Hardwiring advance directives into an electronic medical record.

Abstract

146 Background: Patient preference at the end of life has been extensively researched and documented. Advance Directives (AD) have been shown to make a difference for patients in the areas of quality, cost, and patient satisfaction. Organizations struggle with meeting federal laws and accreditation expectations due to our complex systems. Literature supports “hardwiring” AD documentation into the EMR and providing “one click” accessibility to AD’s. Changing EMR vendors provides a unique opportunity to optimize access to AD’s, both through patient education /endorsement, review of providers’ role, and engagement of IT. Methods: Huntsman Cancer Institute at the University of Utah identified an opportunity to improve the process of obtaining AD's during a change to Epic as an EMR. MD/RN champions brought a team together that included pastoral care, social work, medical records, and IT. The group used national "Decision Day" efforts as a platform for kicking off the project. Notable barriers to implementation included AD’s from previous EMR not migrating, inadequate systems for RN and SW consultation, lack of triggers to engage provider support, and MD order sets requiring major revisions Accessibility on the banner from any view was deemed best practice. Audits were created to give feedback to hospital staff and the quality department. This effort was also identified as a priority quality goal for the entire institution. Results: There have been significant improvements in assessing patients, obtaining AD's, and providing easy access to these records. Conclusions: EMR systems do not always come with processes in place to address the need to obtain AD's, scan or enter them into the EMR, and provide easy access during critical decision points in patient care. Collaboration with the IT team in identifying institutional requirements and workflow is critical as an organization identifies the need to improve AD system flow or begins planning for transition to a new EMR.