Cloud-Based Medical Registries Make Patients’ Wishes Known

Bloomberg Law

• Quick, electronic access to medical orders, advanced directives
• New platform underway in Colorado

Most people don’t go around with living wills and “Do Not Resuscitate” orders in their back pockets.

For that reason, when an emergency strikes and a patient is unable to speak for him or herself, family members or physicians have to make critical health-care decisions without full knowledge of the patient’s desires.

That situation can be avoided when health-care providers, emergency medical personnel, and family members have immediate electronic access to documents describing a patient’s treatment wishes, Nathan A. Kottkamp, a health-care attorney with McGuire Woods in Richmond, Va., told Bloomberg Law.

Electronic Registry

“If each member of the team is pulling [those documents] from a central registry, it resolves the basic logistics of having [them] available when an emergency happens,” he said. “It makes it possible for the information to be shared easily as well, regardless of where the patient first presents it.” Kottkamp is also founder and chair of National Healthcare Decisions Day, an annual event to educate the public and providers about the importance of advance care planning.

Such registries contain an electronic record of a patient’s treatment wishes. States are increasingly interested in them, since they have “been proven to be useful” from a quality assurance and research perspective, said Amy Vandenbroucke, executive director of the National POLST Paradigm, an organization with a focus on emphasizing patients’ wishes about the medical treatments they receive, including end-of-life care.

A POLST (Physician Orders for Life Sustaining Treatment) form is a tool to ensure that patient treatment wishes are known and will be followed by health-care professionals during a medical crisis, she told Bloomberg Law in an email. POLST forms are intended for patients with a serious illness or frailty whose current health status indicates a need for standing medical orders. It is not an advance care directive, which is the appropriate toolfor healthy and unhealthy people alike to use to make future end-of-life care wishes known to loved ones.

Provides Access

Having both POLST forms and other advance care directives on a registry allows health-care professionals and emergency personnel to access such information by mobile phone, laptop, or other networked device if a paper copy can’t be found.

"[C]onceptually, it is great to be able to provide these seriously ill and frail patients one less thing to worry about,” Vandenbroucke said.

A similar program is underway in Colorado, where the Colorado Regional Health Information Organization is partnering with Health-e-MedRecord to allow secure sharing of patients’ treatment wishes on CORHIO’s statewide health information exchange. The exchange, with more than 12,000 users and 74 hospitals participating, advises health-care professionals and organizations on the most effective uses of electronic health records, and provides data to health plans and accountable care organizations.

Colorado Platform

The partnership, announced Oct. 4, will allow secure sharing of advance care directives, including living wills, “Do Not Resuscitate” orders, and other documents conveying a patient’s treatment wishes. The “Medcordance” platform also allows sharing of documents among family members and caregivers at the patient’s request.

The platform will provide real-time access to Colorado MOST—Medical Orders for Scope of Treatment, which is similar to POLST, Dr. Carlo Reyes, CEO and founder of Health-e-MedRecord, told Bloomberg Law Oct. 5. An advantage of the electronic platform is “the ubiquitous nature of the cloud-based medical form,” he said.

“It allows everyone who needs access to have access. You don’t even need to be in the room to provide important documents to the hospital” about a loved one, he said.

“Pretty soon we’re going to see whole states embracing this level of engagement between patients and physicians,” he said.

To contact the reporter on this story: Tripp Baltz in Denver at abaltz@bloomberglaw.com

To contact the editor responsible for this story: Brian Broderick at bbroderick@bloomberglaw.com