Need to Improve Documentation of End-of-life Care Wishes in EHRs

Need to Improve Documentation of End-of-life Care Wishes in EHRs

Equipping electronic health records to provide quick and easy access to advance care directives is necessary to ensure that patients get the treatment they want. www.medicaltranscriptionservicecompany.com

MTS Transcription Services United States

(800) 670 2809

Electronic health records (EHRs) are digital records that can provide comprehensive health information about the patient, including demographics, administrative and billing data, progress notes, diagnoses, medical histories, medications, lab results, etc. However, while most hospitals and physician practices have adopted electronic health records (EHRs), these systems are far from perfect. For instance, most EHR documentation options do not allow for complete capture of the clinical narrative, but the availability of medical transcription services helps overcome this challenge. Recent reports say that one serious shortcoming of some EHRs is that they do not provide quick and easy access to the patient’s end-of-life care wishes.

Medicare reimburses physicians for end-of-life counseling and experts encourage patients to document an advance care plan to ensure that they get the treatment they want. However, the problem is that it is difficult for physicians to find and implement that directive.

Lack of Access to End-of-life Wishes leads to Treatment Patients Sought to Avoid The New York Times (NYT) recently reported on the story of an elderly patient who was intubated in the intensive care unit – the treatment that he had specifically wished to avoid.

The patient had learned from his doctor that there were no further therapies to slow the growth of his cancer. He had requested that, when things got worse, there would be no breathing tubes or chest compressions. But the emergency team failed to see his advance care directive in the EHR, and as a result, the patient ended up getting the care he didn’t want. According to the report, this happened because the patient’s end-of-life directive was not readily available in the EHR, at a time when it was needed.

In 2016, the Star Tribune had reported a similar story. Beth Bedell, a Minnesotan with an inoperable brain tumor, had included a do-not-resuscitate (DNR) order in her advance directive in the hospital’s electronic health record system. But when she went to the emergency room, the medical staff could not locate her advance care planning documents and provided the treatment that she particularly wanted to avoid. Though the ER team saved her life, Bedell was concerned that clinicians did not follow her wishes for no resuscitation, which she had documented after she was diagnosed with a brain tumor.

www.medicaltranscriptionservicecompany.com

(800) 670 2809

Lack of Standardized Processes to Record and Store Advance Care Directives According to the Pew Research Center, care that patients get near the end of life often does not reflect their values, goals, and informed preferences. The report notes that this is largely due to EHR design flaws and lack of standardized processes to record and store endof-life directives. A 2014 case study of a hospital in Texas found that advance directives could be stored in any one of seven different places in an EHR. The reasons why patients’ end-of-life wishes could get ignored, according to Pew Research Center, are: -

Poor design of some EHRs may pose a barrier to efforts by patients to document their wishes

-

There is no designated location for advance care planning notes in many EHRs

-

In an emergency, clinicians may not notice that the patient has an advance care plan

-

Physicians and nurses may not have the time to look through the various EHR tabs or check all the options

An Advisory Board report says lack of EHR interoperability is another problem. Providers may remain unaware of the patient's wishes as the software used by the patient's primary care provider may not communicate with another provider's software.

Need for Quick and Easy Access to End-of-life Care Documentation In order to improve end-of-life care documentation, Software Advice conducted a survey to understand the perspectives and needs of patients and caregivers on the matter. The key findings of the survey are as follows: -

Up to 69 percent of patients surveyed rated caregiver accessibility to end-of-life medical treatment plans as “extremely” or “very important.”

-

The ability to access end-of-life care instructions from any location is the main reason why respondents prefer storing them in EHR system rather than on paper.

-

65 percent of professional caregivers said that storing store end-of-life instructions in an EHR system is more efficient than storing them in paper records.

-

Up to 27 percent of patients were unsure about where to store end-of-life care

There are many advantages to equipping EHRs to provide easy access to end-of-life directives, according to the Software Advice survey report. Patients need to be educated about the benefits of electronic documentation over paper forms for storing end-of-life care directives:

www.medicaltranscriptionservicecompany.com

(800) 670 2809

-

Compared to paper records, EHRs offer a safe means of storing important information

-

Storing such information on paper may be counterproductive as paper records can be easily misplaced or left behind in emergency situations.

-

As cloud-based EHRs are not they are not location-specific, these important documents and decisions are potentially accessible from anywhere in the world. This is crucial in time-sensitive situations.

Medical transcription outsourcing provides physicians with access to timely, error-free, complete and meaningful notes that can be integrated with the EHR. To further meet patient needs, EHRs should make it easy for providers to locate and review end-of-life care plans in an urgent situation. This will help them begin discussions with their patients about the type of care they want or do not want. Determining and documenting patients’ end-oflife directives in an accessible manner in EHRs would ensure that patients’ wishes are followed and also make it easier for providers to meet one of the conditions needed to receive federal financial incentives.

www.medicaltranscriptionservicecompany.com

(800) 670 2809