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Digital Health Tools Help Patients, Doctors Plan for End-of-Life Care

Health systems are using mHealth platforms to make sure patients, their family and caregivers and doctors have advanced care plans in place when the time comes.

By Eric Wicklund

- Healthcare providers are using mHealth to help patients and their families prepare for the end of their healthcare journey.

Through a secure online platform, providers can meet with patients, family members and caregivers in any location to map out advance care plans. They can bring in specialists and counselors to explain the different paths to end-of-life care, resolve family conflicts, even explain DNR orders.

“Towards the end of life, many patients get care that they wouldn’t want if they really understood what it entails,” Steve Wardle, CEO and co-founder of Iris Plans, a Texas-based developer of online palliative care tools that launched this past March, recently told Xconomy. “This puts patients in the driver’s seat and empowers them to be more active in their decision-making.”

About a year ago, the Centers for Medicare & Medicaid Services announced that it would reimburse advanced care planning services for physicians who consult with their patients on advanced directives ike a living will, the designation of a healthcare proxy, Medical Orders for Life-Sustaining Treatment (MOLST) and the preparation for hospice care, among others. Effective January 1, 2016, Medicare is paying $86 for 30 minutes of advanced care planning in a physician’s office or $80 for the same service in a hospital (CPT billing code 99497), and $75 for an additional 30 minutes of consultation in either site (add-on CPT billing code 99498). 

Iris Plans recently announced a partnership with University of Utah Health Plans, part of the University of Utah Health Care network, to offer online advanced care planning to the more than 150,000 members in its network. UUHP officials see the service as an online meeting room, where family members can get together without having to travel long distances and can have access to a wide variety of resources.

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“Telehealth has an advantage over a health clinic: Families who are spread across the country can join in the call,” Wardle said. “It’s important to have the next of kin who will be walking through the illness with you.”

Iris Plans is one of the newer companies in an ecosystem focused on helping patients map out their own journeys before they lose the ability to make their own decisions. A survey taken last year found that only 12 percent of patients in an ICU had discussed advanced care planning with their physician; a separate study, meanwhile, found that three of every four physicians whose patients have an advanced care plan are unaware of that plan.

Chicago-based Emmi Solutions, a Wolters Kluwer Health company, targets providers who want to discuss palliative care plans with patients and their caregivers but don’t know how to begin. Emmi offers an online service using "simple language, compelling visuals and empathetic narration to help people make sense of complex medical information.”

"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, says 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."

Dallas-based ADVault, meanwhile, markets its MyDirectives digital advanced care planning tool as a means of getting the patient’s wishes recorded and stored ahead of time, so that physicians and family members have a clear understanding of what to do when the time comes.

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"People should be able to put their voice in the cloud somewhere," Jeff Zucker, CEO of the three-year-old company, said in a 2015 interview. A patient’s plans for palliative care are “a kitchen table discussion, not an operating room discussion,” he says, and should be made with family in attendance, rather than hastily called in from all corners of the globe.

In either case – in the ICU or at the kitchen table – healthcare providers say an mHealth platform gives them the ability to better inform a patient of the options, pulls in resources where needed, and puts the patient in charge of that care plan. It’s much better than having a doctor or nurse scramble for an available family member in an emergency, and ensures that the right care is being delivered at the right time.

“The more I know about the patients I treat, the better doctor I am,” Brian Yeaman, MD, the chief administrative officer at Coordinated Care Oklahoma and chief medical information officer of the Norman (Okla.) Regional Health System, said in 2015, when Cerner announced that MyDirectives would be offered through CCO, its HIE platform partner, which reaches some 4.2 million people in seven health systems.

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