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How one simple technology solution protects patients' end-of-life decisions

January 26, 2017

    With an aging population and broadened Medicare reimbursement rates for advance care planning, providers and health systems are increasingly interested in developing and improving their end-of-life care protocols. Given the sensitivity and customization required for these complex service offerings, it's essential for providers to meet the highest standards of care every time.

    On the forefront of innovation in the advance care planning field is Dr. Mirarchi, the medical director of UPMC Hamot's ED, a regular feature of the Care Transformation Center blog. Dr. Mirarchi leads The Realistic Interpretation of Advanced Directives (TRIAD) studies to further organizational understanding of the most pressing errors surrounding advance directives and POLST (Physician Orders for Life-Sustaining Treatment). The most recent iteration, TRIAD VIII, has been accepted by the Journal of Patient Safety for publication.

    Dr. Mirarchi's most recent project incorporates easy-to-use technology with highly individualized Resuscitation Safety Statements in order to equip providers with accessible, comprehensible, and accurate information on patient end-of-life care preferences.

    More from Dr. Mirarchi: The ABCDEs of advance care planning

    Patients of Dr. Mirarchi can now opt to produce "My Informed Decisions (MIDEO) Resuscitation Cards": personalized, digitized, card-sized advance directives designed to be carried around in a wallet or purse. MIDEO cards complement advance directive legal documents and POLST by reducing the guessing game for providers during critical moments.

    QR codes on portable advance directive cards increase accessibility to patient's wishes

    Before creating a Resuscitation Safety Statement, Dr. Mirarchi meets with each patient to discuss options in depth and determine the most effective way to communicate patient wishes with clinicians. Patients sign a HIPAA disclosure waiver so that the card can include salient information, such as:

    • Name
    • Picture
    • Date of birth
    • Relevant medical history
    • Contact information of the patient's PCP, health care agent, attorney, and Dr. Mirarchi's practice

    Importantly, the MIDEO Card also features a QR code, which can be easily scanned by emergency providers using a free smartphone app. The code directs the provider to a short video featuring the patient (or the patient's health care agent) clearly specifying their wishes to either accept initial life-saving care or proceed with end-of-life care.

    Providers receive the most time sensitive and critical information in the first minute of the video and are later directed to detailed legal documents for more information.

    Dr. Mirarchi's primary goal is to create an industry standard for advance care planning that prioritizes the individualization and nuance that end-of-life planning deserves.


    More on advance care planning

    It's not a checkbox, but a patient-centered conversation

    Read more

    Questions about how to better support end-of-life planning? Email me at sullivada@advisory.com.

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