End-of-Life Care: Helping Patients Make Tough Decisions Session # 125, August 11, 2021 Mike McSh e rry Chief Executive Officer Xealth

DISCLAIMER: The views and opinions expressed in this presentation are solely those of the author/presenter and do not necessarily represent any policy or position of HIMSS. 1 Welcome

Mike McSh e rry CEO and Co-founder, Xealth #HIMSS21 2 Conflict of Interest

Mike McSherry has no real or apparent conflicts of interest to report.

#HIMSS21 3 Agenda

• Reviewing the importance of advance care planning

• Video impacting patient’s decision making

• Initial manual pilot results

• E-mail automation project

• Discussion / Q&A

#HIMSS21 4 Learning Objectives

• Identify target patients for receiving information in advance of their appointment

• Design patient behavior to return the information and drive engagement

• Evaluate communication methods and materials that are most effective

• Create outreach based on utilization

#HIMSS21 5 California Healthcare Foundation Survey 2021: Death and Dying in California DIFFICULT 80% Want to talk to their doctor about end -of-life care. CONVERSATIONS WANT TO TALK

7% Have actually discussed end-of-life with their doctor. DISCUSSED

6 Spreading at Scale: A Practical Leadership Model for Change

“Essential core values at [Providence] include honoring the dignity of every human being and caring compassionately for every patient. In the clinical space, this means that we believe that all the care that we provide should be consistent with each person.” Amy Compton-Phillips, MD CHIEF CLINICAL OFFICER, PROVIDENCE

#HIMSS21 7 8 #HIMSS21 Search Engines

NOT ON THE FIRST PAGE? WHERE DO YOU TURN?

#HIMSS21 9 Patients want video mediums.

#HIMSS21 10 Is video helpful?

#HIMSS21 11 #HIMSS21 12 #HIMSS21 13 Television as an example No. of CPR No. (%) of No. of No. of CPR Attempts Immediate Program Episodes Arrests Shown Average Age Survivors Casualty 26 26 26 35 11 (42%) ER 14 18 17 29 7 (41%) Grey's Anatomy 23 17 13 42 6 (46%) Holby City 25 15 14 39 8 (57%) Total 88 76 70 36 32 (46%)

PMID 19699021 #HIMSS21 14 Television as an example No. of CPR No. (%) of No. of No. of CPR Attempts Immediate Program Episodes Arrests Shown Average Age Survivors Casualty 26 26 26 35 11 (42%) ER 14 18 17 29 7 (41%) Grey's Anatomy 23 17 13 42 6 (46%) Holby City 25 15 14 39 8 (57%) Total 88 76 70 36 32 (46%)

#HIMSS21 15 PMID 19699021 #HIMSS21 16 Rate of Advance Care Planning Documentation 100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0% Before Videos After Videos #HIMSS21 17 doi: 10.1007/s11606-016-3730-2 18 #HIMSS21 18 36

#HIMSS21 19 Initial Pilot – Single Primary Care Practice Weekly Completed Viewings 40 35 30 25 20 15 10 5 0 8/1/16 9/1/16 10/1/16 11/1/16 12/1/16 1/1/17

#HIMSS21 20 “ “Can we just automate this? We asked our colleagues “what went wrong?”

The Answer was clearly – TOO MANY CLICKS.

#HIMSS21 21 22 Email Address

Age 65 or Older

Annual Wellness Visit

Project Design Not First Providence Visit

APPOINTMENT (VIRTUAL OR IN-PERSON) No Advance Directive in EHR

Not Declined ACP Conversation

Not Seen This Video in Last 90 Days

#HIMSS21 23 Process Services

7 DAYS

APPOINTMENT AUTOMATED (VIRTUAL OR E-MAIL IN-PERSON)

#HIMSS21 24 Branded

Appointment Reminder

Normalize

Link to video

Link to Advance Directive

Alternative Suggestion

Congrats!

Signed by Clinician #HIMSS21 25 8,000+ Advance Directives

#HIMSS21 26 The Results

66% 25% 10x ADVANCED DIRECTIVES EMAIL ENGAGEMENT VIDEOS WATCHED ON FILE

#HIMSS21 27 How did we do all of this …?

