What Quarantine Has Taught Us – Digital Health is a Must

Digital health tools — whether telehealth apps, electronic medical records or advance care plans — have become critically important over the past several months as people across the country stay home to flatten the curve. 

Doctors and healthcare providers have quickly adapted to caring for patients without seeing them in-person in order to ensure preventative health services, chronic condition care and treatments continue despite the coronavirus pandemic. Even as  states slowly reopen, our new normal is largely more digital and will remain that way. 

There’s never been a more critical time to get acquainted with the many digital health tools available to patients and consumers. We’re seven months into home quarantine with no return insight to what we all know as normal, and we must find ways to move aspects of our health and wellness online. 

Online resources that provide support to help keep your health in check, which range from online wellness tips to websites that help you organize your medical documents, have seen a significant uptick in traffic and usage during this pandemic. Online fitness classes that can help you maintain a healthy lifestyle can be found on every corner of the net and telehealth is now available from many providers – but what about advance care planning? Advance care plans are vital, especially now, and if you haven’t made one yet it’s time to start thinking about it. 

Advance care plans are critical to ensure you have a voice in your care in the event you cannot speak for yourself so doctors are able to  provide care that respects your wishes. They also allow people to designate a health proxy if they’re unable to speak for themselves. 

Especially now, with  COVID-19, it is essential to have an advance care plan in case you or your loved one cannot dictate healthcare desires. If you’re one of 75% of Americans over the age of 18 that don’t have a plan, now’s the time to make one. If you’re one of the far too few people who do have one, it’s likely out of date, and even worse, on paper! 

Many of us are quarantining far from home, worrying about loved ones and their health and well-being during this time. By encouraging them to create an advance care plan, you can ensure that their wishes will be respected in an emergency, even if you are not there. An advance care plan clearly articulates the needs of your loved ones to physicians and encourages families to have the tough conversations about health priorities that are necessary in this moment.

MyDirectives.com is a free online platform that allows you to upload video, paper documents and more and has an accompanying iphone app. Plans created online are more accessible and can be taken anywhere, unlike paper copies that are often hard to find or out of reach in times of crisis. Another benefit of creating an online plan is that your plan can be altered at any time and shared with family as well as medical providers whenever necessary. 

In an emergency we also have to ask ourselves, would we remember to bring all essential documents and would we know where to find them? A digital advance care plan makes it easy to access important materials and leaves you with a little less to worry about during a health crisis. 

Many people still find comfort in carrying something with them, in case your cell phone dies, or you’re locked out of a loved one’s phone and you serve as their proxy. MyDirectives is one digital platform that also has an accompanying wallet card that allows doctors to quickly access your medical history when you arrive at the hospital. Doctors can scan this card to access your medical history as well as your advance care plan. 

Now more than ever, we must utilize the technology available to us to ensure our safety and protect what is important to us when disaster strikes. By planning ahead and using your resources, you and your loved ones can be prepared for any medical emergency. Protect the wishes of yourself and your loved ones, make an advance care plan today. 

iMedical App: MyDirectives -A good advance planning app for patients

by Douglas Maurer DO, MPH, FAAFP via MedPage Today

Despite universal recommendations from numerous healthcare groups, most people lack an advance care plan. One study found that only approximately 25% of adults in the HealthStyles Survey had completed one. Additionally, the lack of an advance care plan leads to unwanted care — for example, in another study, 25% of patients cited unwanted care as a fear. Many patients and providers simply don’t fully understand what is/isn’t an advance care plan. These are not simply DNR/DNI orders, a living will, or Physician Orders for Life-Sustaining Treatment (POLST) or similar medical orders. These advance care plans include statements of patients’ wishes at the end of life, CPR desires, care at home/hospice, organ donation, etc.

MyDirectives first launched their companion app for iOS in 2015. Both the website and app can be used separately, but ideally they should be together. The website is probably the best place to start, but I did my plan on the app first, and then went to the website to fill it out more completely.

The website discusses the goals of “create, update, and share.” This way a user can immediately complete and sign a valid advance care plan and share it with their family, friends, and healthcare providers. Any updates made in the app or on the website seamlessly sync with one another and with the Apple Health app. The app allows the user to digitally sign the plan, make a video of the person’s wishes; use photos and videos to confirm the person’s identity; share the plan with others via email, text, and QR reader; and show the plan on an iPhone lockscreen, etc.

The multimedia components of the website and app are outstanding. A truly polished product — and completely free!

