While mHealth is being touted as a way of improving healthcare delivery, it can also have a role in clarifying how a patient wants to be treated by doctors in an emergency.
Recording a person's wishes on medical care online – with mobile access – goes a long way toward helping doctors manage care for patients who can't speak for themselves. It could also prevent long, drawn-out battles over extending healthcare for those who don't want it, and offer piece of mind for the consumer and all family members.
Determining one's healthcare wishes - including any decision to discontinue care - "is a kitchen table discussion, not an operating room discussion," says Jeff Zucker, CEO of Dallas-based ADVault, which offers MyDirectives digital advance care planning. But if a patient is incapacitated and the physician doesn't know what was discussed at the kitchen table, he or she won't know what the patient wants. That could involve anything from a wish to be treated by one's family doctor to a request that doctors discontinue care in a catastrophic situation.
MyDirectives launched roughly two years ago, after about six years in stealth, says Zucker, and is now accessible in all 50 states and 32 countries. It gives consumers – and, just as importantly, providers and payers – online access to a platform for planning for future care contingencies. Consumers post or record their wishes, and it's available if ever needed by health providers who subscribe to the service.
This, of course, supposes a physician in the ER or OR or at an accident site has immediate access to a computer station. By making the platform available on mobile devices, though, the physician can quickly check for any appropriate directives, while a consumer can make or amend his or her directives at any time and any place.
"People should be able to put their voice in the cloud somewhere," Zucker says.
The mobile platform also works well when a patient's relatives or caregivers are hesitant to accept a directive. The physician could then call up the patient's care directive and show a video that the patient had recorded previously. And it works well to clarify a consumer's status as an organ donor, to declare one's healthcare agents, and to notify insurers when a member is hospitalized.
ADVault announced two partnerships during the recent HIMSS15 Conference & Exhibition in Chicago. First, Humana announced that it would offer MyDirectives to select members.
"Making sure individuals can share important personal and medical information is critical in today¹s evolving healthcare system, and we believe digital advance care planning is a great option for consumers," said Eric Rackow, president of Humana At Home, in a release. "A digital directive¹s ease, interoperability and accessibility empowers Humana¹s members to take steps to improve their healthcare experience."
Shortly afterward, Cerner announced that MyDirectives would be offered through its HIE platform partner Coordinated Care Oklahoma, which reaches some 4.2 million people through seven health systems.
“The more I know about the patients I treat, the better doctor I am,” Brian Yeaman, MD, the chief administrative officer at CCO and chief medical information officer at Norman (Okla.) Regional Health System, said in a release.
Approaching the market from a different angle is Emmi Solutions, which offers an Advance Directives platform targeted at providers who want to have an end-of-life-care discussion with patients and their caregivers but need direction on how to handle such a sensitive subject. The platform serves up "simple language, compelling visuals and empathetic narration to help people make sense of complex medical information," giving providers easily accessible assistance when sitting down with patients and their family members.
According to the organizers of National Healthcare Decisions Day – which was held April 16 – only 12 percent of patients in an ICU with an advance directive had received help from their physicians in creating it; another study found that as many as three-quarters of physicians whose patients had an advance directive didn't know about it.
"There are serious communication challenges around advance care planning and they contribute to the emotional and financial burdens on patients, their families and their caretakers," Geri Lynn Baumblatt, Emmi Solutions' executive director of patient engagement, said in a press release. "Empowering people to make decisions about their own care before reaching a point where they can no longer speak for themselves can shift that experience from one of stress and confusion to one where everyone involved including the family and care team is readily prepared to follow the person's wishes."
Zucker agrees. Communication breakdowns between doctor and patient have been persistent since the first living will was drafted in 1969, he says, with some of the more high-profile cases – think Terry Schiavo – making international news. By offering a means by which everyone can make his or her last wishes accessed at any time and any place, he says, "you're taking a lot of pain out of" the process.
