--- title: "Providers on advance care plans in EHR. | Sutter Health" description: "Results suggest that providers desire standardized workflows for advance care planning discussion and documentation." url: "https://www.sutterhealth.org/research/publications/providers-on-advance-care-plans-ehr-1055312324" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Providers on advance care plans in EHR. # Provider perspectives on advance care planning documentation in the electronic health record. Dillon E, Chuang J, Gupta A, Tapper S, Lai S, Yu P, Ritchie C, & Tai-Seale M. _Am J Hosp Palliat Care. 1049909117693578. doi: 10.1177/1049909117693578. \[Epub ahead of print\]_ 2017-01-01 ## Abstract CONTEXT: Advance care planning (ACP) is valued by patients and clinicians, yet documenting ACP in an accessible manner is problematic. OBJECTIVES: In order to understand how providers incorporate electronic health record (EHR) ACP documentation into clinical practice, we interviewed providers in primary care and specialty departments about ACP practices (n = 13) and analyzed EHR data on 358 primary care providers (PCPs) and 79 specialists at a large multispecialty group practice. METHODS: Structured interviews were conducted with 13 providers with high and low rates of ACP documentation in primary care, oncology, pulmonology, and cardiology departments. The EHR problem list data on Advance Health Care Directives (AHCDs) and Physician Orders for Life-Sustaining Treatment (POLST) were used to calculate ACP documentation rates. RESULTS: Examining seriously ill patients ≥65 years with no preexisting ACP documentation seen by providers during 2013 to 2014, 88.6% (AHCD) and 91.1% (POLST) of 79 specialists had zero ACP documentations. Of 358 PCPs, 29.1% (AHCD) and 62.3% (POLST) had zero ACP documentations. Interviewed PCPs often believed ACP documentation was beneficial and accessible, while specialists more often did not. Specialists expressed more confusion about documenting ACP, whereas PCPs reported standard clinic workflows. Problems with interoperability between outpatient and inpatient EHR systems and lack of consensus about who should document ACP were sources of variations in practices. CONCLUSION: Results suggest that providers desire standardized workflows for ACP discussion and documentation. New Medicare reimbursement for ACP and an increasing number of quality metrics for ACP are incentives for health-care systems to address barriers to ACP documentation. [PubMed abstract](http://journals.sagepub.com/doi/abs/10.1177/1049909117693578) ## Research topics - [Aging and Longevity](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Aging+and+Longevity%5C%22%22) - [All Cancer](https://www.sutterhealth.org/research-search-results?query=%22%5C%22All+Cancer%5C%22%22) - [Cardiovascular Diseases](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Cardiovascular+Diseases%5C%22%22) - [Health Services](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Health+Services%5C%22%22) - [Lung Diseases](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Lung+Diseases%5C%22%22) - [Medical Informatics](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Medical+Informatics%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Comorbid chronic diseases and their associations with quality of life among gynecological cancer survivors.](https://www.sutterhealth.org/research/publications/chronic-diseases-qol-gyn-cancer-survivors-1055312386) Wang JW, Sun L, Li J, Cong XH, Chen XF, Tang Z, Yu DH, Zhang TR, Luo ZN, Yuan ZP, Yu JM. BMC Public Health. 15:965. doi: 10.1186/s12889-015-2240-1. 2015 Sep 25 - Publication ### [Vocational rehabilitation of cancer patients.](https://www.sutterhealth.org/research/publications/vocational-rehabilitation-cancer-pts-1055312356) Helene G. Brown HG, Tai-Seale M. Semin Oncol Nurs. 8(3):202-211. 1992 Aug 01 - Publication ### [Precision lifestyle medicine: a new frontier in the science of behavior change and population health.](https://www.sutterhealth.org/research/publications/precision-lifestyle-medicine-1055312346) Ma J, Rosas LG, Lv N. Am J Prev Med. pii: S0749-3797(15)00638-8. doi: 10.1016/j.amepre.2015.09.035. \[Epub ahead of print\] 2015 Dec 01 - Publication ### [Impact of home-based, patient-centered support for people with advanced illness in an open health system: a retrospective claims analysis of health expenditures, utilization, and quality of care at end of life.](https://www.sutterhealth.org/research/publications/impact-of-palliative-care-program-cost-use-qol-1055312725) Sudat SEK, Franco A, Pressman AR, Rosenfeld K, Gornet E, Stewart W. Palliat Med. 2018 Feb;32(2):485-492. doi: 10.1177/0269216317711824. Epub 2017 Jun 7. 2018 Feb 01 - Publication ### [Community-based palliative care and advance care planning documentation: evidence from a multispecialty group.](https://www.sutterhealth.org/research/publications/palliative-care-advance-care-planning-documentation-1055312325) Tai-Seale M, Yang Y, Dillon E, Tapper S, Lai S, Yu P, Allore H, Ritchie C. 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Epub 2017 Oct 24. 2017 Oct 24 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/providers-on-advance-care-plans-ehr-1055312324#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Providers on advance care plans in EHR."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/providers-on-advance-care-plans-ehr-1055312324#medicalscholarlyarticle","name":"Provider perspectives on advance care planning documentation in the electronic health record.","headline":"Providers on advance care plans in EHR.","abstract":"CONTEXT: Advance care planning (ACP) is valued by patients and clinicians, yet documenting ACP in an accessible manner is problematic. OBJECTIVES: In order to understand how providers incorporate electronic health record (EHR) ACP documentation into clinical practice, we interviewed providers in primary care and specialty departments about ACP practices (n = 13) and analyzed EHR data on 358 primary care providers (PCPs) and 79 specialists at a large multispecialty group practice. METHODS: Structured interviews were conducted with 13 providers with high and low rates of ACP documentation in primary care, oncology, pulmonology, and cardiology departments. The EHR problem list data on Advance Health Care Directives (AHCDs) and Physician Orders for Life-Sustaining Treatment (POLST) were used to calculate ACP documentation rates. RESULTS: Examining seriously ill patients ≥65 years with no preexisting ACP documentation seen by providers during 2013 to 2014, 88.6% (AHCD) and 91.1% (POLST) of 79 specialists had zero ACP documentations. Of 358 PCPs, 29.1% (AHCD) and 62.3% (POLST) had zero ACP documentations. Interviewed PCPs often believed ACP documentation was beneficial and accessible, while specialists more often did not. Specialists expressed more confusion about documenting ACP, whereas PCPs reported standard clinic workflows. Problems with interoperability between outpatient and inpatient EHR systems and lack of consensus about who should document ACP were sources of variations in practices. CONCLUSION: Results suggest that providers desire standardized workflows for ACP discussion and documentation. 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