Electronic Sharing of Advance Care Planning (ACP) Documents in Massachusetts

MeHI is a partner with the Massachusetts Coalition for Serious Illness Care (the Coalition) on an initiative to facilitate electronic sharing of advance care planning documents, designed to help achieve the Coalition’s goals of ensuring that patients’ wishes, preferences, and goals of care are documented and made accessible regardless of place of care. The mission of the Coalition is to ensure that everyone in Massachusetts receives healthcare that is in accordance with their goals, values and preferences at all stage of life and in all steps of their care.

In addition to the Coalition, MeHI is collaborating with Massachusetts Executive Office of Elder Affairs (EOEA), the Massachusetts Department of Public Health (DPH), and other stakeholders to examine methods, architectures and technologies that can be used by providers to reliably share ACP documents electronically – across systems and platforms – to improve the ability of clinicians, emergency medical services, and other institutional and community caregivers to quickly and reliably identify a patient’s wishes and care preferences at every setting.

As we know, patients want their care preferences known, respected, and shared with all their families and care providers and clinicians want to know and honor their patients' care choices. We know there are many challenges – and many technological options available – to digitizing and sharing these documents. Our intent through this endeavor is to gather sufficient information and input in order to develop recommendations to the Commonwealth for an innovative, feasible course of action that uses technology to ensure that patients’ wishes, preferences and goals of care are both documented and made accessible regardless of place of care.

Program Timeline

Date	Activity
May 24, 2017	Inaugural Stakeholder meeting Include broad sector and geographic representation
July 31, 2017	MeHI issues Request for Information (RFI) for Sharing of ACP Documents to: Better understand tech solutions to e-capture/share ACP documents and their potential for implementation in MA
September 15, 2017	RFI responses due (received 7 responses)
Summer/Fall 2017	Conduct ACP Landscape Analysis of: Current ACP challenges in MA Other state models Emerging themes: Critical to ensure sufficient resources for training, outreach and education Create a learning system with data analytics Implement in multiple stages
October 18, 2017	Meeting with BIDMC Patient-Family Advisor Focus Group
December 7, 2017	Public meeting to discuss e-sharing of ACP documents in MA to: Develop common understanding about e-sharing ACP documents Gather public input about the right approach for MA, including: Necessary components Stakeholders to involve Key metrics to track Click here for meeting resources.
January - March 2018	Synthesize comments; conduct additional research; draft recommendations
April 26, 2018	Stakeholder meeting to review draft recommendations, including Stakeholder Responsibilities Timing and Scope Funding Required Key Metrics
TBD	Future activities will include: Small group stakeholder meetings to receive input from all sectors, including, e.g., emergency responders, home health, skilled nursing, Councils on Aging, patient-family and other community groups Revise draft recommendations Second public meeting to discuss draft recommendations Finalize and Present Recommendations

Next Steps

While the end-goal of this initiative is to digitize all forms of ACP documentation, it was generally agreed that it was crucial to start the effort with a focused, manageable, and measureable program. To that end, stakeholders identified electronic access to patient Medical Orders for Life–Sustaining Treatment (“MOLST”) forms as a critical need with a high potential to significantly improve the quality of end-of-life care.

As part of the evolution of its MOLST program, Massachusetts recently applied to join the National POLST Paradigm. This will require that the Commonwealth revise its current MOLST form and policies in order to be compliant with national paradigm requirements. The DPH, with support from the DPH Palliative Care Advisory Council, will lead this effort.

Transitioning to a new, nationally-compliant POLST form is a complicated undertaking and will require substantial outreach, training and support for providers as they transition to new forms and processes. An extensive education effort will also be needed to ensure that care providers – as well as patients and families – are aware of the revised MOLST program requirements.

Based on this proposed MOLST update, stakeholders recommended that Massachusetts introduce an e-MOLST solution in tandem with the DPH statewide rollout of an updated paper-based MOLST form. Toward that end, we will be looking to introduce an e-MOLST pilot, in a select geographical region of the Commonwealth, concurrent with introduction of the new paper-based MOLST.