When John F. Kennedy spoke about the new frontier of the 60’s during the National Democratic Convention, he was referring to the set of challenges, not a set of promises. Fast forward 50 years, and we now have 75 million Baby Boomers – a massive “gray wave” that could soon overtake and overwhelm our healthcare and social security systems. In fact, 10 thousand American citizens will turn 65 today – and tomorrow, and every day for the next 10 years. Most of them will become Medicare beneficiaries, and all of them will need increased healthcare services as they age.
I had the privilege of interviewing Scott Brown, the Co-Founder and President of MyDirectives®, who was awarded the 2013 Healthcare Startup of the Year Award by Healthcare Unbound. MyDirectives has also been singled out by the National Coordinator for Health IT, Farzad Mostashari, as one of the first small businesses to become fully compatible with the government’s Blue Button® system, which provides patients with a quick and secure way to access their electronic health records. Brown left his successful law practice, where he was an international lawyer for over 15 years, to develop a service that he and Co-Founder Jeff Zucker believe has the potential to impact millions and save the healthcare system.
Why would someone not from the healthcare space make such a bold move? Brown shared extremely keen insights as he questioned healthcare system orthodoxies – I think that you will enjoy reading about his innovation journey.
LeAnna Carey: Scott, why would anyone ever leave a lucrative career as a partner in a large, well-established law firm to jump into healthcare during its greatest time of uncertainty?
Scott Brown: That’s an excellent question! Actually, it’s a very personal story. My grandmother spent the last 20 years of her life in a nursing home suffering from multiple strokes, slowly descending into dementia, and being admitted to the ICU repeatedly during the last two years of her life. She had a miserable end-of-life experience, and I saw the stress that experience put on our family all the way up to her death and even afterwards. At the same time, the Terri Schiavo drama was playing out on the public stage in 2005, and the voice that was by far the most important – Terri Schiavo’s – was completely missing from the debate. At some point, it occurred to me that my own mother, who has suffered from Multiple Sclerosis for over 30 years, would eventually end up in a state where she won’t be able to communicate, and I did not want my family to go through this trauma again. When I started looking around for a solution, I realized that there wasn’t a good solution to these problems – the advance directives that have existed for over 40 years are terrible documents! Almost no one has them; if they do have them, they’re not available when they’re needed; and even if they are available, nine times out of ten they’re absolutely useless documents. I thought, “There has to be a better way,” but the more digging and research I did, the more I came to understand that there wasn’t a better way, so I decided to create one.
LC: How did you get past the idea stage?
SB: We started with research. We conducted almost 6 years of research, development, beta testing, and so on. We had to find out why past efforts at advance care planning and advance directives had failed before we could develop a viable solution to the problem. What was already “out there”? Why hadn’t it worked for my grandmother, why won’t it work for my mom (or me, or my wife, or my children)? We interviewed hundreds of doctors, lawyers, ethicists, thought leaders in the critical care, hospice, palliative care, and end-of-life care space, policymakers – anyone who we thought could give us some insight to what a practical, viable solution to advance care planning would look like. Once we had a better handle on that, we just jumped in and tried to find the best people we could work with to develop MyDirectives and bring it to market.
LC: What is the one thing that you have you learned?
SB: If I had to choose, I suppose it would be that these end-of-life conversations are happening too late. For 40 years, healthcare “thought leaders” and policymakers have focused advance directives efforts on people who are older, or on people who are already terminally or chronically ill, and the result has been complete and utter failure. That is simply too late to start these conversations – it hasn’t worked; it doesn’t work; and it won’t work.
LC: Let’s dig deeper into the business value proposition…
SB: MyDirectives is the world’s first all-digital online advance care planning tool. We are free to consumers and will always be. MyDirectives allows consumers to create and update their advance care plan, which is really more than just a medical directive. Documents are then stored in a secure database that’s available to them and their medical providers (emergency first responders, hospital admissions staff, emergency room nurses, and doctors) 24 hours a day, seven days a week, anywhere in the world. It is the only Advanced Care Planning (ACP) tool that:
(1) Seamlessly integrates into any EHR, EMR, PHR, HIE* or patient portal.
(2) Incorporates extensive security/admin tools to track changes to users’ ACPs and ensure that only the most recent version is used.
(3) Combines all of the elements of a living will and a medical power of attorney with patient preferences regarding resuscitation efforts, hospice/palliative care, autopsy, and organ donation, as well as qualitative care preferences in the My Thoughts section.
(4) Allows users with a terminal illness to upload and store a POLST/MOLST, a DNR/DNAR* Order, and other similar forms to ensure that they will be available to healthcare providers at critical moments.
