Computerized Records Don’t Put Advance Directives in Doctors’ Hands

It’s still a problem for your clients:  Electronic hospital records (EHRS) won’t make clients’ advance directives readily available in many cases. A recent news article in USA Today profiles this problem. And a highly respected hospital consulting organization summed up the article this way:

Looking for a patient’s end-of-life wishes? In many EHRs, it’s ‘file not found.’

How can this be? After all, one purpose of having medical records in electronic form is to make information easier to find. This article, written by Kaiser Health News, bears out what I’ve been saying for years. A surprising set of technical problems prevent EHRs from providing the access to advance directives that we’d expect. Here’s what they found:

1. Incompatible systems. Your client goes to the emergency department which, in many cases, uses different software from your client’s doctor’s office, where your client’s advance directive is stored. These two electronic medical records don’t talk to each other in many cases, even if the doctor is part of the hospital’s network.
2. Scattered records. Different doctors, hospitals, nursing homes, etc. may have your clients’ advance directives. Many of these entities don’t talk to each other electronically, especially if they are in different health care networks.
3. It’s in there, but it’s hard to find.  Surprisingly, many EHRs don’t have a designated place in the EHR to store the advance directive. This makes it very hard to look for – and staff don’t even know if they’re looking for something that actually exists!Ask a doctor or nurse working at a hospital with an electronic hospital record (EHR) and they’ll probably tell you — without irony — “yes, even if the advance directive is in there, it can be really hard to find.”
4. Doctors and nurses don’t have time for a full-out search of the EHR to look for an advance directive. “If they’re not able to access to advance directive quickly and easily, they’re honestly likely not to use it,” said Torrie Fields, senior program manager for palliative care at Blue Shield of California.
5. Limits on usefulness of state registries, which aim to address the problem. Only a handful of states have such electronic registries, and there are issues with how to fund them, according to the article. In addition, they create new problems. According to Marian Grant, director of policy and professional engagement at the Coalition to Transform Advanced Care and a nursing professor at the University of Maryland, in a critical situation “We are moving very fast. We don’t have extra staff to say, ‘She might have an advance directive somewhere – check the top five directories and let me know.’  A busy resident is going to look in one place, and if they don’t find it, move on.”

Your takeaway: counsel your clients that they can’t rely on a hospital to find their advance directive at a moment’s notice, even if the client has supplied it previously. Sounds crazy, I know. But they’ll need a better plan.

Randi J. Siegel, MBA, is the President of DocuBank® (docubank.com), which ensures that the emergency information and healthcare directives of its 250,000+ enrollees are available 24/7/365 through the largest advance directives registry in the U.S., as well as access to an online safe for storage of digital assets and other vital documents. Working with estate planning professionals since 1997, Randi frequently speaks at national estate planning conferences and has appeared on radio and television as an authority on registries. A member of the Philadelphia Estate Planning Council, the International Society of Advance Care Planning and the Coalition to Transform Advanced Care, Randi is active in health education and public engagement related to advance care planning/advance directives. She serves as Pennsylvania liaison to the National Healthcare Decisions Day initiative and as a board member of the Center for Advocacy for the Rights and Interests of the Elderly. Randi is an ongoing contributor to the Academy blog.

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