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

Advance directive completion and collection is a complex process including collecting documents, checking them for accuracy, and uploading them into a hospital or health system's electronic health record (EHR). Hospitals and health systems need mechanisms to facilitate the process.

To use the EHR patient portal and Health Informatics & Information Management System (HIIMS) personnel to collect and check the quality of advance care planning (ACP) documents and surrogate decision makers, and integrate them into the EHR.

Single arm time series quality improvement project.

Health IT, HIIMS, and the Advance Care Planning Program collaboratively developed a mechanism for ACP documents and surrogates submitted through the patient portal to be evaluated by HIIMS personnel who received training to process information entered by patients. HIIMS personnel integrate documents and surrogate information into the EHR or return a rejection message to the patient.

Number of documents submitted, accepted, rejected, and accepted after resubmission, and the number of surrogates entered, updated, and removed.

Over 41 months from May 2021 to September 2024, 7274 ACP documents were uploaded via the patient portal (mean 177 documents per month): 4700 (65%) accepted on first submission and 2574 (35%) rejected. Of rejected documents, 397 (15%) were resubmitted and accepted within the month. Over time, the proportion of accepted documents increased. During the study period, 12,509 surrogates were added (mean 305 per month), 1790 were updated, and 911 were removed.

Engaging HIIMS personnel can facilitate ACP document capture through a common EHR portal, including quality checks and patient feedback.