Managing Advanced Directives and Healthcare Proxies

I was recently asked how we ensure Advanced Directives and Healthcare Proxies are broadly communicated to all caregivers at BIDMC, among all stakeholders in Massachusetts, and how they could be communicated throughout the country.

At BIDMC, our inpatient record enables providers to enter advance directive details and document specific orders in provider order entry. Per hospital policy, Do Not Resusitate orders entered as an inpatient expire at discharge and must be rewritten on subsequent admissions. All advance directives are displayed on our hospital dashboards (see screenshot above), so all caregivers are notified of all patient preferences. These dashboards are the entry point to all our Provider Order Entry and inpatient functions, so all caregivers use them.

At BIDMC, our ambulatory and inpatient record support a shared Health Care Proxy function. The proxy function enables users to enter the patient's proxy information and its details, the proxy name and contact information, and a free text comment. Proxy information is displayed in both the ambulatory and inpatient profiles.

Our Massachusetts community-wide health information exchange record, sent to providers on inpatient and emergency department discharge, includes sharing of advance directive information.

Nationally, the HITSP interoperability specifications for clinical summaries include advance directive information. For an example, see my lifetime medical record.

In the future, I imagine that personal health records such as Microsoft HealthVault and Google Health will support Advanced Directive and Healthcare Proxy data sharing. BIDMC will continue to work with Google, Microsoft and other PHR providers to support such functions.