Oregon Health & Science University, in partnership with Silicon Valley startup Vynca, Oregon POLST and the Oregon POLST Registry, today announced the launch of ePOLST, a fully integrated electronic version of the Physician Orders for Life-Sustaining Treatment, commonly known as POLST, which will assist health care systems in more accurately recording and accessing the wishes of patients who are nearing the end of life.
“For decades, Oregon has led the country in systems change to assure the wishes of those who are nearing the end of life are consistently honored,” said Susan W. Tolle, M.D., director of the OHSU Center for Ethics in Health Care, chair of the Oregon POLST Task Force and a leader behind the original POLST form. “The last thing any patient wants is to have clearly documented their treatment wishes through a delicate and thoughtful conversation with their health care professional and family members, and then not have those wishes honored.”
The POLST form was created in 1990 in an effort to ensure the wishes of those with advanced illness or frailty are followed. POLST programs have been adopted or are in development in 43 states across the country. POLST forms are strongly associated with desired care received. A survey of patients showed that less than 10 percent of patients want to die in the hospital. Unfortunately, without a POLST form, four times that many still do.
In the first phase of the launch, ePOLST, which was tested, refined and piloted at OHSU, allows OHSU clinicians to electronically and more quickly and accurately submit a POLST form, drastically reducing the need for paper forms, which are error-prone. (The current statewide error rate for paper POLST forms submitted to the Oregon POLST Registry is 18 percent.)
OHSU clinicians can also now easily view a patient’s POLST form, which is located at the top of their EPIC electronic health record, if they have one. This is critical in crisis situations where care teams are making decisions about treatment options.
In the next phase, OHSU clinicians will be able to electronically search the Oregon POLST Registry through ePOLST, which will make it easier to find POLST forms from other health care systems. In Oregon, more than 250,000 POLST forms have been submitted to the registry since its inception in 2009. More than 5,000 health care professionals have called the registry seeking forms in a time of urgent need -- 2,000 of those patients had POLST forms provided to guide their care.
“As an intensive care unit physician, I have seen the end-of-life care wishes of patients ignored simply because we couldn’t find a POLST form for them. This is a terrible outcome and very traumatic for the patient, family members and healthcare providers,” said Ryan Van Wert, M.D., co-founder of Vynca and Clinical Instructor of Medicine in Pulmonary and Critical Care Medicine at Stanford University. “These documents can’t be easily shared between care settings, and we created this solution to solve the problem. We don’t want anyone to slip through the cracks. It made perfect sense for us to work with OHSU because of their national leadership with POLST.”
New educational materials have been developed to help patients more fully understand how POLST orders can turn their wishes to have or to limit treatment in to action as medical orders. To assure the quality of these important conversations we are teaching clinicians and care teams how to use the newly available “just in time” patient educational materials now linked to the ePOLST Program.
“The fewer errors we have with POLST forms, and the easier we can find forms, the better care we can give to our patients, while also respecting their wishes,” said Tolle. “We’re continually working to improve systems and reduce the number of patients whose treatment wishes are not honored. ePOLST will also allow OHSU to provide better information to other health care systems, and more informed research, which benefits everyone.”
ePOLST was funded through a grant from the California HealthCare Foundation.
Vynca is a healthcare technology company based in Palo Alto, CA. Vynca technology breaks down traditional health data silos with high value, secure, cloud-based products. Our mission is to improve care delivery at the end of life. Vynca technology breaks down traditional health data silos with high value, secure, cloud-based products. Our mission is to improve care delivery at the end of life. Vynca's technology suite enables best practices in advance care planning, helping to ensure that an individual's last wishes are honored. Vynca bridges the care continuum with a flexible integration strategy to electronic health records, including our flagship integration with Epic. Vynca has roots in the Stanford Program in Biodesign. For more information, please visit www.vynca.org.