Handful of states promise physicians online access to advance directives

Virginia has become the latest state to launch an online registry for advance directives that eventually will be connected to a statewide health information exchange.

By connecting the advance directive to an information exchange, a physician could access it without having to contact family or caregivers, or find out a patient's login and password to current online registry programs. That connection would allow a physician to follow through on the patient's wishes without any obligation to contact anyone.

When physicians will have that access depends on when each state has its information exchange up and running.

Virginia recently launched a website open to any resident, allowing anyone to file and store documents, at no charge, to express end-of-life wishes. Virginia's registry will be tied to its statewide information exchange, scheduled to launch in 2013.

Several states have dedicated online registry programs, or are partnering with nationwide organizations such as the U.S. Living Will Registry, to offer advance directive filing and storage. While the documents are crucial to family members who must make decisions on a patient's behalf if they become incapacitated, they would have to know the document's whereabouts and the username and password to access it ahead of time.

The AARP of Virginia supported the creation of its state's database, saying that less than 25% of the U.S. population have advance directive documents filed.

When an incapacitated patient doesn't have an advance directive, tough decisions often fall to relatives who may not ever have talked to that person about his or her wishes. A study in the March 1, 2011, Annals of Internal Medicine found that one in three surrogate decision-makers carries lasting emotional duress from decisions they made on behalf of someone else. The findings came from a systematic review of 40 studies (link).

Debbie Secor, chief information officer of the Virginia Dept. of Health, said situations in which those documents can't be found or accessed is when a health information exchange would make it easier on physicians.

"The facilitation of it will be easy once it's connected to the HIE, and that's certainly the goal," she said.

According to the AARP, other states that have advance directive documents connected to an information exchange, or are in the process of connecting them, include Idaho, Montana and West Virginia. Washington state had a program that was cut due to a budget shortfall.

The recording of the existence of advance directives for patients 65 and older is a menu objective included in the stage one requirements for the meaningful use incentive program for electronic medical record systems. Physicians must meet five of the 10 menu objectives. These elective objectives will change to required objectives for stage two, which goes into effect in 2013.

In January 2011, the Centers for Medicare & Medicaid Services backed away from a policy that would have paid physicians to advise patients on end-of-life and other advance-care planning during annual wellness visits. It was a controversial proposal during the health reform debate that fueled arguments by reform critics about so-called government death panels, even though they never existed or were called for in the legislation.