Abstract
In April 2015, Oregon Health & Science University (OHSU) deployed a web-based, electronic medical record-embedded application created by third party vendor Vynca Inc. to allow real-time education, and completion of Physician Orders for Life Sustaining Treatment (POLST). Forms are automatically linked to the Epic Systems™ electronic health record (EHR) patient header and submitted to a state Registry, improving efficiency, accuracy, and rapid access to and retrieval of these important medical orders. POLST Forms, implemented in Oregon in 1992, are standardized portable medical orders used to document patient treatment goals for end-of-life care. In 2009, Oregon developed the first POLST-only statewide registry with a legislative mandate requiring POLST form signers to register the form unless the patient opts out. The Registry offers 24/7 emergency access to POLST Forms for Emergency Medical Services, Emergency Departments, and Acute Care Units. Because POLST is intended for those nearing end of life, immediate access to these forms at the time of an emergency is critical. Delays in registering a POLST Form may result in unwanted treatment if the paper form is not immediately available. An electronic POLST Form completion system (ePOLST) was implemented to support direct Registry submission. Other benefits of the system include single-sign-on, transmission of HL7 data for patient demographics and other relevant information, elimination of potential errors in form completion using internalized logic, built-in real-time video and text-based education materials for both patients and health care professionals, and mobile linkage for signature capture.
References
Oregon POLST History. www.orpolst.org/history, accessed April 19, 2016.
Hickman, S.E., Nelson, C.A., Perrin, N.A., et al., A comparison of methods to communicate treatment preferences in nursing facilities: traditional practices versus the physician orders for life-sustaining treatment program. J. Am. Geriatr. Soc. 58(7):1241–1248, 2010.
Fromme, E.K., Zive, D., Schmidt, T.A., et al., POLST registry do-not-resuscitate orders and other patient treatment preferences. JAMA. 307(1):34–35, 2012.
Richardson, D.K., Fromme, E., Zive, D., et al., Concordance of out-of-hospital and emergency department cardiac arrest resuscitation with documented end-of-life choices in Oregon. Ann. Emerg. Med. 63(4):375–383, 2014.
Fromme, E.K., Zive, D., Schmidt, T.A., et al., Association between physician orders for life-sustaining treatment for scope of treatment and in-hospital death in Oregon. J. Am. Geriatr. Soc. 62(7):1246–1251, 2014.
Moss AH, Zive DM, Falkenstine, EC, et al. POLST medical intervention orders and in-hospital death rates: comparable patterns in two state registries. J Am Geriatr Soc 64(8):1739–1741, 2016.
Fromme, E.K., Zive, D., Schmidt, T.A., et al., The Oregon physician orders for life-sustaining treatment registry: a preliminary study of emergency medical services utilization. J. Emerg. Med. 44(4):796–805, 2013.
Schmidt, T.A., Zive, D., Fromme, E.K., et al., Physician orders for life-sustaining treatment (POLST): lessons learned from analysis of the Oregon POLST registry. Resuscitation. 85(4):480–485, 2014.
Oregon Revised Statute (ORS 127.663 to 127.684). https://www.oregonlegislature.gov/bills_laws/ors/ors127.html, accessed 4/19/16.
National POLST Paradigm Task Force. Recommendations for Electronic Health Records and Physicians Orders for Life Sustaining Treatment (POLST) Paradigm Forms. http://www.polst.org/wp-content/uploads/2015/04/2015.03.26-EHR-standards-1-1.pdf, accessed April 5, 2016.
Oregon POLST Registry. 2015 Annu. Rep. http://www.orpolstregistry.org/wp-content/uploads/2012/09/Oregon-POLST-Registry-Annual-Report_2015_Final.pdf, accessed April 5, 2016.
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This article is part of the Topical Collection on Systems-Level Quality Improvement.
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Zive, D.M., Cook, J., Yang, C. et al. Implementation of a Novel Electronic Health Record-Embedded Physician Orders for Life-Sustaining Treatment System. J Med Syst 40, 245 (2016). https://doi.org/10.1007/s10916-016-0605-3
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DOI: https://doi.org/10.1007/s10916-016-0605-3