EHR alerts can facilitate end-of-life discussions

Electronic health record alerts can improve the rate and timing that physicians initiate discussions with their terminally ill patients about their end-of-life preferences, according to a new study published in the Journal of Clinical Oncology.

Patients' preferences about end-of-life care often are not documented in their medical records, making it difficult for other providers to know about and follow them. The researchers, from the Massachusetts General Hospital Cancer Center in Boston, created a two-phase study to see if electronic prompts could encourage oncologists to document their patients' end-of-life preferences. They designed specific email reminders to the physicians regarding 100 patients with incurable lung cancer who were starting new chemotherapy regimes.

The researchers found that when physicians received these email alerts, 33.7 percent of their patients had their end-of-life status documented in their EHRs, compared to just 14.5 percent of patients in a control group. They also found that the physicians who received the email prompts had such discussions with their patients sooner; it only took 8.6 months for the physicians to record the patients' preferences, compared to 10.5 months for the control group.  

The more frequent and earlier documentation is significant because it enables the clinicians to capture patients' preferences before they are hospitalized and in crisis mode, according to a Reuters article.

Other studies have shown that email reminders improve follow up care and outcomes. Both Stages 2 and 3 of the Meaningful Use program require providers to record in their EHRs whether a patient has an advance directive, but the program does not require providers to capture the end-of-life preferences of patients.

A new website called PREPARE uses audio and video content to walk patients through the steps of making complex medical decisions. It was developed at the San Francisco VA Medical Center and the Veterans Health Research Institute by researchers who recently published a study on advance care planning in the Journal of Pain and Symptom Management.

To learn more:
- here's the study abstract
- read the Reuters article