Why was MIDEO created?

MIDEO was created to solve a patient-safety failure that has existed in healthcare for decades. During emergencies, physicians and clinicians are often forced to make life-and-death decisions without a clear understanding of what the patient actually wants. MIDEO provides video-based advance directives that help make advance care planning safer, clearer, more accessible, and actually usable at the bedside.

Dr. Ferdinando L. Mirarchi, DO, created MIDEO based on his years working as the medical director of the Emergency Department at a busy city hospital in Erie, PA. He personally witnessed how traditional paper advance directives frequently failed during medical emergencies.

What problems do traditional paper advance directives have?

Traditional paper advance directives often cannot be found when patients arrive by ambulance, are wrongly misinterpreted as do not resuscitate orders, contain vague wording that doesn't match current medical situations, are interpreted differently by various physicians and clinicians under pressure, and create confusion among family members who must rely on memory.

How does MIDEO improve advance care planning?

MIDEO allows patients to use their real voice, tone, and intent to create a compliant advance directive paired with video that has instant access for clinicians. Patients can explain in their own voice what matters most, what outcomes they would accept, and where their lines are. This eliminates guesswork for clinicians and reduces stress for families during medical emergencies.

What is a video advance directive?

A video advance directive is a patient-safety solution that combines traditional advance directive documentation with video recording of the patient explaining their healthcare wishes in their own voice. This format allows patients to bring their face and voice everywhere with them, making their wishes clearly understood, easy to access, hard to misinterpret, and available when decisions are urgent.

What does an advance directive mean?

An advance directive is a legal plan for medical care if you can’t speak for yourself. With MIDEO, you record your wishes on video in your own words and pair that with a legally compliant advance directive form so clinicians have clear instructions.

What’s the difference between health care proxy vs advance directive?

A health care proxy (medical power of attorney) is the person you name to make medical decisions if you cannot speak. An advance directive is the document recording your treatment preferences (e.g. CPR, ventilation, artificial nutrition) even when you can’t communicate; MIDEO helps you capture both video directive and proxy details.

How do I create an advance directive online?

You can choose Self‑Guided to record your video, e‑sign the advance directive form, and name your health care proxy entirely online. Or choose Physician Guided for one‑on‑one help, whether via telehealth or in person, with a clinician coaching your decisions.

Will Medicare or insurance cover advance care planning?

Often yes: advance care planning is covered by Medicare (using CPT codes 99497/99498) and by many commercial plans. MIDEO’s services are accepted by most major insurances; eligibility and coverage vary by state, and benefits are verified before appointment.

Our Story: Why MIDEO Was Created

MIDEO—My Informed Decision on VidEO—was created to solve a patient-safety failure that has existed in healthcare for decades. Unfortunately, during emergencies, Physicians and clinicians are often forced to make life-and-death decisions without a clear or reliable understanding of what the patient actually wants. In other words, we are making a medical guess.

Ferdinando L. Mirarchi, DO, built MIDEO from the years he worked as the medical director of the Emergency Department (ED) at a busy city hospital in Erie, PA.

In the ED, he personally saw how decisions were often made in seconds. Families are not always present, and traditional paper advance directives—sometimes called advance healthcare directives or advance medical directives—were frequently unavailable, outdated, vague, or misunderstood.

After witnessing the need for clearer advance directives, Dr. Mirarchi created MIDEO as a patient-safety solution to help make advance care planning safer, clearer, more accessible, and actually usable at the bedside by Physicians as well as other clinicians involved in your medical care.

The problem Dr. Mirarchi kept seeing in real medical emergencies

In emergency situations, Dr. Mirarchi saw first hand how “paper planning” often failed. These were some of the issues his team often encountered:

A living will can’t be found when a patient arrives by ambulance
Even if the living will was found, it was often wrongly misinterpreted as a do not resuscitate order.
A form exists, but the wording is vague or doesn’t match the current medical situation
Various Physicians and Clinicians interpret the same advance directive in different ways under pressure
Families were crushed and paralyzed by the fear of guilt and making a wrong decision
Families disagree because they are relying on memory

One of the most dangerous real-world failures was that a paper living will could be misread as “this person is a DNR.”

Those patterns are what pushed Dr. Mirarchi to ask a simple question that becomes urgent in every type of medical resuscitation, code, ICU admission, and critical handoff:

How can physicians and clinicians safely honor patient wishes if we cannot clearly understand them in real time?

It was that question that created MIDEO.

Two near-miss moments that changed everything

Early in Dr. Mirarchi’s career, he experienced two situations that crystallized the problem.

In one case, a patient’s written documentation was interpreted in a way that nearly prevented immediate, life-saving treatment during a simple straight forward heart attack that quickly changed into cardiac arrest. It wasn’t until a more experienced physician stepped in and did what needed to be done and saved her life.

In another case, an acutely ill male patient arrived unable to speak for himself, and a “living will” was referenced in the chaos of emergency care. Treatment began aggressively, only for the patient’s spouse to arrive later and explain that the patient was already in hospice, suffering, and wanted comfort-focused care rather than resuscitation.

While these were completely different patients with completely different wishes, both had the same underlying failure: paper advance directives did not produce bedside clarity and resulted in both undertreatment and then over treatment. Thus living wills are broken tools that place you and your family at risk of harm.

Those experiences moved Dr. Mirarchi to act to find a solution. If advance care planning is supposed to protect patient autonomy, the output must be something Physicians and clinicians can understand instantly and act on correctly. Those moments were the birth of MIDEO

The TRIAD research proved what works when pressure is high

To address the problem at a systems level, Dr. Mirarchi launched the TRIAD (The Realistic Interpretation of Advance Directives) patient-safety research database.

A pivotal nationwide study in the TRIAD series compared traditional paper living wills with video-based advance directives. The conclusion was that patient to clinician video significantly improved interpretation accuracy, reduced confusion, and increased clinician confidence and agreement, especially around the hardest distinction in real emergency care of when a patient wants life-saving intervention versus when they want to allow a natural death.

That research led to a clear realization that advance directives do not fail because patients don’t care but because the format often does not survive real in-hospital conditions, especially in the emergency room and the various settings that a patient will receive medical care.

The TRIAD Research Helped Design MIDEO

The TRIAD research showed that there was a problem that was not disclosed to patients, but it also revealed that a solution was required and could be created. A tool was critically needed to fix the bedside confusion that it uncovered. Dr. Mirarchi created MIDEO to close the gap between what advance care planning is supposed to do and what clinicians can actually use during a medical emergency.

MIDEO made it so patients could bring their face and voice everywhere with them, even in situations where they couldn’t speak for themselves in the moment. Thus MIDEO allows the patient to be seen, heard and understood.

It allows you to use your real voice, tone, and intent to create a compliant advance directive paired with your video with instant access that clinicians can pull up wherever you are being treated.

A video advance directive lets a patient explain in their own voice what matters most, what outcomes they would accept, and where the lines are. Clinicians do not have to guess at tone or interpret legal phrasing in a crisis. Families do not have to translate a loved one’s values under stress.

MIDEO’s mission

MIDEO was created to make sure every patient’s informed medical wishes are:

Clearly understood
Easy to access
Hard to misinterpret
Available when decisions are urgent

Ready to make your wishes clear before a crisis?

Whether you’re starting life care planning for the first time or updating an existing advance directive, MIDEO helps you document your wishes in a way clinicians can use when timelines are tight and clarity matters most.

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