July 2017 update: Please note the following modifications to this project for the San Diego pilot. San Diego Health Connect (SDHC) has contracted with Stella Technology as the technology vendor to implement an electronic POLST registry that integrates directly with SDHC’s health information exchange. The Contra Costa County pilot remains under coordination of the Alameda-Contra Costa Medical Association (ACCMA), with Vynca as technology vendor.

The board of directors of the California Health Care Foundation (CHCF) has approved a two-and-a-half-year project to develop an electronic registry for Physician Orders for Life-Sustaining Treatment (POLST).

POLST is a standardized form that clearly states what level of medical treatment a patient wants during serious illness or toward the end of life. POLST gives seriously ill patients more control over their treatment and also helps them talk with their health care team and loved ones about their choices. In this way, POLST can help reduce patient and family suffering and make sure patient wishes are known and honored. Unlike an advance directive, POLST is signed by the patient and a physician, nurse practitioner, or physician assistant, and becomes a medical order that moves with the patient across care settings.

While New York, Oregon, Utah, and West Virginia have established electronic registries that store, manage, and provide access to POLST forms, in California most POLST information is maintained only as a pink piece of paper that stays with the patient or the medical record. When POLST information is needed during emergencies or when a patient is unable to communicate, a paper form may not be readily available, hindering care or resulting in care that is against the patient’s wishes.

“The POLST form is a powerful tool for helping patients specify the treatments they do and don’t want,” said Kate O’Malley, RN, MS, senior program officer at CHCF. “But when the paper form is not immediately available, it can result in unwanted care for the patient. Building and testing an electronic database for POLST forms can improve access to this critical information.”

CHCF has worked successfully with the Coalition for Compassionate Care of California (CCCC) to promote widespread adoption of POLST in California since 2007. The new initiative is designed to develop and test a secure, cloud-based web portal for electronic submission, storage, and retrieval of POLST data, helping to inform efforts to develop a permanent POLST registry in the state. CCCC is the home of the California POLST program and will serve as operations center for the registry.

“POLST use is widespread in California but more can be done to increase its effectiveness,” said Judy Thomas, CEO of the Coalition for Compassionate Care of California. “A registry is the next logical step to help ensure patient preferences can be easily accessed across all care settings during an emergency.”

The registry pilot project was spurred by passage of California State Senate Bill 19 (Wolk) in October 2015, which authorized a pilot test for an electronic registry (POLST eRegistry) and the identification of a state agency — the California Emergency Medical Services Authority (EMSA) — as lead agency for the pilot.

Howard Backer, MD, director of EMSA, observed, “The evolution of the POLST form from a piece of pink paper to full integration into the health record is an essential step to making it available to emergency medical providers responding to patient’s homes and providers in the emergency department.”

With CHCF’s financial (up to $3 million) and technical support, CCCC and EMSA will work to develop the POLST pilot registry initiative. The project will provide staff resources necessary to create a cloud-based registry for completed POLST forms to be securely submitted and retrieved. The pilot registry will be tested and evaluated in two locations: San Diego and Contra Costa Counties. Learning from the pilot will help guide possible future expansion statewide.

California-based health care technology company Vynca was selected as the vendor for the registry software after completing a competitive request for proposals process. Vynca has extensive experience developing solutions to digitize and share electronic POLST documentation.

Forty-seven states have adopted POLST. California is one of only three states to be recognized by the National POLST Paradigm Task Force as having a “mature” POLST program. A 2011 study in Oregon (PDF) found that people with advanced illness or frailty with a POLST form had their end-of-life treatment wishes honored 94% of the time.

Project Partners

• The Coalition for Compassion Care of California (CCCC) has been California’s lead on POLST awareness and implementation since 2007. CCCC will be responsible for project management, project partners, and implementation activities, and would establish the Registry Operations Center, overseeing day-to-day operation of the registry and a call support center.
• As identified by SB 19, the Emergency Medical Services Authority (EMSA) will be responsible for guidelines development for the eRegistry, facilitating coordination of emergency medical services within pilot sites, and liaising with the legislature and with the California Department of Health and Human Services.
• The software company Vynca will serve as the technology vendor and will design and build the cloud-based web portal for electronic submission, storage, and retrieval of POLST. Vynca is focused exclusively on developing technology solutions for advance care planning and POLST. The company also has experience working on technology integration with the Oregon POLST Registry (OPR), linking the OPR to the EPIC electronic health record.
• The San Diego pilot will be coordinated locally by San Diego Health Connect (SDHC). SDHC is a health information exchange organization, operating in San Diego since 2010, and includes health systems, hospitals, nursing homes, clinics, and emergency medical services.
• The Contra Costa pilot will be coordinated by the Alameda-Contra Costa Medical Association (ACCMA), a professional association of physicians committed to addressing health issues of concern to patients and doctors in the East Bay. A regional chapter of the California Medical Association, ACCMA has a leadership role in the county health delivery landscape and has been a partner in POLST adoption activities since 2008.

Contact Information:

About the California Health Care Foundation