October 2016

Hearing the Patient’s Voice in an EmergencyA Community Approach to Creating Emergency, Critical and Advance Care Plans

(ECACPs)

2

The Problem

Wessex AHSN

October 2016

Millions Need A Voice2.3m CHD sufferers

5m Diabetes sufferers1.25m COPD sufferers

2,000 car accident deaths

16,000 in persistent vegetative states

490,000 people die every year

without their voice being heard

Comments

Wessex AHSN

Understanding the Opportunity

Large market opportunity, currently unmet

3October 2016

4

Why Record a Patient’s Voice

Wessex AHSN

October 2016

EPaCCs ProgrammeCommissioned on the

basis of an HMT business case of £1,488

saving per death. Attempts to target 2% of predictable deaths

NHS estimates a person with a statement of decisions, preferences and wishes in place will save the system between £1450 and £2100

per patient

Comments

5

What Would A Population Level Approach Save?

Wessex AHSN

October 2016

Economics of a national approachWhen the Figures Add UpBoth houses of the US Congress have looked at similar figures and decided to offer $75 to everyone one Medicaid and Medicare to create a digital ECACP.

Comments

Wessex AHSN

Return for Hampshire

Population

Large market opportunity, currently unmet

6October 2016

1,320,000 Annual Deaths c13.000

English ModelTarget 2% of predictable deaths to save £1,450 net per patient. Savings in Hampshire: 230 x £1,450* = £333,500 p.a.

MyDirectives’ Digital Model

*Lowest end of potential savings based on Gundersen Healthcare Studies in Wisconsin and CoordinateMyCare studies in London

Target 50% of population to capture 25% of deaths to save £1,450 net per patient. Savings in Hampshire: 3250 deaths x £1,450 = £4,712,500p.a. (Conservative)

7

What stops us asking the community to help

Wessex AHSN

October 2016

“70% of people will lack decision-making

capacity at the time decisions near the end

of life are needed.”

Citizens think:

It involves lawyers and health professionals

Families know their wishes

It’s about life-limiting treatments

Believe they are too complex to complete

Health Professionals think:

People need help answering

They have to witness

The decisions won’t be trusted unless a professional

records them

Nobody will do it unless they know they are dying – they don’t like raising the subject

Comments

8

How To Create Community Approach

Wessex AHSN

October 2016

Karen Detering, Austin Health, Melbourne: “Training 1000s of

health professionals to help citizens to create

directives is not sustainable.”

Create structured standard international digital forms that are easy to complete

Support with written and video educational material Introduce “video-selfie” statements and signatures

Share digital documents and educational material with “supporters/health agents”

Confirm the documents with digital witness signatures Create a digital audit trail

Insist people re-witness the record regularly Nudge people to progressively fill-in statements over lifetime

Make accessible and editable 24/7 Integrate the “patient’s voice” with existing primary and

secondary care systems using HL7 rules for content and transportation

Invite millions to get involved and start a community movement

Comments

9

How MyDirectives Works

Wessex AHSN

ADVault – Process Flow – Creation/Sharing/Retrieval

October 2016

Consumer creates videos and statements. Signs and has them witnessed. All held in ADVault’s repository.

Consumers share and discuss their preferences values and goals with people “health agents” they want to speak for them if they can’t speak for themselves. This can include family doctors.

Unrelated individuals are asked to witness the documents

Retrieval

Creation

Sharing

Via global database link in medical system. HIE

Via live pdf in an electronic patient record or HIE

Via QR code, link or print out provided by patient or health agents

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How MyDirectives Creates Adoption

Wessex AHSN

ADVault – Process Flow - Outreach

October 2016

Hospital or primary care service design appropriate outreach criteria

Patient may be invited to create MyD during consultation

Clinicians with access to MyDirectives can search global database

Patients invited by text to visit MyD

Patients invited by email to visit MyD

Patients invited by letter to visit MyD

Comments

MyDirectives can be adopted through multiple routes.

MyDirectives can be retrieved by multiple agencies with confidence they are always viewing the most up to date copy.

MyDirectives can be used as a “highway” for other uploaded documents into clinical systems.

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UK Adoption and Retrieval Approach

Wessex AHSN

Changing the Rules

October 2016

12

What MyDirectives Needs

Wessex AHSN

October 2016

Our first UK community-wide evaluation site –

could that be you?

13

MyDirectives’ Apple iPhone Collaboration

Wessex AHSN

October 2016