This week I would like to diverge momentarily from discussing palliative care access to a topic closely aligned with many of the tenets of palliative care medicine. This is the development and dissemination of POLST forms. The Physician Orders for Life-Sustaining Treatment forms have become a companion cause to many palliative care advocacy groups. In fact, the trend in POLST documentation is to establish a state or federal electronic repository of these documents.
The POLST is a predetermined, defined medical order for patient care. These orders are often utilized in emergent situations and contain immediately actionable interventions. The challenge of adhering to patient’s wishes, in particularly at end of life, has been discussed in previous weeks and contributes to the drive behind creating a nation-wide POLST registry. Research has demonstrated that obtaining quick access to this piece of paper, albeit brightly colored, has been challenging and thus patient wishes may not be followed in an emergent situation (Zive & Schmidt, 2012).
A number of questions arise when considering an electronic POLST registry:
How will these records be accessed?
Where will they be housed?
Who will have access to retrieve these physician orders?
How will the privacy of each record be maintained?
POLST legislation is relatively new in California (CA). Assembly Bill 3000 legalized the use of POLST forms and came into effect in 2009. The Coalition of Compassionate Care of California (CCCC) manages the use of POLST in the state. Of note, the CCCC is the prevailing non-profit involved in the Palliative Care Access Project underway in California. One challenge in CA is that the emergency response system in the state is composed of 32 separate agencies. This means there is no definitive residence for a POLST registry database.
The California Healthcare Foundation (CHCF) has researched the need for an electronic POLST registry and has begun a pilot program to develop this electronic system just this year. The organization is calling for submissions from technology vendors to develop a prototype and discuss assimilation into existing electronic medical record (EMR) systems. The POLST Paradigm Task Force registry has submitted recommendations to CHCF on the functional requirements of this system. These have included a mechanism to ensure accuracy of data entry, protection from unauthorized access and compliance with HIPPA. An interesting consideration is the ability to cross-reference the ePOLST system with the California Death Registry.
I can appreciate the slow and meditative process in which CHCF, CCCC and the state of California have proceeded into the world of electronic health care registries. POLST forms have solid evidence supporting their use. Providing quick and accurate access to these forms is paramount for providing patient centered care and achieving positive outcomes. An appropriate use of technology may generate greater patient satisfaction with medical interventions in emergent or end-of-life situations.
There are many questions to be answered in the development of a successful ePOLST repository. This provides a great opportunity for the health care industry to reach out to the business, technology and information management sectors in a positive collaboration effort.
This video provided by HealthIT offers a wonderful justification for health information exchange in a way the public can understand. Just for your viewing pleasure!
California Healthcare Foundation. (2014). Briefing- exploring the need for a POLST registry in California. Retrieved from http://www.chcf.org/events/2014/briefing-polst-registry
HealthIT.gov(2014). What is HIE? Retrieved from http://www.healthit.gov/providers-professionals/health-information-exchange/what-hie
POLST California. (2015). California POLST registry analysis. Retrieved from http://capolst.org/
Zive, D. and Schmidt, T. (2012). Pathways to POLST registry development: Lessons learned. Retrieved from http://www.polst.org/wp-content/uploads/2012/12/POLST-Registry.pdf