By Doug Kunz, Senior Product Manager.
As someone who works with IT, often the problems I grapple with can start to seem a little abstract. Last week, however, I was honored to represent Stella Technology at the California Coalition for Compassionate Care (CCCC) 2019 Palliative Care Summit. It was a privilege to see the all-too-human faces of the health care providers – and even a few patients – whose lives are touched by my work. I spoke a little, listened a lot, and came away with the following insights about the current state of Advance Care Planning and electronic POLST registries in California.
First, electronic registries for patients’ POLST documents are best pursued at the level of an entire community or region. I was very interested to hear about the experiences of a large integrated healthcare system that has created its own POLST Registry, and the challenges of a single institution–driven effort. Although this healthcare system had met some of their objectives – primarily increasing the quality and capture rate of POLST forms when clinically appropriate for patients – the “holy grail” of making those patients’ forms available across the continuum of care still eludes them. The difficulties that this organization has encountered in its POLST-specific efforts to exchange patient data across organizational boundaries stand in contrast to what we have experienced in implementing a POLST Registry by partnering with an HIE, San Diego Health Connect. An established HIE already has the interpersonal relationships, implementation and support staff, contractual arrangements, and technical infrastructure needed to make a POLST Registry implementation a success across all of the healthcare provider organizations in a community.
Next, enabling EMS personnel to efficiently access POLST forms during an emergency response requires a design that is focused on enabling good integration with EMS workflows: it cannot be addressed as an afterthought. At the Summit I had the pleasure of speaking with people who serve at all levels of EMS agencies from throughout California, and I was very proud of the results we have been able to obtain within the City of San Diego, where about 200 POLST forms per month are being accessed by first responders due to the “one-touch POLST access” we have been able to deploy there. I was saddened to hear the frustration of EMS personnel in other regions of California who have clearly not had their workflow needs met and make little use of their local POLST registries. Finally, some conversations with EMS personnel and our collaborators at San Diego Health Connect resulted in some promising potential improvement ideas for surfacing POLST forms to first responders even earlier in an emergency response than we already do. I came away from the Summit feeling energized and hopeful at the potential for making an even bigger difference than we already are.
Finally, I anticipate that soon we will see efforts to enable interoperability between the electronic POLST Registries that already exist in California. It makes sense to build on efforts that have been successful, and making POLST forms available more widely across the state – regardless of which POLST Registry “hosts” a particular form – makes each individual POLST Registry more valuable, while improving the lives of patients and healthcare providers. I’m looking forward to identifying what role we at Stella Technology can play in helping to make this vision a reality.