicate. Our research has shown what people want -

• Control of their End of Life (EOL) care
•  Know they can have everything done
•  Be well informed on various options
•  Free of pain and suffering
•  Not a burden to their caregivers

• Document not available – paper version, left a home, cannot find it – document does not follow patient when sent to another facility; sometime the document does not follow from ED to ICU!
• Document not helpful – not signed properly (state laws), confusing format, no specific medical directive – requires asking someone questions, to interpret the document – voiding paper forms with copies across multiple care settings is impossible – how do I know if this is the current version?
• Document overridden by Family / HCPOA – sometimes the default, regardless of a document being available
• No Timeline – how long do you want this care provided? Some unwanted care lasts for years!

•  Document available – 24x7x365 – EMS portal, ED portal, family / caregiver links – from smartphone!
• At the bedside, in the chart, linked to the EMR / HER
• Follows the patient when transferred to other facilities (admitting and discharge) and within departments in facilities
• Only the current version!
• Document helpful – completely revamped for both patient and doctor view
• Compliance with federal and state laws – signatures, witnesses, etc.,
• Extensive education to help authoring the document – but separated from the document output
• Specific output formats – for individual, for caregiver, for physician, for provider, for payer
• Specific medical directives - not I want to listen to music and get foot massages
• Document CAN’T overridden by Family / HCPOA – encourage family input during the creation of the document, but not after to eliminate the last-minute panic decisions of “do everything – save my mom!”
• Specific Timeline – allows you to specify a set time interval of improvement for specific care instructions – “I do not want to be on a machine” versus “I do not want to be on a machine for more than 4 weeks” – this is the safety net.

There are several distinct phases that represent a complete ACP solution:

-       Education

-       Document Authoring - including compliance with federal and state laws

-       Document Storage

-       Document Retrieval

-       Document Change Management

Until we provide useful information in a useful format, the problem is NOT solved by providing access to documents that are not designed to be presented in the format based on the intended audience. If doctors and nurses will not use the document, then it is ineffective!

Regarding compliance with federal and state laws, TurboTax would have failed if they walked away from compliance, and either directly or indirectly, told their customers it is their job to assure compliance. By taking the time (and money) to keep track of federal and state laws, they obtained significant adoption.

I would like to hear your thoughts

John Cachat

Co-Founder

Directed Medical Systems

https://www.dhirubhai.net/in/johncachat/

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Comments on "Advance Care Planning is Wrong" Podcast with Sean Morrison Aug 2020

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#advancecareplanning #telehealth #advancedirectives #POLST #MOST #livingwill