The Challenge

End-of-life care that is inconsistent with a patient’s wishes is a common scenario that creates stressful interactions between family members and imposes significant unnecessary costs. A legal document called an advance directive exists for individuals to predetermine end-of-life wishes and related medical decisions should they be unable do so themselves. An advance directive also reduces stress amongst family members, loved ones and healthcare providers.

With an advance directive, individuals can communicate their care preferences including the treatments they do and do not want. Without one, difficult decisions can be left to family guesswork and disagreements that can be emotionally fraught. End-of-life wishes might not be honored. Patients might not receive the treatment they want or they may receive treatment the don’t want.

Yet according to a 2014 survey by the American Journal of Preventive Medicine, just 26.3 percent of Americans have an advance directive. More often than not, individuals simply do not know what an advance directive is, its utility or how to create one. Penn Medicine, one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care, both sought to mitigate this shortcoming and increase the number of patients that have an advance directive and have made it available to their family members and providers so their preferences are known and followed. And knowing that technology could be a driving force in this mission, they tapped Arcweb Technologies to design and develop a solution.

Solving a Personal Health Challenge for Providers, Patients and Families

The Approach

After research-focused design and iterative development phases, the team created the initial version of OurDirectives which has continued to evolve. OurDirectives is an easy-to-use web application that not only educates patients on the purpose and functionality of advance directives but also allows them to create one from directly within the product and easily share it with those that need to know. The application serves a dual purpose as a learning platform for Penn Medicine faculty and staff, producing data and teachable insights (e.g. on where people get stuck in the process) that they can then use to guide patients through the process of understanding and creating an advance directive.

A responsively designed web application was created so that it can function effectively on both tablet and desktop browsers, OurDirectives presents patient preferences in an approachable way, explaining clearly what an advance directive is. The application then walks the patient through a series of information-rich survey questions. For example, OurDirectives informs the patient that choosing a single healthcare agent to make medical decisions should they themselves be unable to do so can help caregivers follow their wishes rather than leaving it to family guesswork. The system also documents preferences related to organ donation, quality of life choices, life support options, medical decisions and more.

Upon completing the series of questions, patients can print their advance directive, sign with witnesses per Pennsylvania law, and share it with caregivers, family members and anyone else who may need access to it.

Arcweb Technologies designed OurDirectives to be easy for providers to update, improve, and refine as they gather and analyze anonymous patient preferences. The product features a fully customizable, easy-to-use form builder on the backend where providers can act on patient data trends and behaviors, modify question language, rearrange questions and more.

The Results

Thanks to a thoughtful, purpose-driven approach, Penn Medicine and Arcweb Technologies were able to design and develop a technology that solves a unique yet universal healthcare problem.

We worked with Arcweb Technologies to rapidly deploy multiple product iterations as we tested different designs with our patients, providers, and families. This methodology not only ensured proper product design, development and delivery but also tied directly to our objective of enhancing advance directive education and making sure patients receive the care they want.

Roy Rosin, Chief Innovation Officer, Penn Medicine

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