Healthcare IT Today
By David Hung

Pandemic or no pandemic, having an Advanced Care or End-of-Life (EOL) plan is important. Discussing it is a necessary first step. Then you have to document it and make it available/accessible so that it can be respected when the situation calls for it. None of this is easy, but thankfully there are tools to help make the discussion easier and platforms from companies like Vynca where those plans can be captured, housed, and accessed.

Death is an uncomfortable topic of discussion at the best of times. It’s even more uncomfortable to talk about your own death. It’s depressing and dare I say, morbid. But if you ask any emergency room clinician, they will tell you that NOW is the best time to discuss + document your care preferences.

What most people don’t realize about Advance Care Plans (aka Advance Directives) is that they are as much for you as they are for your loved ones. Imagine for a moment that you are in a coma, being sustained by a host of medical devices that are pumping blood and oxygen into your body. Now imagine your wife/husband/son/daughter/friend having to make the decision whether or not to continue sustaining you in this state or whether to let you go. I cannot think of a more gut-wrenching decision. Whatever they decide is likely to haunt them forever. Why put them through that?

Having a plan, documented ahead of time, absolves your loved ones from having to make that difficult decision. YOU get to make it. YOU get to dictate how the story ends.

As a pulmonary and critical care specialist, Ryan Van Wert MD, Co-Founder and CEO of Vynca, has seen his fair share of end-of-life situations and the devasting impact it has on the individual, their loved ones and clinicians.

“We would see time and again, people coming through the ED who either hadn’t had a conversation about their care preferences or they had a conversation but the document was in a safe-deposit box or left at home,” recalled Van Wert on a The Health Technology Podcast earlier this year. “At that point we do what we’ve been trained to do, which is to sustain and prolong life.”

This takes a toll on everyone involved – the patient who isn’t having their care preferences honored at a critical time, families who have to watch their loved ones in distress and clinicians who know they are likely not providing care that is consistent with an individual’s wishes.

“When people are faced with a serious illness, they often have not had meaningful end-of-life conversations, codified those conversations in an easy-to-access way that allows clinicians to direct the care they want” explained Van Wert. “Unfortunately our healthcare system is setup solely to sustain life which is counter to the preference of most people with serious illness. Most would like to avoid aggressive life-sustaining interventions and focus instead on quality of life.”

Van Wert set out to change all of that by co-founding Vynca, a company that digitizes the advance care planning process, giving patients, their families, and their care teams access to patients’ desires and resources for end of life, palliative, and hospice care.

Vynca helps patients, families and care teams through a multi-pronged approach:

  1. Allowing the patient to reflect on their individual values. Vynca seeks to ensure patients have gone through the process of evaluating their unique goals and priorities. For a younger, healthier person, these conversations typically arise following a sudden illness or accident. For older patients, the discussions likely happens when chronic conditions develop.
  2. Keeping advance care plans safe and accessible. Vynca aggregates advance care plans in a secure cloud and shares those documents with patients, loved ones, and clinicians. To date, they have more than a million documents on file.
  3. Pointing patients and families to available resources. Patients and families often don’t realize they have alternatives to hospital ED’s, Through Vynca they can see palliative and other services that are available.

Vynca has partnered with over 80 hospitals, health plans and ACOs. They also serve as the back-end platform for five state registries, including the Oregon POLST Registry.

One thing that the Vynca team has found is that proper care planning and support has a material impact on admissions and patient satisfaction. According to Van Wert: “Study after study has shown that when providers ask patients to participate in their advance care planning, they achieve higher satisfaction scores. It gives patients a sense that their care teams truly listen and understand their unique values and philosophy. And the scores are sustained for the duration of care, even if the providers don’t revisit the topic on subsequent visits.”

When I sat down with Van Wert fort his interview, we were in the midst of the COVID-19 crisis. Sadly, one of the things that the pandemic has highlighted, is how few people have their care preferences documented.

“It’s become a critical part of managing the COVID-19 crisis because we know the people impacted most from a morbidity and mortality standpoint are those of advanced age and with chronic conditions,” said Ryan. “In this case, it’s bringing to the forefront the reality that we all have to be reflecting on this. As much as there is a higher risk profile, the reality is that every one of us could be faced with decisions around life sustaining therapy and our preferences. Everyone over the age of 18 needs to reflect on it and share their decisions with clinicians and loved ones.”

In this COVID-19 crisis, the difficult decisions around life sustaining therapy need to be made in a very short amount of time – hours or even minutes in some cases. And often, the patients aren’t able to voice their wishes to their families or care teams. This puts the burden on families to have to make a heart wrenching decision on the fly and shoulder the guilt of whatever choice they make.

Watching the full interview to hear:

  • How proper advance planning can have an impact on admissions
  • How supporting patients through end-of-life discussions can lead to a sustained positive reputation for primary care physicians
  • How conversations about care preferences are unique to each patient – young, older, chronic conditions, etc.
  • Why it’s important to ask your loved ones what they would like to happen in an end-of-life situation (you will likely be surprised by the answers)
  • Why families tend to fall back on “life sustaining care” as a default, and why that might not be the best option