Physician Orders for Life‐Sustaining Treatment (POLST) is a standardized medical order form that indicates which specific treatments, such as a ventilator or feeding tube, a seriously ill patient does or does not want. Unlike a health care directive, a POLST form is signed by the patient and physician and is intended to serve as medical orders that move with the patient across settings of care.
Forty-seven states have adopted POLST. New York, Idaho, Oregon, Utah, and West Virginia have established electronic registries that store, manage, and provide access to POLST forms. A 2013 study in Oregon found that people with advanced illness or frailty who had a POLST form had their wishes honored 94% of the time.
In October 2015, the California State legislature passed Senate Bill 19 (Wolk), which authorized a pilot test for an electronic registry (POLST eRegistry). The legislation issues a mandate for providers in the pilot locations who complete a form to submit it to the registry, and the identification of a state agency — the Emergency Medical Services Authority (EMSA) — as the lead agency for the pilot.
In September 2016, CHCF launched a POLST eRegistry pilot in California, in collaboration with EMSA and the Coalition for Compassionate Care of California. The pilot is testing the development and implementation of POLST eRegistries in two community settings, the City of San Diego and Contra Costa County. These registries will enable the submission, storage, and retrieval of POLST forms across participating care settings with the goal of demonstrating feasibility, functionality, quality, and acceptability of the registries to inform and support the development of statewide electronic access to POLST.
Each pilot site has committed community and technology partners:
- Contra Costa County: Alameda-Contra Costa Medical Association and Vynca
- City of San Diego: San Diego Health Connect and Stella Technology
Additional project partners include California Poison Control, which will serve as a backup call center for emergency medical services personnel, and an evaluation team from Oregon Health and Sciences University and the Public Health Institute.
