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California to Pilot POLST Registry

August 7, 2016
by David Raths
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Moving Physician Orders for Life-Sustaining Treatment beyond pink slips of paper

With financial support from the California Health Care Foundation, two communities in the state will pilot a cloud-based electronic registry for Physician Orders for Life-Sustaining Treatment (POLST).

POLST is a standardized form that clearly states what level of medical treatment a patient wants during serious illness or toward the end of life. POLST gives seriously ill patients more control over their treatment and also helps them talk with their healthcare team and loved ones about their choices. POLST can help reduce patient and family suffering and make sure patient wishes are known and honored. Unlike an advance directive, POLST is signed by the patient and a physician, nurse practitioner, or physician assistant, and becomes a medical order that moves with the patient across care settings.

Some states, including New York, Oregon, Utah, and West Virginia, have established electronic registries that store, manage, and provide access to POLST forms, in most states, including California, most POLST information is maintained only as a pink piece of paper that stays with the patient or the medical record. When POLST information is needed during emergencies or when a patient is unable to communicate, a paper form may not be readily available, hindering care or resulting in care that is against the patient’s wishes.

“The POLST form is a powerful tool for helping patients specify the treatments they do and don’t want,” said Kate O’Malley, R.N., M.S., senior program officer at CHCF, in a prepared statement. “But when the paper form is not immediately available, it can result in unwanted care for the patient. Building and testing an electronic database for POLST forms can improve access to this critical information.”

CHCF has worked successfully with the Coalition for Compassionate Care of California (CCCC) to promote widespread adoption of POLST in California since 2007. The new initiative is designed to develop and test a secure, cloud-based web portal for electronic submission, storage, and retrieval of POLST data, helping to inform efforts to develop a permanent POLST registry in the state. CCCC is the home of the California POLST program and will serve as operations center for the registry.

The registry pilot project was spurred by legislation that passed in October 2015, which authorized a pilot test for an electronic registry (POLST eRegistry) and the identification of a state agency — the California Emergency Medical Services Authority (EMSA) — as lead agency for the pilot.

 “The evolution of the POLST form from a piece of pink paper to full integration into the health record is an essential step to making it available to emergency medical providers responding to patient’s homes and providers in the emergency department,” said Howard Backer, M.D., director of EMSA, in a prepared statement.

With CHCF’s financial (up to $3 million) and technical support, CCCC and EMSA will work to develop the POLST pilot registry initiative. The project will provide staff resources necessary to create a cloud-based registry for completed POLST forms to be securely submitted and retrieved. The pilot registry will be tested and evaluated in two locations: San Diego and Contra Costa Counties. Learning from the pilot will help guide possible future expansion statewide.

California-based technology company Vynca was selected as the vendor for the registry software after a competitive request-for- proposals process. Vynca has extensive experience developing solutions to digitize and share electronic POLST documentation.

San Diego Health Connect, a health information exchange organization that includes health systems, hospitals, nursing homes, clinics, and emergency medical services, will coordinate the San Diego pilot.

The Alameda-Contra Costa Medical Association will coordinate the Contra Costa pilot. The regional chapter of the California Medical Association has been a partner in POLST adoption activities since 2008.

 

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