Committed to Following a Patient's Wishes - 

Advance Directive Documents Exchanged in QHN HIE

Kerri Mosinski HopeWest Senior Vice President

The decision path to transition a patient's care to HopeWest (Hospice & Palliative Care of Western Colorado) can be a very emotional time for the patient and family. Unnecessary interviewing, reviewing of medical histories, and reliving the end-of-life decisions process can add to the stress and emotion. Making the situation even more difficult, frequently the patient is in medical crisis and is being cared for by multiple providers in various care settings.

Historically, when a referral was received at HopeWest, the triage and intake team had to gather a new patient's medical history from various sources by fax. HopeWest's patients are from a large geographic area and they can move quickly from one care setting to another. Their medical information is often scattered and a critical part of the patient's information, the Advance Directive documents (living will, durable medical power of attorney and DNR) that legally define a patient's wishes, need to be located, updated or completed.

The patient's clinical information that is essential to assist the intake team in understanding the patient's immediate care needs, and to establish payment eligibility, is available from the disparate care sources through the QHN health information exchange (HIE). This information helps the team immediately assess the critical patient needs and begin to build a care plan, however historically the Advance Directive documents were not available in the HIE.  

For families, the process of completing Advance Directive documents can involve uncomfortable, difficult conversations with their loved one about end-of-life care. Once these documents are complete the expectation is the directives will be followed.  

When under the direct care of the HopeWest team the Advance Directive process is clearly defined and followed. However, many patients admitted to programs under HopeWest's auspices, are outpatients and they may require care in an alternate care setting, such as the ED. In this situation frequently the patient is unaccompanied by a family member and not in a decisional state. Without immediate access to a patient's Advance Directive documents extraordinary measures may be taken to keep the patient alive and this may be contrary to their wishes.

"HopeWest's connection to QHN allows our intake team to immediately view the Patient Summary which helps frame the admission conversation, prioritize the admission and dramatically reduce duplicative testing.  On the rare occasion when QHN is not accessible our triage nurse is hysterical," said Kerri Mosinski, Senior Vice President of Clinical Services at HopeWest. "However the concern was patients in hospice and palliative care were not having their end-of-life care wishes followed, especially in care transitions, such as transfers to ED for emergent or urgent care."

In response to this community healthcare need QHN's team worked with the HopeWest staff to establish a system to record and place scanned copies of the Advance Directive documents in the HIE. This information is currently in the Patient Summary and also accessible in the Virtual Health Record (VHR). A new Clinical Documents tab has been established in the VHR to house the Advance Directives and other sensitive patient care documents, such as pain contracts.

"ER physicians are ecstatic to have this information in the VHR. Prior to this they had to call HopeWest, have them look-up the patient and await a return the call, now the information and signed documentation is just a few mouse clicks away," explains Mosinski. "This has been a great advancement for patient care in our community. All care providers want to follow the patient's and families wishes."

Hospice and Palliative Care of Western Colorado is now, HopeWest. They provide many programs under their umbrella, Transitions, Living with Cancer, Journeys and inpatient Hospice care. On any given day, they are serving more 300 patients in Mesa County and the Montrose, Delta, and Plateau Valley areas.