(5) Incorporates a unique combination of thought-provoking questions, the ability for the user to choose between “standard” answers and open-ended text boxes, videos, logic-based alerts, definitions, FAQs and other help modules designed to educate and lead the consumer through the process of creating a well-thought-out, high-quality ACP that – in stark contrast with previous generations of state-based advance directives and forms sold to consumers by private companies – will actually provide useful, actionable information and instructions to caregivers and healthcare providers if and when needed.
LC: You asked a good friend to come on board, Jeff Zucker, who is now the CEO – conventional wisdom says, that it is not a good idea to work with friends or family. Clearly, you made a great decision – you are now a global company with incredible momentum – I’m guessing that you would do it again…
SB: It’s been an amazing experience, and I couldn’t ask for a better business partner. We definitely bring different things to the table. I bring the legal background and tend to be very analytical about certain issues, and I have the experience to help us structure and build relationships with our investors and partners. Jeff brings real world business experience and a different kind of analytical ability, not to mention, a limitless amount of energy and tenacity. Our personal styles and energy are complementary. One of the greatest assets we have, though, is our passion for sharing MyDirectives with the world. We honestly believe we can improve lives and save the healthcare system.
What advice would you give to newbie innovators?
SB: Ask first, why doesn’t this innovation already exist? We had to find out why past efforts at advance care planning had failed. Also, before you try to develop an innovative product or service, make sure that “if you build it, they will come.”
I would also tell them they need to ask themselves whether they are truly passionate about what they consider to be their innovation. Are they realistic about the challenges they’ll face and the potential to create change?
One of the challenges we faced was that neither Jeff nor I were from the medical, healthcare sector, so we had a learning curve. We had to learn how the ecosystem works. We’re still pressing through road blocks – from consumers that don’t want to talk about a taboo subject like death; to policymakers that are afraid to talk about advance care planning even though national polls show that 96% of Americans across all demographics say it’s important for these issues to be a priority for the healthcare system; to so-called “thought leaders” on advance care planning that are so afraid of admitting that there might possibly be a “better way” than what they’ve preached for the last 30 years that they do all they can to protect the status quo – the list goes on and on.
LC: What is the next step for MyDirectives?
SB: We went live quietly over a year ago, and we are already being used in almost all 50 states and several foreign countries. The reaction has been tremendous, and the next stage is for us to go big. We have some very interesting projects going on with our commercial partners. For example, the Baylor Health Care System is working on a wider-scale implementation of MyDirectives throughout their healthcare system. We have projects going on across the United States – we’re turning a corner and seeing a “sea shift.” Things that weren’t possible six or seven years ago when we started are now becoming mainstream conversations. We’re looking at that next stage and at making MyDirectives a household name.
LC: Last words?
SB: Anyone who thinks that the Baby Boomer generation is going to go quietly into the night is wrong. There are new innovations every day on care delivery, but unfortunately, very little has been done to improve quality of care at that last stage of life. Despite all of the talk by thought leaders and policymakers about “patient engagement,” we’re letting the demographic that accounts for the largest portion of our annual healthcare spend slip through the cracks. Going forward, this is a demographic that will become more important – whenever 75 million Baby Boomers start to talk about something, it becomes culturally significant, and they’re starting to talk about how they want to spend the end of their lives. We have to educate consumers on the benefits of effective advance care planning, and then ensure that their decisions are documented and honored. Think about it: This is the one area where it truly is a win-win for all of the stakeholders – the patient (and the patient’s loved ones), the doctor, and the payer. We have doctors today that are being forced to do things to patients that they wouldn’t want for themselves, that they wouldn’t do for their loved ones, and that they don’t believe are going to help the patient because they’re guessing in the dark, and all of this is being done at enormous expense to the system. We can fix all of this by simply educating consumers, empowering them to make informed decisions about their healthcare, and then ensuring that those decisions are available if, when, and where needed. We’re always looking for the next great partner to work with to make this happen.
image credit: mydirectives.ocm
DNR – Do not resuscitate
DNAR – Do not attempt to resuscitate
POLST – Physicians/Medical Orders for Life Sustaining Treatment
EHR – Electronic health record
EMR – Electronic medical record
PHR – Personal health record
HIE – Health information exchange
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LeAnna J. Carey is the Chief Digital & Healthcare Officer for Innovation Excellence; the host of Innovation Talk by TheHealthMaven. If you are a contrarian or question orthodoxies, you highly qualify to be a guest on her show. You are invited to follow Lea @TheHealthMaven. Lea is also the cofounder of AuraViva, a mobile healthcare company – and yes, she innovates.