Daniela Lamas1,2, Natalie Panariello2, Natalie Henrich2, Bernard Hammes3, Laura C Hanson4, Diane E Meier5, Nancy Guinn6, Janet Corrigan7, Sean Hubber8, Hannah Luetke-Stahlman9, Susan Block2,10. 1. 1 Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital , Boston, Massachusetts. 2. 2 Ariadne Labs , a Joint Center between Brigham and Women's Hospital, Boston, Massachusetts. 3. 3 Emeritus Medical Staff, Gundersen Lutheran Medical Center , La Crosse, Wisconsin. 4. 4 Palliative Care Programs, Division of Geriatric Medicine, University of North Carolina School of Medicine , Chapel Hill, North Carolina. 5. 5 Hertzberg Palliative Care Institute of the Brookdale Department of Geriatrics , Icahn School of Medicine at Mount Sinai, New York, New York. 6. 6 Presbyterian Healthcare Services , Albuquerque, New Mexico . 7. 7 Chief Program Officer for Patient Care, Gordon and Betty Moore Foundation , Palo Alto, California. 8. 8 Epic Systems Corp. , Verona, Wisconsin. 9. 9 Cerner Corp. , Kansas City, Missouri. 10. 10 Division of Psychosocial Oncology, Dana-Farber Cancer Institute , Boston, Massachusetts.
Abstract
OBJECTIVE: To develop a set of clinically relevant recommendations to improve the state of advance care planning (ACP) documentation in the electronic health record (EHR). BACKGROUND: Advance care planning (ACP) is a key process that supports goal-concordant care. For preferences to be honored, clinicians must be able to reliably record, find, and use ACP documentation. However, there are no standards to guide ACP documentation in the electronic health record (EHR). METHODS: We interviewed 21 key informants to understand the strengths and weaknesses of EHR documentation systems for ACP and identify best practices. We analyzed these interviews using a qualitative content analysis approach and subsequently developed a preliminary set of recommendations. These recommendations were vetted and refined in a second round of input from a national panel of content experts. RESULTS: Informants identified six themes regarding current inadequacies in documentation and accessibility of ACP information and opportunities for improvement. DISCUSSION: We offer a set of concise, clinically relevant recommendations, informed by expert opinion, to improve the state of ACP documentation in the EHR.
OBJECTIVE: To develop a set of clinically relevant recommendations to improve the state of advance care planning (ACP) documentation in the electronic health record (EHR). BACKGROUND: Advance care planning (ACP) is a key process that supports goal-concordant care. For preferences to be honored, clinicians must be able to reliably record, find, and use ACP documentation. However, there are no standards to guide ACP documentation in the electronic health record (EHR). METHODS: We interviewed 21 key informants to understand the strengths and weaknesses of EHR documentation systems for ACP and identify best practices. We analyzed these interviews using a qualitative content analysis approach and subsequently developed a preliminary set of recommendations. These recommendations were vetted and refined in a second round of input from a national panel of content experts. RESULTS: Informants identified six themes regarding current inadequacies in documentation and accessibility of ACP information and opportunities for improvement. DISCUSSION: We offer a set of concise, clinically relevant recommendations, informed by expert opinion, to improve the state of ACP documentation in the EHR.
Keywords:
advance care planning; electronic health records; palliative care
Authors: Matthew E Modes; Ruth A Engelberg; Lois Downey; Elizabeth L Nielsen; J Randall Curtis; Erin K Kross Journal: J Pain Symptom Manage Date: 2018-11-01 Impact factor: 3.612
Authors: Andrew S Epstein; Anjali V Desai; Camila Bernal; Danielle Romano; Peter J Wan; Molly Okpako; Kelly Anderson; Kimberly Chow; Dana Kramer; Claudia Calderon; Virginia V Klimek; Robin Rawlins-Duell; Diane L Reidy; Jessica I Goldberg; Elizabeth Cruz; Judith E Nelson Journal: J Pain Symptom Manage Date: 2019-04-26 Impact factor: 3.612
Authors: Matthew E Modes; Susan R Heckbert; Ruth A Engelberg; Elizabeth L Nielsen; J Randall Curtis; Erin K Kross Journal: J Pain Symptom Manage Date: 2020-05-07 Impact factor: 3.612
Authors: Anuj K Dalal; Patricia Dykes; Lipika Samal; Kelly McNally; Eli Mlaver; Cathy S Yoon; Stuart R Lipsitz; David W Bates Journal: Appl Clin Inform Date: 2019-05-29 Impact factor: 2.342
Authors: Elizabeth A Luth; Adoma Manful; Joel S Weissman; Amanda Reich; Keren Ladin; Robert Semco; Ishani Ganguli Journal: J Gen Intern Med Date: 2022-01-26 Impact factor: 5.128
Authors: Terri R Fried; Andrea L Paiva; Colleen A Redding; Lynne Iannone; John R O'Leary; Maria Zenoni; Megan M Risi; Slawomir Mejnartowicz; Joseph S Rossi Journal: Ann Intern Med Date: 2021-08-31 Impact factor: 25.391
Authors: Andrew S Epstein; Michael Riley; Judith E Nelson; Camila Bernal; Steven Martin; Han Xiao Journal: Cancer Date: 2022-07-22 Impact factor: 6.921