Is this a typical scenario for your nursing staff? While admitting a patient in his late 80’s, a nurse asks whether he has a living will or advance directive, explaining she needs to see the original and put a copy in his chart. “Yes,” his wife offers, “but we keep it in our safe deposit box.” Neither of them drive so a couple of weeks go by before the visiting nurse finally gets a copy.
Another scenario is more common in hospitals than during a start of care home visit. The octogenarian arrives via ambulance through the emergency entrance, about to lose consciousness. “Sir, do you have an advance directive?” Same answer as above, from his wife, hours later.
These logistical obstacles experienced frequently by health care providers are reminiscent of a scene in the 1983 classic, “Terms of Endearment” where Jack Nicholson takes Shirley MacLaine for a ride in his hard-top convertible Corvette. When it starts to rain, they find themselves miles from home on a country road. “Can’t you put the top up?” she asks. Jack answers, “The top is at home in my garage.”
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“If providers do not see a document stating patient choices, patients have little chance of controlling their own care.” |
The way most people store their signed and notarized Advance Directive (AD) documents recalls Shirley’s problem, with considerably less humor. No one carries the document with them everywhere they go, nor is anyone standing near their home filing cabinet or bank safe deposit box when they come face to face with end-of-life decisions.
New company; new solution
It appears that a technology solution is finally on the horizon. A new company calling itself “Embark Health” is preparing to introduce an electronic Advance Directive next month that can be accessed when needed, instantly and easily. The new company’s management team and its product idea were apparently impressive enough to have attracted former United Healthcare and SecureHorizons CEO Kenneth A. Burdick to invest and serve as Chairman.
According to the company’s advance materials, obtained by HCTR, Congress enacted the Patient Self Determination Act in 1991, giving patients and families, not healthcare providers, the legal right to make critical end-of-life decisions. However, all too often, patients are still not getting the care they have chosen in advance, 19 years later. Only 15%-20% of Americans have an AD. Those who do have one do not always have their instructions carried out.
“If providers do not see a document stating patient choices, patients have little chance of controlling their own care,” the company’s explanation begins. “If
a patient cannot speak, providers may make the decisions alone. In some states, families can be excluded from decisions, even if they are confident they know what the patient would want. When families disagree among themselves, courts could assign a guardian who does not know the patient to make the decision.”
What Embark Health has done is to create an electronic storage service with a number of fail-safe features. When released next month, Embark’s Advance Directives Clearinghouse will not only store documents but keep them “clear, correct and current.” Documents will be reviewed by Embark staff for compliance with laws in the patient’s state.
An alert system consisting initially of wallet cards and stickers will let providers know that an AD exists and can be immediately accessed on the Embark site or via a 24/7 toll-free call center.
The company is also setting up education and communication programs to reduce confusion among all parties involved in end-of-life decisions.
Legal support services
In addition, there will be a nationwide legal support network to ensure Embark members’ wishes are properly observed. Patients will be guided to designate a healthcare agent and an alternate, whom Embark will educate about their responsibilities. Members will pay a low annual fee to use all Advance Directives Clearinghouse services.
Embark Chief Development Officer Bill Behnke told HCTR the company’s mission is to provide a service that solves a problem for both patients and providers. The problems are not caused by mal-intent on the part of providers or family members but by logistical challenges inherent in the current system, or lack of one, he explained.
Behnke also explained Embark’s business model. “We plan to partner with health plans, hospitals, employers, charities, physician groups, home care companies and other organizations who want to offer this to their clients and members,” he told HCTR, adding that the company plans additional products after this one has been established.
Burdick wrote in his letter introducing himself as CEO, “While this is not a silver bullet cure for all that ails the American health care system, I am proud and privileged to be engaged in a mission that can accomplish three important objectives:
- honor the most personal decisions of individual patients
- protect physicians and hospitals from unnecesssary legal liability
- more effectively utilize the vast resources of our moden health care system
We will follow up on this story when Embark introduces the system on February 1. A web site, www.embarkhealth.com, will be turned on Monday, January 18.
January 15th, 2010 at 7:47 am
I am a nurse that works with many health plans and I wish each of them would mandate that their patients have advance directives and be placed some where so that us healthcare providers can access them. Sounds like this solution might do that.
January 15th, 2010 at 8:30 am
Amy,
I couldn’t agree more. The reason I gave this startup company so much attention is that I have experienced the problem and immediately understood the value. One of the examples I presented in the first few paragraphs actually describes my own parents’ recent experience with a home care nurse asking for Dad’s AD original during the OASIS assessment visit. “It’s in the safe deposit box,” were Mom’s words.
TR
January 15th, 2010 at 4:45 pm
Amy, thanks for your comment. We absolutely make certain healthcare providers can access patients AD’s anywhere and anytime. Our goal is to educate every American on why having an AD available when needed is so important for them and their family. We officially launch February 1st but have already had a tremendous response from providers and patients all over the country. Feel free to email me with any additional questions or comments. Bill Behnke bbehnke@embarkhealth.com
January 16th, 2010 at 3:13 pm
Another company which has been offering this service for several years is DocuBank (www.docubank.com); I have this for personal use, and found it impressive when I was alone in an acute state, in an ER.
January 18th, 2010 at 1:44 pm
Margaret….I am a healthcare provider and you are right in that DocuBank is, indeed, a fine and experienced company. However, it is not nearly as comprehensive as Embark health and has significant flaws within its structure that could still leave patients without many of the protections they might need and deserve.
Here are some examples:
–Like with most services of their kind, Docubank relies on patients to provide them with accurate, current, properly completed documents. Companies like Docubank then merely digitize what the patient provides. There are innumerable examples of this issue being a potential problem.
–The form may be incomplete or not notarized or witnessed properly, making it invalid. Again, since simple digitization services do not have a process for validation, for quality control, or for updating/keeping current, the offering is only as good as the patient’s willingness and ability to do so themselves.
–Education and support for Agents, for relatives, and for others is passive, again relying on others to come to the website, to be proactive in searching for information, or for learning about conversation topics. Most research shows patients are not vigilant and pro-active on a long term, consistent basis about their detailed health information.
–Since Docubank and others do not actively involve themselves in the actual completion of the document, they also are not actually involved in helping the patient understand their choices, from choices on the Living Will to choices about who would make the most effective Agent.
There are many other issues that fine firms like Docubank do not address. After all, at their core they are a digitization and retrieval firm. From what I understand, Embark Health provides a more comprehensive advance directive, patient’s rights service. And that could potentially mean the difference between a patient’s wishes being respected or not.
I think patients and providers will benefit greatly from Embark.
January 26th, 2010 at 8:52 am
I am nurse that encountered this problem numerous times while working in CCU. I think this is an ingenious idea and will be a tremendous burden off the family and medical staff during a time that is already stressful enough. I also believe the annual fee is well worth this service. I hope all healthcare providers will refer their patients to this service. Technology at its best!
Angela Williard, RN, BSN