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Electronic Records Offer A Chance To Ensure Patients’ End-Of-Life Plans Aren’t Lost In Critical Moments

In a recent article from Kaiser Health News, Shefali Luthra details the amazing potential of electronic medical records, especially when it comes to the realm of end-of-life care and planning. However, the current state of electronic records leaves much to be desired. Read more in the excerpt below:

In a perfect world, patients with advance directives 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.

But this ideal is still in the distance. Patients’ documents often go missing in maze-like files or are rendered unreadable by incompatible software. And this risk continues even as health systems and physician practices adopt new electronic health records. So advocates and policymakers are pushing for a fix.

The problem isn’t new, experts noted. Advance directives were lost during the era of paper records, too. But, so far, digital efforts have fallen short.

“When these systems don’t work — and currently, they don’t work well enough — then that has a huge negative feedback on doctors and patients and families,” said Dr. Lachlan Forrow, director of the ethics and palliative care program at Boston’s Beth Israel Deaconess Medical Center. “Like, why even bother?” Thinking through and writing down end-of-life preferences can be grueling, he added.

Still, end-of-life planning has been encouraged by ethicists and experts in recent years, who say it communicates patient choices about medical interventions like being connected to a ventilator or feeding tube, or being resuscitated after heart failure — especially when patients can’t speak for themselves. This January, Medicare began paying doctors to discuss end-of-life wishes with patients, a policy almost 90 percent of Americans support. Meanwhile, according to 2015 figures from the Kaiser Family Foundation, 60 percent of adults older than 65 have such directives. (KHN is an editorially independent program of the foundation.)

Here’s how difficulties arise. Maybe 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 like a “do-not-resuscitate” order.

“An individual will fill out an advance directive, but unless they bring a copy with them, the provider will likely not know or see it exists,” said Kim Callinan, chief program officer at Compassion & Choices, a Colorado-based group that advocates for end-of-life care options. 

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