A Yet Unrealized Promise: Structured Advance Care Planning Elements in the Electronic Health Record
Joshua R Lakin, Daniel A Gundersen, Charlotta Lindvall, Michael K Paasche-Orlow, James A Tulsky, Elise N Brannen, Kathryn I Pollak, Danielle Kennedy, Jody-Ann McLeggon, Jeremiah J Stout, Angelo Volandes, ACP-PEACE Investigators, S Yousuf Zafar, Maria Torroella Carney, Diana Martins-Welch, Camille Chan, Craig E Devoe, Michael Qiu, Jon C Tilburt, Charles L Loprinzi, Parvez A Rahman, Aretha Delight Davis, Areej El-Jawahri, Joshua R Lakin, Daniel A Gundersen, Charlotta Lindvall, Michael K Paasche-Orlow, James A Tulsky, Elise N Brannen, Kathryn I Pollak, Danielle Kennedy, Jody-Ann McLeggon, Jeremiah J Stout, Angelo Volandes, ACP-PEACE Investigators, S Yousuf Zafar, Maria Torroella Carney, Diana Martins-Welch, Camille Chan, Craig E Devoe, Michael Qiu, Jon C Tilburt, Charles L Loprinzi, Parvez A Rahman, Aretha Delight Davis, Areej El-Jawahri
Abstract
Background: Electronic health records (EHRs) may help enable reliable, rapid data management for many uses, such as facilitating communication of advance care planning (ACP). However, issues with validity and accuracy of EHRs hinder the use of ACP information for practical applications. Design: We present a cross-sectional pilot study of 433 older adults with cancer from three large health care systems, participating in an ongoing multisite pragmatic trial (4UH3AG060626-02). We compared data extracted from dedicated structured EHR fields for ACP to a chart review of corresponding ACP documentation contained in the medical chart. Results: Structured ACP data existed for 43.2% of patients and varied by site (25.7% -48.9%). Of the identified structured ACP data elements, 59.2% of recorded elements were correct, 23.7% were incorrect, and 17.1% were duplicates with heterogeneity across sites. Conclusion: Structured ACP data in EHRs were frequently incorrect. This represents a problem for patients and their families, as well as quality improvement and research efforts. Clinical Trials Registration: NCT03609177.
Keywords: advance care planning; electronic health records; end-of-life care; patient-physician communication.
Conflict of interest statement
Dr. Tulsky is a Founding Director of VitalTalk, a nonprofit organization focused on clinician communication skills training, from which he receives no compensation. Dr. Volandes has a financial interest in the nonprofit foundation Nous Foundation (d/b/a ACP Decisions, 501c3). The nonprofit organization develops ACP video decision aids and support tools. Dr. Volandes' interests were reviewed and are managed by Massachusetts General Hospital and Partners HealthCare in accordance with their conflict of interest policies. None of the other authors have any conflict of interests to disclose.
Source: PubMed