The Center for Healthcare Innovation (CHI) prides itself on bringing cutting-edge ideas and concepts to the clinical arena and using this technology to better the livelihood of individuals. Research in end-of-life care is an area where CHI—and its members—have significant expertise. This led the leaders of CHI to travel to the Texas Medical Center and meet with the Koda Health team as their work in advance care planning was closely aligned to the Center’s interests and expertise. Wake Forest Center for Healthcare Innovation and Koda Health have since developed a strong, working partnership that led to the submission of a grant through the National Science Foundation (NSF) Small Business Technology Transfer, which was awarded to both institutions. 

Project Introduction and the Impact of COVID-19

One of the societal trends accompanying longer lifespans and improved medical technology is a disconnect between many patients’ wishes and end-of-life care they receive. With 80% of Americans preferring to die at home, whereas only 31% do1, it is evident that medical intervention in terminal cases can lead to overtreatment2, which contributes up to $101BUSD to medical care costs annually3. This unwanted care goes against patients’ wishes and results in great costs to society, with more than 25% of Medicare spending accruing during the last year of life4. 
The COVID-19 pandemic represents unprecedented challenges to our health care system, which are most dramatically visible through a lack of bed capacity in intensive care units. For the families of those patients who do not survive the disease, the loss of a loved one is exacerbated by the separation in their last hours due to the infectious risk. The existence of an Advanced-Care Directive (ACD) would dramatically reduce the impact on the families of those patients that face the decision to end continued life support, and those who prefer not to be kept alive in terminal intensive care situations will have their own wishes respected. Further, any increase in ACDs will ensure that care delivered to patients is in accordance with their goals and quality of life preferences, redirecting patients who prefer comfort care to the home and freeing up intensive care capacity for patients who prefer interventional care. At the same time, with the present strain on the medical system, family doctors are not likely to make a conversation on end-of-life care a priority.

Therefore, there is an urgent need for a new approach: a cloud-based, personalized, and non-judgmental platform which tailors the Advanced Care Planning (ACP) dialogue to patients’ personalities and cultural backgrounds through machine learning.  

We propose to promote ACP conversations by utilizing the Electronic Health Record (EHR) to identify patients and send portal invitations to them to use Koda Health’s Advance Care Planning Platform. Our research will evaluate the feasibility of administering the Koda Health platform to conduct digital ACP. 

Phase 1 Project 

Koda Health and CHI have partnered together to perform a Phase 1 NSF-funded study that will target ACP conversations to adults through an application developed by the Koda Health team. The outcome of this will be a proof-of-concept of a digital platform for advanced-care planning which engages with patients using a machine learning guided dialogue. The platform delivers personalized audiovisual content adapted to individual and cultural preferences of patients, who interact with it on their own time and without fear of human judgement to ensure that the end-of-life care requests of patients are met. 

With increasing deployment in health systems, the Koda Health platform will deliver a more differentiated dialogue as it interacts with, and learns from, more patients. Deployed through patient websites of health systems, the platform integrates demographic and electronic health data and auto generates legally binding advanced-care planning, advanced to each jurisdiction. 

This pilot study will have two paths for participants to take:

  • The first path will allow patients to go through the Koda Health Platform by creating an account and using the groundbreaking technology to have their ACP conversations virtually.
  • The second path will have patients go through an ACP interview led by Dr. Desh Mohan to discuss this topic one on one. 

Once patients complete either path, they will have the option of completing the other path in order to compare which one seems to be better suited for their needs and ability. Ultimately, the patient will be able to have these important planning sessions completed and recorded so that their future wishes and goals are visible to others.