Computerized Advanced Directives
04/08/05 Portland, Ore.
As current events prompt a national discussion on dying patients' wishes, OHSU launches a system aimed at ensuring one's directives can be found when an emergency arises
"In light of national media events, patients more often ask, 'How can I be sure my wishes will be followed?'" said Susan Tolle, M.D., director of the OHSU Center for Ethics in Health Care. "They are pleased to learn that their advance directive or POLST form can be scanned into the electronic record system. This means that a reminder will pop up on the OHSU computer screen to alert any future health professional who cares for them of the existence of these important documents."
The POLST program was originated in Oregon. It allows chronically ill patients to direct their end-of-life care by discussing a detailed care plan that is signed by their physician. POLST forms provide specific health care directives about treatments that are wanted and those that are not. If a chronically ill patient enters the hospital and is incapacitated, an alert screen notifies the medical team of the POLST and directs them how to react. For example, a patient with advanced lung disease may want to be hospitalized with pneumonia, but may not want to be placed on a breathing machine in the intensive care unit. Doctors need to know this immediately to respect the patient's wishes the minute he or she arrives at the hospital.
Along with the POLST form, OHSU patients also have their advance directives filed electronically with their medical records. This service is valuable for healthy adults who suffer from sudden illness or traumatic injury -- in these cases, initially, all emergency medical treatments are provided. If patients are unable to make their wishes known because an injury to the brain is severe and prolonged, health professionals look for an advance directive to find out who the patient has appointed to speak on his or her behalf. OHSU's new electronic record system ensures that an advance directive will be found when needed. This legal document allows health care professionals to clearly understand and follow the patient's wishes, even when family members passionately disagree.
"The alert system makes it possible for me to quickly and easily locate a patient's previously documented medical wishes from any workstation in the hospital," explained Barbara Glidewell, director of the Department of Patient Relations at OHSU Hospital. "It's an important tool that's used on a near daily basis to ensure our patients' wishes are respected."
"In the emergency department, things can happen very quickly, and knowing a patient's end-of-life wishes really helps to make the correct decision," said Terri Schmidt, M.D., an emergency room physician at OHSU Hospital. "Having the new electronic POLST information can help to assure patients get the treatments they want and helps them avoid interventions they would not want"
OHSU patients interested in taking part in the new system, which was launched in January 2005, should talk to their physician and provide a copy of their POLST or advance directive form, which can be electronically scanned and directly linked to their health records. While enrollment in the system is only available to OHSU patients at this time, the patients do not need to be treated at OHSU for the alert to occur. The treating hospital would be informed when the patient's medical records are obtained. The end-of-life documents could then be sent to the treating hospital electronically.
For additional information on POLST and advance directives, visit www.POLST.org.