An electronic upgrade has given health providers at Oregon Health & Science University Hospital greater access to patients' end-of-life care wishes.
The recently implemented upgrade allows OHSU Hospital providers to electronically retrieve information from Oregon's Physician Orders for Life-Sustaining Treatment registry.
Susan Tolle, M.D., director of the OHSU Center for Ethics in Health Care in Portland, says the innovation has boosted OHSU's ability to provide the kinds of end-of-life care that patients want — and only what they want.
The upgrade is especially important for patients who cannot make their wishes known when they are brought to the hospital. "You may not know that the patient has a form in the registry," says Tolle, who also is an internist and professor of medicine at OHSU. "The patient may be too ill to speak, and there may not yet be anyone with them who knows anything about them."
Tolle is a founder of the POLST program, which was launched in the early 1990s. Back then, she recalls, it was not unusual for patients at the end of life to be given more intensive care than they wanted. "Information did not flow effectively from one setting to another for patients who were incapable of speaking for themselves," she says.
In 2009, POLST was expanded into a statewide registry that providers could call. Going statewide improved the flow of information, but the system was limited by the preponderance of paper records, Tolle says.
"POLST worked great if emergency medical personnel were called and it was visible in the home," Tolle says. "There were bright pink POLST forms on the refrigerator, or maybe the POLST magnet. But sometimes it couldn't be found. You have to be paper and electronic at the same time for this system to work."
An electronic version of POLST went live at OHSU in 2015, allowing automated submission of information into the state registry. The electronic system was developed by Vynca, a California-based provider of advance care planning solutions.
"Our system allows for these documents to be created in a completely digital format, legible and error-free, and that can be shared across care ecosystems," says Ryan Van Wert, M.D., Vynca's co-founder and chief medical officer.
In June, OHSU's ePOLST system was upgraded to make it bidirectional, meaning OHSU Hospital providers can electronically access patient information housed in the statewide registry.
The upgrade serves a great need, Tolle says, noting that OHSU Hospital is a statewide trauma center and does not have records on all the patients for whom it cares.
"We now expect OHSU to get it right every time," Tolle says. "We expect that if a patient does not want to go to intensive care, does not want to be intubated, that that will not happen. We're almost all the way there now."
Electronic access to a patien's end-of-life wishes also is gaining traction at other health organizations. Samaritan Health Services, based in Corvallis, Ore., logged on to ePOLST early this year. Van Wert says Vynca is working with Samaritan to make its system bidirectional as well.
Tolle notes that the Oregon registry also can partner with other technology providers to attain such upgrades. "We're continuing to push out information," she says."