POLST Paradigm Form Registries State Topic Idaho New York Oregon Utah Washington West Virginia Active for POLST Paradigm Forms Yes Yes Yes Yes No Yes Documents Retained in Form repository: POST forms, Combination Living Will/ Durable Power of Attorney for Healthcare. Any advance planning documents meeting statutory requirements emolst form and separate forms that document goals, values and beliefs as well as all associated ethical and legal documentation. Separate self-submit advance directive registries are run regionally with limited success and questionable security, depending on the model used. Form repository: POLST Forms only. Hybrid form completion system with repository functionality: POLST Forms only. Form repository: POLST Forms, advance directives, and associated documentation (when registry was operational). Form repository: Advance directives, POST Forms, Surrogate Selection Checklists, Combined Medical Power of Attorney and Living Wills, and miscellaneous related documents. Platform Paper submission based Both web and phone access based emolst A form completion system plus registry in one web-based system that can be accessed by authorized users (healthcare professionals) anywhere there s an internet connection or integrated into an EMR. Data are also queryable by authorized entities (HIEs, RHIOs, etc.) SQL backend, web based database. Accepts paper (copies, but primarily efax), electronic transmissions (Direct Secure Messaging, sftp), and epolst generated documents. Page 1 of 6
Data Collection Capability Limited to document type No dashboard System guides provider completion of emolst forms which guarantees accuracy through logic-based coding. Forms and all documentation are automatically included in the registry where they are searchable by all other emolst users (health care Professionals) statewide. Workflow features included and also provide dashboard of to dos for providers. Admin functionality and addtl dashboards available for admin users and key providers from health systems. Super admin tools available for managing the whole state. API available. Data is both abstracted from the form, and a scanned copy of the form is imported as well. Data reporting includes time elements (time from signature to receipt, time from receipt to entry, # of forms received per month, sender information, signer information, call center information (emergency access 24/7 through call center), business office information (packets sent, calls received, Not Ready form followup, etc). We also have APIs and sftp connectivity for bidirectional capability with IEs and epolst systems Admin functionality and additional dashboards available for admin users. Who Submits Individuals, legal representatives, authorized surrogates, providers (physicians, PAs, APRNs). Health care professionals complete emolst with automatic and immediate inclusion in searchable / queryable statewide registry. Individuals ma y submit advance directives through regional registries or RHIO patient portal. RHIO patient portal is secure. Regional registries may not be. Health Systems, clinics, hospitals, long term care facilities, hospice, and individuals. Form preparers and signers. When operational, individuals or legally authorized representatives submitted materials. submitted to the Washington are still available online through a national vendor. Individuals or legally authorized representatives. Page 2 of 6
Who Can Access Health care providers access form content through web- based interface. Requires patient identifying codes from wallet card. Any authorized health care professional can gain access to the registry. Different levels of clinical and administrative access exist to cover all professional roles and responsibilities. Access is individually configurable. Oregon EMS providers, Emergency Departments and Hospital Acute Care Units have 24/7 emergency access via a call center. Longterm care facilities, hospitals, clinics, health systems, hospice, and other users access POLST Forms through the back office (M-F, 8-4). Bidirectional capacity with epolst and Emergency Department Information Exchange to launch summer 17. Health care systems, providers access content through a web-based interface. When operational, materials were accessed through a web- based interface, requiring patient identification. After the ceased operations, registrants materials were maintained on the site and are accessible using already provided patient identification. When available through the West Virginia Health Information Network, e-directive will soon be available to all participating providers. Currently is collecting materials in a free-standing repository. Accessible 24/7/365 Only with patient login and passcode info. Yes Yes, and through EMR once bidirectional is up. Yes, with unique username and password. Available through Electronic Health Records Only if scanned in. Yes, amount of information, type of information and how it s accessed varies depending on integration choices. Upcoming bidirectional capacity will allow EMR access for hospitals using certain epolst systems. Only if scanned in at this time. Accessible through Regional Health Information Exchange or Health Information Exchange No Yes, depending on RHIO integration choices. There are many RHIOs in NYS (>6?). Upcoming launch with Emergency Department Information Exchange will allow ED awareness of form from. Yes Page 3 of 6
Available through the Internet Yes Yes Operate orpolstregistry.org with information, but no direct POLST Form viewing. Yes, as long as the healthcare provider has a username/password. Available through a Call Center No, but can call Secretary of State s office during business hours. No, but any authorized provider should be able to search via the website 24/7/365. Yes (24/7) Yes, during business hours (M-F, 8:00am to 4:30pm EST). Single Platform or Multiple Registries (If yes, please specific if they communicate with one another.) Single, one platform for all of NYS. Can be accessed via the web or via an EMR. Same database instance is always accessed. Single, statewide Single, one platform /registry statewide. Disaster Recovery and High Availability Plans in Place HIPAA and HITECH Compliant Yes Yes Yes Yes Yes Yes Encryption Yes, encrypted at rest and in transit. Yes Yes Audit Capabilities Yes Yes No Page 4 of 6
Research Functionality and/or Utility None Yes, full set data exports are possible from super admin backend. Yes, and required by legislation. Oregon Health Authority IRB and home institution IRB have oversight and we also utilize a data request form. None Educational for Health Care Providers (If yes, specify if this is justin-time or linked information.) Yes Yes, many different resources incorporated into the system including just in time education, videos, links, quick reference definitions, etc. Yes, orpolstregistry.org and oregonpolst.org Yes, on WV Center for End- of-life Care s website, www.wvendoflife.org Educational for Patients/Families /Surrogates (If yes, please specify.) Yes Yes, both embedded in the emolst system and in reference links to other outside materials. Yes, orpolstregistry.org and oregonpolst.org Yes, https://wvhin.hieadvan tage.com Website Yes NYSeMOLSTregistry.com orpolstregistry.org https://wvhin.hieadvantage.com Contacts /System Ownership Owner Organization Type Pat Bomba MD, MACP emolst Project Director patricia.bomba@lifethc.com Katie Orem MPH, emolst Administrator katie.orem@excellus.com Excellus BlueCross BlueShield Dana Zive MPH, Director polstreg@ohsu.edu Data owned by the Oregon Health Authority. build owned by OHSU. operated under contract with OHA Nonprofit Health Plan State Nonprofit Evan Falkenstine Data Administrator, edirective OR WV Center for End-of- Life Care (877-209- 8086) WV Center for End-of- Life Care e-directive. Page 5 of 6
/System Funding Sources Currently supported exclusively by Excellus BlueCross BlueShield. Originally started with small grant from NYSDOH and support from Excellus BlueCross BlueShield. Oregon POLST piloted in one county with philanthropic funds. 2009: House Bill mandated, including submission (unless patient optsout). Funded from State general fund. funded under the WV Center for End-of-Life Care, which is grant funded through the WV Department of Health and Human Resources. Page 6 of 6