EHRs give advance directive objective short shrift

Electronic health records have fallen down on the job when it comes to dealing with the advance directive objective, according to a new blog post from Carl Bergman.

Stage 1 of Meaningful Use requires that more than 50 percent of unique patients 65 years and older admitted to an eligible hospital or critical access hospital have in their medical records an indication of advance directive status recorded. Stage 2 goes a bit farther, requiring the record to be included as structured data.

However, Bergman, a consultant who serves as managing partner of free service that enables providers to compare different ambulatory EHR products--found that most EHRs do not have a function for recording the advance directive status. Only four--athenahealth, Cerner, MEDITECH and Practice Fusion--had an advance directive function. Some of the other EHR systems, including those from major vendors, such as Allscripts, provided no particular implementation for this menu objective, although a few did list the requirement. 

So while providers may meet the Meaningful Use objective, it's not necessarily having the practical effect that may have been intended by the requirement.

"If the EHR treats a directive as a miscellaneous document, odds are it won't be known, let alone followed when needed," Bergman says. "To be used effectively, an EHR needs a specific place for directives and they should be readily available."

Interestingly, two out of the four vendors with the function--athenahealth and Practice Fusion--specialize in ambulatory EHRs, not hospital ones.

Patient engagement, of which advanced directives is arguably a part, is a major focus of the later Stages of Meaningful Use. Several legislators asked ONC in a September 2013 letter to provide more emphasis on patient engagement, including advance directives in Stage 3 of the program. 

To learn more:
- read the blog post
- here's the letter to ONC