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.