Communicating Risks to Foster Compliance

By Lindsay McKenzie, via Inside Higher Ed

Dinner Table Discussions

Rita Manfredi, an emergency physician at George Washington University Hospital, worries that unless students have been personally affected by COVID-19, they won’t take safety precautions seriously. While messaging about measures to prevent the spread of the disease are important, getting students to understand the risks should start in their homes through discussion with their family, said Manfredi.

“Students think that they’re invincible,” said Manfredi. While young people are less likely to become seriously ill from COVID-19, they may experience unexplained chronic symptoms after getting sick, she said. There is also a serious risk they may spread the disease to their friends, their professors and, once they return home, to their family.

“We need students to understand that when they go back to college, it won’t be the same. But I don’t think they do understand that. I think they’re expecting to go back and live life as they did before,” said Manfredi. “Some students have been at home since March, and they are craving social interaction. How do you tell college kids, you know, you really shouldn’t be going to that bar or sports event because you won’t be able to drink without taking off your mask?”

Manfredi, who has a son who is preparing to go to college, recommends that families sit down for a “dinner table discussion” before students go back to campus. Parents should talk about safety measures, such as masks, social distancing, hand washing and regularly disinfecting surfaces. “Ventilation is also really important,” said Manfredi. She encourages students to open windows in their dorm rooms and instructors to hold classes outside, if possible. In addition to these measures, Manfredi wants families to discuss what should happen in the event that someone becomes seriously ill.

While uncomfortable, discussions about advance care planning are important and signify how seriously students should take COVID-19, said Manfredi. When young people end up intensive care, their parents often have no idea what their child’s wishes might be, which can cause a lot of stress and uncertainty about how to proceed, said Manfredi. It is a good idea for young people to know their parents’ wishes, too, she said.

“Students need to understand this is not just a flu.”

Advance Care Plans Are Essential But Often Overlooked

By Jim Miller, Special to the Star-Advertiser

Dear Savvy Senior: All this horrible coronavirus carnage got me thinking about my own end-of-life decisions if I were to get sick. Can you recommend some good resources that can help me create a living will or advance directive, or other pertinent documents? I’ve put it off long enough. — Almost 70

Dear Almost: Creating a living will (also known as an advance directive) is one of those things most people plan to do but rarely get around to actually doing. Only about one-third of Americans currently have one. But the cold, hard reality of the novel coronavirus may be changing that. Here’s what you should know, along with some resources to help you create an advance directive.

Advance directives

To adequately spell out your wishes regarding your end-of-life medical treatment, you need two key documents: A “living will,” which tells your doctor what kind of care you want to receive if you become incapacitated, and a “health care power of attorney” (or health care proxy), which names a person you authorize to make medical decisions on your behalf if you become unable to.

These two documents are known as an “advance directive,” and will only be utilized if you are too ill to make medical decisions yourself. You can also change or update it whenever you please.

It isn’t necessary to hire a lawyer to prepare an advance directive. There are free or low-cost resources available today to help you create one, and it takes only a few minutes from start to finish.

One that I highly recommend that’s completely free to use is My Directives (mydirectives.com). This is an online tool and mobile app that will help you create, store and share a detailed, customized digital advance directive. The easy-to-use platform combines eight thoughtful questions to guide you through the process. If you’re not computer-savvy, ask a family member or trusted friend to help you.

The advantage of having a digital advance directive versus a paper document is being able to access it quickly and easily via smartphone, which is crucial in emergency situations, when they’re most often needed.

If, however, you’d rather have a paper document, one of the best do-it-yourself options is the Five Wishes advance directive (online forms are available, too). Created by Aging With Dignity, a nonprofit advocacy organization, Five Wishes costs $5 and is available in many languages. To learn more or to receive a copy, visit fivewishes.org or call 850-681-2010.

Another tool you should know about that will compliment your advance directive is the Physician Orders for Life-Sustaining Treatment, or POLST (sometimes called Medical Orders for Life- Sustaining Treatment, or MOLST). A POLST form translates your end-of-life wishes into medical orders to be honored by your doctors. To learn more about your state’s program or set one up, see POLST.org.

Readers should also know that if you’ve already prepared an advance directive paper document, a POLST form or the VA advance directive form 10-0137, you can upload, store and share these documents at mydirectives.com.

And finally, to ensure your final wishes are followed, make sure to tell your family members, health care proxy and doctors. If you make a digital advance directive or have uploaded your existing forms, you can easily share them electronically to everyone involved. Or, if you make a paper advance directive that isn’t uploaded, you should provide everyone copies to help prevent stress and arguments later.