Daily across the United States, clinicians are engaged in difficult end-of-life conversations with patients and families. Unfortunately, these conversations have become even more routine for many frontline providers because more than 280,000 Americans have died from COVID-19 as of November 2020.1 Nearly 70% of the U.S. adult population does not have a plan for end-of-life care.2 This lack of planning leaves loved ones uncertain about when and how to make critical end-of-life health care decisions. This uncertainty can lead to an unintentional extension of care beyond the patient’s wishes. Intermountain Healthcare recognized the need to improve the quality of advance care planning (ACP) to know and honor the wishes of the patients they serve.
“Health care providers care for patients daily with chronic illnesses and injuries that require critical treatment decisions be made without a patient’s advance care planning preferences in place,” said Mary Helen Stricklin, MSN, RNC, Intermountain Healthcare’s system nursing director for palliative care. “When ACP is not there, people don't know what to do — and they're making life and death decisions — which can be traumatizing, divide families and can involve stressful, ethical and moral dilemmas for everyone involved.”
Intermountain Healthcare is committed to improving ACP and following patient directives.
“At Intermountain, we want the patient's wishes to be recognized and followed,” said Kathryn Kuttler, PhD, Intermountain’s advanced decision support director.
Intermountain is a not-for-profit health system of 24 hospitals, 225 clinics, a Medical Group with 2,600 employed physicians and advanced practice clinicians, a health insurance company called SelectHealth, and other health services in Idaho, Utah, and Nevada.
Using Vynca’s advance care planning digital solution integrated into Intermountain’s Cerner Millennium® electronic health record, called iCentra, Intermountain implemented a new ACP dashboard that provides caregivers with more consistent, reliable digital storage and retrieval for all ACP documents. The dashboard features built-in logic to check that documents are legally compliant, which helps prevent patients from giving inconsistent messages to caregivers.
“If you need information instantly, the ACP dashboard gives you a quick, color-coded look at what the patient already chose, without having to pull-up the full document. The visual cues and consistency help caregivers find the information quickly in urgent situations,” said Stricklin.
Because the Vynca dashboard is fully integrated into iCentra, clinicians can access patients’ ACP status and documents within their workflow. Integrating the dashboard with these essential capabilities provided new opportunities to discuss ACP on telehealth visits during the pandemic, leading caregivers to initiate conversations more frequently. Patients and providers can create and sign documents within the dashboard, which immediately appear in the patient’s record.
“For example, we had a telehealth conversation with a patient and walked him through what to expect if he were to get COVID-19 given his current health situation. During that ACP conversation, he indicated that he did not want to come to the hospital, he did not want to be resuscitated if his heart stopped, and he would prefer to die at home,” said Stricklin. “The electronic Provider Order of Life Sustaining Treatment was completed. The patient, preparer, and provider all signed the document from different locations. That electronic ease allowed us to complete the document quickly and have it in place before a crisis occurred.”
1 COVID Data Tracker, Centers for Disease Control and Prevention, accessed December 8, 2020, https://covid.cdc.gov/covid-data-tracker/#cases_casesper100klast7days
2 Approximately One In Three US Adults Completes Any Type Of Advance Directive For End-Of-Life Care," Health Affairs, accessed November 18, 2020, https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2017.0175