28 Vendor 1 Vendor 2 Vendor 3 Vendor 4+

Contracting Contracting Contracting Contracting Security Security Security Security Patient Identity Patient Identity Patient Identity Patient Identity HL7, FHIR, Other HL7, FHIR, Other HL7, FHIR, Other HL7, FHIR, Other VPN VPN VPN VPN EHR Workflow EHR Workflow EHR Workflow EHR Workflow Provider UX Provider UX Provider UX Provider UX Patient UX Patient UX Patient UX Patient UX Portal Integration Portal Integration Portal Integration Portal Integration Analytics Analytics Analytics Analytics

Provider System

EHR System

#HIMSS21 29 Vendor 1 Vendor 2 Vendor 3 Vendor 4

Digital Health Platform

Streamlines and simplifies digital health solution deployment

Provider System

EHR System

#HIMSS21 30 “Digital Formulary” Creation & Management

1 - Integrate 2 - Order 3 - Deliver Consolidate digital tools (data Order digital tools from existing Deliver to patient via email and existing + rules) clinical workflow patient portal

5 - Analyze 4 - Monitor Evaluate and optimize overall digital Quickly access data and usage for an ecosystem individual patient, or across all solutions #HIMSS21 31 ORDER COMMUNICATE ENGAGE / AUTHENTICATE ACTIVATE

Workflow Integrated HS Branded HS Directed HS Digital Front Door EHR Digital Care – Manual Email MyChart Content

Data Out Triggered by Order SMS HS Custom Portal Mobile Apps Automated HL7 Reminders DOB - Direct Access Web Portal FHIR Batch Enroll Consent (RPM / Data) HL7 Registry Data Batch files PHI / DATA RULES ENGINE + INTEGRATION PLATFORM ORDER STATUS DIGITAL VENDORS

Visit type Comms Prefs / Control Content Type HOW / WHEN / WHY EHR Location Diagnosis Order Status do you want to enroll the patient, manage their Data In Order Event Group ID engagement, and monitor Clinical Condition(s) Demographics Inbox / Basket their progress? Flowsheets HL7 MDM DATA

MONITORING / RPM PLATFORM CONNECTED EXTERNAL DATABASES DH Vendor DB

Partner Managed Passive Monitor Non-EHR Patient ID Mgmt Content Management Active Monitor Clinical Via Digital Care System ACO / Employer Data Warehouse Alerts Patient Matching Patient Analytics Payer #HIMSS21 32 Advance Care Directives – Streamlining & Automating the Process Email communication (reminders or confirmations) (If appt made and rules met) Detects whether patient Detects Automatically sends email with watched video and / or appointment video + Advance Directive downloaded forms, triggers In-Visit Notifications scheduled download action

No action, except reflect in Digital monitor view (if desired) Automation Platform

Status of engagement Checks data against rules with content available in Monitor View for Advance Directive the EHR (e.g. did they download the form?)

Demographics (EHR) Clinicals (EHR) Non-Oncology Patients > 65 No AD on File Oncology Patients > 18 Email in EHR Not First Time Visit

#HIMSS21 33 Lessons Learned

System-wide automation projects Frequent check-ins and report outs with key 1 are possible 3 stakeholders drive momentum forward

Frontline champions are essential Engagement is high, but more must be 2 for buy -in 4 done to Streamline the process

#HIMSS21 34 Next Steps

• Enhance e-mail template to bolster patient engagement • Adapt the subject line • A/B Test

• Pilot other scenarios for sending additional automated video information • Trigger at time of referral to outpatient palliative care clinic (which have high no- show rates)

• Expansion to other service lines • Cancer Centers have requested modified version of this project

#HIMSS21 35 20% of US healthcare spend occurs in the last 12 weeks of life. We have an opportunity and responsibility to make sure care in those final weeks aligns with patient wishes.

#HIMSS21 36 Questions Discussion

#HIMSS21 37 Thank you!

Mike McSherry CEO and co-founder, Xealth [email protected] linkedin.com/in/mikemcsherry/

Matthew Gonzales, MD, FAAHPM CMIO, Institute for Human Caring, Providence [email protected] @mattgonzalesmd

#HIMSS21 38