Multiple locations of advance care planning documentation in an electronic health record: are they easy to find?

BACKGROUND: The ambulatory care setting is a new frontier for advance care planning (ACP). While electronic health records (EHR) have been expected to make ACP documentation more retrievable, the literature is silent on the locations of ACP documentation in EHRs and how readily they can be found.

OBJECTIVE: The study's objective is to identify the locations of ACP documentation in EpicCare EHR and to determine which patient and primary care provider (PCP) characteristics are associated with having a scanned ACP document. A scanned document (SD) is the only documentation containing signatures (unsigned documents are not legally valid).

DESIGN: The study design is a retrospective review of EpicCare EHR records. The search of terms included advance directives, living will, Physician Orders for Life-Sustaining Treatments (POLST), power of attorney, and do-not-resuscitate.

SETTING/SUBJECTS: Subjects were patients in a multispecialty practice in California age 65 or older who had at least one ACP documentation in the EHR.

MEASUREMENTS: Measurements were types and locations of documentation, and characteristics of patients and physicians.

RESULTS: About 50.9% of patients age 65 or older had at least one ACP documentation in the EHR (n=60,105). About 33.5% of patients with ACP documentation (n=30,566) had an SD. Patients' age, gender, race, illnesses, and when their physician started at the medical group were statistically significantly associated with the probability of having a scanned ACP document.

CONCLUSIONS: Only 33.5% of patients with ACP documentation somewhere in the EHR had an SD. Standardizing the location of these documents should become a priority to improve care. Actions are needed to eliminate disparities.