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AZ HIE Integrates Advance Directives to Inform Clinical Decision Making

The HIE integrated an advance directive registry to inform clinical decision making through seamless access to patients’ end-of-life care wishes.

Health Current, Arizona's statewide health information exchange (HIE), has announced that it will integrate advance directives to provide seamless access to patients’ end-of-life care wishes for clinical decision making.

The HIE has partnered with the vendor Care Directives to create the Arizona Healthcare Directives Registry (AzHDR).

The AzHDR will provide a secure, reliable place to complete, upload, and save Arizonans' advance directives so providers have access to patients’ end-of-life care wishes.

"We are eager and excited to work with Care Directives on this critically important service that promises to help eliminate the barriers of communicating what healthcare and treatment decisions should be made if you are unable to communicate these wishes," Melissa Kotrys, CEO of Health Current, said in a public statement.

The vendor’s platform collects advance directive documents, including living wills, healthcare power of attorney forms, and pre-hospital medical care directives, often referred to as Do Not Resuscitate orders (DNRs). Then, the platform connects the data to healthcare providers in real-time at the point of care.

Provider access to accurate, up-to-date advance directive documents is key in ensuring they meet patient’s end-of-life care wishes. However, these documents can sometimes get lost in translation due to industry silos, leaving providers without crucial information to guide clinical decision making.

The AzHDR will live within the statewide HIE so that providers can access patients’ end-of-life wishes across the care continuum.

When developing the registry, Health Current enlisted the expertise of 30 advance care industry leaders from across the state, such as Sarah Ascher, associate vice president of United Way of Tucson and Southern Arizona’s End of Life Care Partnership.

“Our shared mission is to enhance the way we live by fundamentally changing the way we talk about death," Ascher explained. "The AzHDR and Health Current are key to our work in helping to break down silos to ensure people receive the care they desire at the end of life."

Following COVID-19’s devastating death toll, advance care planning has become more common for patients and their loved ones across the country.

During the height of the pandemic’s second wave in December 2020, Vanderbilt Health announced the integration of an End of Life Care Plan into its EHR patient portal.

“Every patient’s decision regarding end of life is very personal, and the clinical care plan needs to be tailored, keeping the patient’s goals front and center,” Shubhada Jagasia, MD, chief of staff at Vanderbilt University Adult Hospital and Clinics, said in a press release at the time of the announcement.

“These decisions need to be made at the right time during the care of the patient and documented in the electronic medical record,” Jagasia continued. “This need has been accentuated during the COVID pandemic, as limited hospital visitation policies and lack of consistent family presence at the patient’s bedside makes reliable knowledge of the patient’s end-of-life wishes even more important.”

When a clinician opens a patient’s EHR, the integration alerts them to ask the patient if they have completed an End of Life Care Plan. If the patient has not completed it, the clinician can explain how to upload the information.

“Now more than ever, it’s important for us to ask these questions, and for patients and families to talk among themselves now about their wishes related to health care interventions and end-of-life care,” Mohana Karlekar, MD, director of VUMC Palliative Care, said at the time of the announcement. “Families need to know what their loved one wants so they can advocate for them appropriately.”

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