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Common Good Advance Care Planning

Create a system that helps people get informed advance care planning done efficiently, and makes it immediately available in an emergency.

Photo of Doug Wilson
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Who is your idea designed for and how does it reimagine the end-of-life experience?

It is designed for interested individuals, but more for those responsible for medical care of populations. I imagine never again breaking the ribs of a person I later learn never wanted that. I imagine every adult who comes into the hospital has had prior education regarding care options in critical illness/injury, and has their values and preferences clearly defined and accessible.

This is designed for the current reality of medical practice, where there is time pressure to get things done efficiently. When someone identifies a population, for example adults coming to X clinic or health system, we help build a standardized process where those people are contacted by email or push notification through the patient portal. They can work on the process at home, or they can be walked through it by an assistant at the provider's office. The start of the online process involves the person choosing someone who looks like they do, and who speaks the language they feel most comfortable in. This person then "walks them through" the whole process through video assistance on each page, so that even if they are illiterate or have poor eyesight, they can do this themselves and preserve dignity. If desired, they can see a leader in their spiritual tradition offering guidance regarding advance care planning.

They choose their surrogate decision-makers, and give them general a general outline of what type of care they'd like if they got too sick to communicate from their current state of health. Then they imagine how those care preferences might change it their circumstances changed... for example if they became demented or had only a short time to live anyway.

The person then reads a short prompt into their phone or computer while video capture positively identifies them. The prompt has the person name decision-makers and express their general values for care currently. This video is linked to the AD which gets sent out to decision-makers and other interested parties via email. Thus, although the person can make it legal by going to get it notarized or witnessed, even if that part doesn't get completed, the family knows the person's values and wishes.

The system can then be done as little as 10 minutes into the process, or if appropriate can go on into great detail regarding values and wishes, including the interactive creation of a sample POLST/MOLST form to greatly simplify the conversation with the signing provider.

Patients retain control of their info, which is protected in the cloud and can be changed by two-factor authentication (including fingerprint ID on smartphones). Their choices are available via one click from the header of the inpatient and outpatient EHR, and available to emergency responders.

We envision a not for profit foundation which helps connect the excellent work already ongoing in the field, such that whatever electonic process a person uses to document, it can be accessed by providers who need to know.

What early, lightweight experiment might you try out in your own community to find out if the idea will meet your expectations?

See above poster presentation where we did something similar in paper, and got the majority of our 20,000 adults to have their wishes documented. Next step will be testing with a simplified website.

What skills, input or guidance from the OpenIDEO community would be most helpful in building out or refining your idea?

We are looking for partnerships to help build this into the most beautiful option for helping people get care that's true to their values. We envision this being held in a sacred public trust, not-for-profit collaborative. We envision financing to come from health systems most likely to benefit. We'd be grateful for ideas, web user experience experts, and financial partnerships.

Tell us about your work experience:

I work in healthcare as a family doctor, in hospital medicine, and palliative care. I have an interest in design, but apart from building an airplane haven't done much formally in that arena.

This idea emerged from

  • A group brainstorm
  • An Individual


Join the conversation:

Photo of Lois Perelson-Gross

Hi Doug,
This is an exciting concept. Thank you.
Question: Your project depends on a number of technological features that may be unfamiliar to people of the age &/or SES you want to reach (fingerprint authorization, video capture) and also seems optimistic in getting people from zero to completed video in 15 minutes. If the lower-tech version of working in person with a human assistant proves more appealing to your target population, how would the human assistants' time be reimbursed?

Photo of Doug Wilson

Thanks for these helpful points, Lois. It's clear that I wasn't ;)
Medicare now reimburses $86 for the conversation, and I think the ideal would be for healthcare providers to train their staff to walk people through this so that the conversation with the provider could be more focused.
The completed video I see as just people reading two sentences, which the program customizes to include their desired DPOA's and general values. I don't know if that will work for most people across a population, but I'm excited to find out!
Most of the AD is just a PDF, with a link to the video.
I appreciate your design creativity!

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