California’s POLST Electronic Registry Pilot
Lessons for all states
Toward the end of life, when seriously ill or frail people cannot communicate their medical treatment choices, they risk receiving care inconsistent with their wishes. The National POLST (Physician Orders for Life-Sustaining Treatment) Paradigm aims to ensure people get the medical treatments they want, and avoid those they do not want, when they cannot speak for themselves in a medical emergency or due to serious illness. It encourages patients and their health care providers to talk about and document preferences related to potential medical intervention options, considering their diagnosis, prognosis, treatment plan, and goals of care. But during an emergency, when POLST information is needed urgently, it may not be readily available, hindering care or resulting in treatment that is against the patient’s wishes.
In 2015, California Senate Bill 19 required the state’s Emergency Management Services Agency (EMSA) to establish a pilot project to operate a POLST electronic registry (eRegistry) with non-state funding.
With financial support from CHCF, the two-year pilot aimed to test the feasibility of a statewide POLST eRegistry through implementation in two communities. EMSA, CHCF, and the Coalition for Compassionate Care of California provided overall pilot leadership.
This publication describes the outcomes of and lessons learned from the pilot, providing insights and considerations for entities interested in pursuing POLST registries. The challenges and considerations for a statewide eRegistry rollout and long-term sustainability fall into five main areas:
- Organizational readiness and commitment
- Community engagement / stakeholder and participant education
- Workflow considerations
- POLST document practices
- Technology features and functions
To assist other organizations preparing for electronic exchange of POLST, the pilot team also developed a POLST eRegistry Readiness Assessment Tool to identify some of the needed preconditions and capabilities, and to help anticipate and address barriers. Additional resources are available through the California POLST Program.
About the Authors
This paper is based on a report prepared by the California POLST eRegistry Pilot Evaluation Team of Abby Dotson, PhD, director of the Oregon POLST Registry and research assistant professor at Oregon Health & Science University; Andrew Broderick, MA, MBA, research program director, Public Health Institute; and Valerie Steinmetz, MPH, program director, Public Health Institute. Synthesis of that evaluation report to prepare this paper was led by John Weir, MS, consultant with Paperclip Management Services and Susan Anthony, health care editor and writer.