Using the Electronic Health Record Patient Portal to Collect Advance Directives and Surrogate Specification.

Area of Science:

• Health Informatics
• Health Information Management
• Patient Engagement

Background:

• Advance directive (AD) completion and collection is a complex, multi-step process.
• Hospitals and health systems require efficient mechanisms for AD document management within electronic health records (EHRs).

Purpose of the Study:

• To implement and evaluate a system using the EHR patient portal and Health Informatics & Information Management System (HIIMS) personnel for collecting, verifying, and integrating advance care planning (ACP) documents and surrogate decision-makers into the EHR.
• To improve the quality and efficiency of ACP document capture and processing.

Main Methods:

• A single-arm, time-series quality improvement project was conducted.
• A collaborative mechanism was developed involving Health IT, HIIMS, and the Advance Care Planning Program.
• HIIMS personnel received specialized training to evaluate ACP documents and surrogate information submitted via the patient portal, integrating them into the EHR or providing patient feedback for re-submission.

Main Results:

• Over 41 months, 7274 ACP documents were uploaded via the patient portal, with 65% accepted on initial submission.
• 15% of initially rejected documents were successfully resubmitted and accepted.
• 12,509 surrogate decision-makers were added, with significant numbers updated and removed during the study period.

Conclusions:

• Engaging HIIMS personnel is a viable strategy to facilitate the capture of ACP documents through a unified EHR patient portal.
• The implemented system effectively incorporates quality checks and provides patient feedback, streamlining the AD process.
• This approach enhances the integration of crucial patient care planning information into the EHR.