End-of-Life Decisions Not Incorporated into Electronic Health Records
January 14, 2015 12:36 PM
A recent, in-depth article in Politico highlights the challenges of transitioning to electronic health records for physicians and other healthcare providers who offer end-of-life care. The main problems cited in the article include the inability to note a patient’s end-of-life decisions, whether or not the patient has designated someone else to make such decisions on their behalf, and the reticence to craft a policy that addresses such issues. According to the article, “Recording the desires of patients who are on their death beds…has become a huge gap in the nationwide effort to computerize patient care.”
While the lack of end-of-life decision support is becoming a serious cause for concern, there don’t appear to be any solutions yet on the horizon. “Now, it seems that lack of digital documentation may be a missed opportunity,” the article states. “Advanced care planning — talking about and recording what individuals do or don’t want when terminally ill — is a weak point in the health care system highlighted in the recent Institute of Medicine report on “Dying in America.””
David Blumenthal, who was the National Coordinator for Health IT, whose office promulgated the original Meaningful Use rules, stated that in an ideal world, rules governing the use and implication of health IT would eventually include advanced care planning.
The article goes on:
“The IOM pinpointed EHRs as an underused resource. Current regulations for the “meaningful use” of the records scarcely address end-of-life care, and the big health IT companies haven’t incorporated it. The rules may change in the future but for now, digital medical files only must have a field to record “yes” or “no” if a patient over age 65 has an advanced directive. They don’t have to note what the directive is, where to find it, what it says — or anything else…
Close to half the states have some version of POLST — Physician Orders for Life Sustaining Treatment — which turns the patients’ preference into a doctor’s order. But that’s for people who are already seriously ill, usually in hospice or nursing homes. With a few exceptions like Oregon and West Virginia, even the states that have approved POLST haven’t fully implemented it, much less computerized all the records…”
NAHC’s affiliates the Hospice Association of America and the Home Care Technology Association of America are looking into this issue further.