HITPC: Spotlight on care planning

End-of-life care planning should be an ongoing activity that is not just reserved for critically ill patients or those over 65 years of age, Larry Wolf, health IT strategist, Kindred Healthcare, said at the Health IT Policy Committee.

“It’s important for young people to do this. Even someone in generally good health should have some structure in place to support them with tough decisions and end-of-life situations,” said Wolf, co-chair of the certification and adoption workgroup, during a discussion of health IT’s role in the management of end-of-life care and how that may be incorporated in Stage 3 of the Meaningful Use (MU) program. In the Stage 2 MU final rule, one menu objective for eligible hospitals requires a record stating whether a patient 65 years or older has an advance directive.

In its charge to develop policies around care planning, the workgroup convened a hearing on Sept. 23 that examined advance directives around care practices and heard from providers and hospitals, Wolf said.

Care planning has sparked some interest in Congress. Sen. Mark Warner (D-Va.), who introduced legislation (S.1439) earlier this year to create a Medicare and Medicaid benefit for patient-centered care planning, participated in the workgroup hearing. Also, several House representatives recently drafted a letter in support of advancing patient and family-centered care planning in MU Stage 3.

One of the largest takeaways from the hearing was the need for conversations about end-of-life planning and ways to get those conversations documented and pushed forward utilizing technology, Wolf said.

Repositories with around-the-clock access can serve that need by containing documentation on care planning preferences. Advance directives, provider notes, provider orders, advance care plans and artifacts like orders that are hand-written orders, audio recorded or video recorded, etc., all are potential additions to repositories, Wolf said.

Only three states have “mature” Physician Orders for Life-Sustaining Treatment Paradigm (POLST) registries, while many more are under development.

Wolf cited New York’s eMOLST (Medical Orders for Life-Sustaining Treatment) program, which is a secure, web-based application in which forms are created as printable pdf documents and stored in an EMR via a link to eMOLST, becoming part of the NYS eMOLST registry, Wolf said. MyDirectives, a web-based system that stores advance medical directives, is another available service.

In light of this discussion, the workgroup offered the following areas for recommendations and further exploration:

• Policies that reflect care planning more broadly as impacting those of all ages;
• The use of repositories and whether EHRs should have the capability to link to them; and
• A pilot to learn more about existing repositories, Stage 2 vendor capabilities and provider implementation; how EHRs handle orders from advance care planning and POLST, the S&I Framework’s updated C-CDA to support care planning; InfoButton as an example of accessing outside resources; and opportunities for partnership and convening.