Q. I have heard several horror stories about Advance Directives being unavailable when needed, as more hospitals are implementing new systems to store and access electronic medical records. Or, in other cases, patients’ documents are being rendered unreadable by incompatible software.
What if a patient’s doctor uses one record system and the emergency room another? If the software doesn’t match up, the ER doctors may be unable to tell if the patient has a preference, such as a “do-not-resuscitate” order.
If this is truly the case, then why even bother with Advance Directives? And, if I do plan ahead, will I have to carry a copy with me so the provider knows it exists or is there another way to guarantee that my Advance Directives will be accessible, if and when they are needed?
A. Incapacity planning, including Advance Medical Directives, a General Financial Power of Attorney, and an authorization to disclose protected health information (HIPAA Authorization), is extremely important for everyone, as it communicates patient choices when they can no longer speak for themselves.
Ideally, patients with advance directives in place would be confident that their doctors and nurses – no matter where they receive care – could know in a split second their end-of-life wishes. However, according to a news report in USA Today/Kaiser Health News, doctors cannot always easily get hold of their patients’ advance directives at the hospital, even in an emergency, and Electronic Health Records (EHRs) sadly aren’t yet helping to solve this availability problem.
Ironically, electronic medical records, which are supposed to help find patient information, create their own problems:
● One problem is that different medical records systems are incompatible, meaning that hospitals often can’t share your Advance Directive among them or even, more surprisingly, between different departments of the same hospital. As a result, you could be admitted to an Emergency Department, which may have one EHR system, and it might not be able to get hold of your Advance Directive in the hospital’s main EHR system.
● Another problem is that it can take too long to find your Advance Directive because most EHR systems aren’t set up to store Advance Directives. “If [medical staff are] not able to access the advance directive quickly and easily, they’re honestly likely not to use it,” says Torrie Fields, senior program manager for palliative care at Blue Shield of California.
● Older patients, who are increasingly likely to have a directive, often get treatment from varied sources — surgeons, hospitals, nursing homes, primary physicians. That increases the odds of unaligned systems, said Dr. Irene Hamrick, who directs geriatric services in family medicine at the University of Wisconsin-Madison.
● An additional complication stems from system design. Many electronic medical records systems don’t have a dedicated tab to mark where such information — if it exists — is stored. After doctors and nurses click through various pages, they still don’t know whether they looked in the right place. Time doesn’t always allow this kind of search.
A survey of ER doctors last year found that 93% are “less frustrated” when Advance Directives are “easily accessible,” and the vast majority of them said the documents let them provide better care and that family members are more satisfied.
Changes May Lie Ahead
Developers of medical records systems are introducing functions that could make it easier to find and read an Advance Directive. For instance, Epic Systems, a company that is among the top sellers of EHR systems, has added a tab intended to indicate clearly whether a patient has an advance directive on file.
The issue has also gotten attention in Congress. Lawmakers have expressed interest in making directives “portable” — that is, easily accessible. Legislation introduced in the Senate by Sen. Mark Warner (D-Va.) includes provisions that could push health facilities to ensure compatibility across different health records for Advance Directives. Rep. Earl Blumenauer (D-Ore.) is also working on legislation, he said in an interview.
Hospitals and health systems are making adjustments, too. The hospital at Oregon Health & Science University, California-based Sharp Hospice and Gunderson Health in Wisconsin are among those that have made in-house software revisions to make advance directives easy to find in electronic health records — for instance, having IT teams add tabs on the record’s main page to indicate if a patient has end-of-life planning documents. Representatives of those hospitals said such efforts aren’t the norm, though.
Meanwhile, a number of states, including Virginia, Vermont, North Carolina and Arizona, have created online databases for residents to upload and store their Advance Directives, but these are only helpful if you wind up in the hospital and your home state. If you’re traveling visiting another state, you’re basically out of luck Recent figures are hard to come by, but in 2007, nine states were counted to have these in place. In these instances, doctors in those states can go online to find a patient’s Advance Directive on those sites. Although they’re secured websites, and directives are password protected, requiring special logins from patients and doctors, specifics vary from state to state.
Rest Assured that Farr Law Firm Clients NEED NOT WORRY- Your Documents ARE ALWAYS Accessible with Docubank
Incapacity Planning documents only do what you want them to do if your loved ones know they exist and can locate them when needed. At Farr Law Firm, P.C., we provide a service called DocuBank to ensure that that the Advanced Medical Directive and other healthcare documents you’ve completed through our firm will be very easily accessible when you need them most, such as when you are hospitalized.
DocuBank is an electronic storage and access service for healthcare directives and other vital health information, such as allergies, medications, and a list of your physicians. DocuBank stores all of your health information so it is available whenever needed.
How does DocuBank work?
● Once we have registered your documents with DocuBank, DocuBank transmits your Advance Medical Directive and other healthcare information to hospitals within moments, 24 hours a day, 7 days a week, around the world.
● Your documents are stored safely in DocuBank’s system and available immediately by using a Member Number and PIN Code located on your DocuBank Emergency Card.
● Hospitals can access your documents by placing a toll free call to 1-800-DOCUBANK to have them faxed, or by clicking the Hospital Button, or using the pop up box on the DocuBank home page to print them immediately.
● When a hospital calls into DocuBank, they also receive a cover page listing your three Emergency Contacts with phone numbers as well as your primary doctor so that they can be reached in an emergency.
Read more about Docubank here.
Why Bother with Advance Medical Directives?
People can have dreadful accidents or face incurable illness at any age. Could hospitals take important decisions like whether to provide, withhold, or withdraw a specific medical treatment into their own hands in the U.S.? Maybe or maybe not. To protect yourself, however, and guarantee that this won’t happen to you or a loved one, Advance Directives are imperative.
An Advance Medical Directive is the document that gives you control over your medical care if you’re unable to speak for yourself. In your Advance Directive, you designate someone to make health care decisions for you if you can’t, and you also give guidance on the types of treatments you would or would not want.
The Time to Plan is NOW
To ensure your wishes are met, it is important to start your planning while your mind is still sharp and your judgment is sound, so you are prepared in advance if a crisis occurs. If you have not done Incapacity Planning, Estate Planning, or Long-Term Care Planning, or if you have a loved one who is nearing the need for long-term care or already receiving long-term care, please contact us for an initial consultation:
Fairfax Estate Planning and Incapacity Planning: 703-691-1888
Fredericksburg Estate Planning and Incapacity Planning: 540-479-1435
Rockville Estate Planning and Incapacity Planning: 301-519-8041
DC Estate Planning and Incapacity Planning: 202-587-2797
About Evan H Farr, CELA, CAP
