In order to be most useful, patient-specific POLST information must be quickly and easily accessible by healthcare providers, particularly emergency response personnel. An electronic POLST registry can help ensure that information about patients’ treatment preferences is immediately available to health providers during a medical emergency, even when a paper copy is not accessible or can’t be located.

 

Authorized by California Senate Bill 19, and funded by the California Health Care Foundation, the California POLST eRegistry Pilot is underway in two California communities – Contra Costa County and San Diego. The project is a joint effort of the California Emergency Medical Services Authority (EMSA), the California Health Care Foundation, and the Coalition for Compassionate Care of California (CCCC).

The pilot project, which is scheduled to run through December 2018, is designed to test the feasibility, functionality, quality, and acceptability of an electronic POLST registry, with the goal of informing and supporting the development of statewide electronic access to POLST.

Pilot Communities

Following an intensive request-for-proposal process, Contra Costa County and San Diego were selected as pilot locations for the California POLST eRegistry pilot because the diversity of these settings offer unique opportunities for testing a POLST registry.

Contra Costa County

Contra Costa County in Northern California has a population of just over 1 million individuals who are served by 5 major health systems, 8 hospitals, approximately 63 skilled nursing facilities, 6 medical groups and 1 EMS provider. The medical community has strong local leadership provided by the Alameda-Contra Costa Medical Association, which is serving as the project manager for the Contra Costa County pilot location. The technology partner for the POLST eRegistry pilot in Contra Costa County is Vynca, Inc.

San Diego

San Diego, in Southern California, has a population of over 3 million individuals who are served by approximately 26 acute hospitals, 70 skilled nursing facilities, more than 100 health centers and independent physician practices, and 2 EMS providers. San Diego is also home to San Diego Health Connect (SDHC), a not-for-profit Health Information Exchange (HIE). SDHC will serve as the project manager for the San Diego pilot. The technology partner for the POLST eRegistry pilot in San Diego is Stella Technology.

 

Key Elements of the California POLST eRegistry Pilot
  • Physician Orders for Life Sustaining Treatment (POLST) is a standardized form that turns a patient’s treatment wishes into actionable medical orders. Printed on bright pink paper, and signed by the patient AND a physician, nurse practitioner or physician assistant, POLST helps give seriously-ill patients more control over their medical treatment.
  • Legislation: California’s initial POLST legislation, California Assembly Bill 3000 (Wolk) was implemented in 2009. The POLST eRegistry Pilot was supported 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 EMS Authority — as lead agency for the pilot.
  • No State Funding:  Per the requirements of SB 19, the California POLST eRegistry Pilot is privately funded. California Health Care Foundation will fund the initial implementation of the POLST eRegistry and pilot testing in two communities.
  • Voluntary for Consumers: Completion of a POLST is always voluntary for consumers. When a consumer who resides in one of the pilot communities voluntarily completes a POLST, a copy of their POLST should be scanned and uploaded by their provider into the POLST eRegistry unless the consumer requests otherwise.
  • Submitting POLST to eRegistry: Physicians, nurse practitioners or physician assistants who practice or operate in one of the two eRegistry pilot communities will submit a copy of a newly completed POLST to the eRegistry Pilot, unless the patient requests otherwise.
  • Accessing the eRegistry: Access to the POLST eRegistry will be limited to licensed health providers who practice or operate within one of the two eRegistry pilot locations. A 24-hour emergency call center will provide back-up access to the eRegistry for EMS providers if they are not able to access the eRegistry directly in the field.
  • Privacy and Security: The operation of the POLST eRegistry Pilot, for all users, will comply with state and federal privacy and security laws and regulations, including, but not limited to, compliance with the Confidentiality of Medical Information Act (Part 2.6 {commencing with Section 56} of Division 1 of the Civil Code) and the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) (Public Law 104-191), found at Parts 160 and 164 of Title 45 of the Code of Federal Regulations.
  • Sunset in 2020: The POLST eRegistry Pilot Program law (SB 19) remains in effect only until January 1, 2020, at which time it will be repealed unless the legislature passes a new statute to delete or extend that date. Key goals of the POLST eRegistry Pilot Project are to demonstrate the successful implementation and use of an electronic POLST eRegistry, and, if the pilot is successful, recommendations to lawmakers about how to create, finance, and sustain statewide electronic access to POLST beyond 2020.

 

Pilot Project Partners

California POLST eRegistry Pilot Project Partners

California Health Care Foundation (CHCF) is an independent philanthropy committed to advancing meaningful, measurable improvements in the way the health care delivery system provides care to the people of California, particularly those with low incomes and those whose needs are not well served by the status quo. CHCF has been a long-time financial supporter of the POLST program in California.

Coalition for Compassionate Care of California (CCCC) is an interdisciplinary collaborative of thought-leaders from healthcare systems and organizations, government agencies, consumer organizations, and the general public dedicated to promoting high-quality, compassionate care for everyone who is seriously ill or nearing the end of life. 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.

California Emergency Medical Services Authority (EMSA): EMSA is charged with providing leadership in developing and implementing EMS systems throughout California and setting standards for the training and scope of practice of various levels of EMS personnel. The POLST form is under the authority of the EMSA Commission. As identified by SB 19, EMSA will be responsible for guidelines development for the eRegistry, facilitating coordination of emergency medical services within pilot sites and serving as the liaison with the legislature and with the California Department of Health and Human Services.

The Contra Costa County pilot will be managed 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 partner in POLST adoption activities since 2008.

The San Diego pilot will be managed by San Diego Health Connect (SDHC). SDHC is a not-for-profit health information exchange organization, operating in San Diego since 2010. SDHC securely connects hospitals, health systems, patients, private health information exchanges (HIEs) and other healthcare stakeholders—so that they can share important health information.

Vynca, Inc. is the technology partner for the Contra Costa County pilot location, and will design and build the cloud-based web portal for electronic submission, storage and retrieval of POLST in Contra Costa County.  Vynca provides business and software solutions to payers and providers to design, build, and deliver comprehensive Advance Care Planning Programs. Vynca’s software solutions integrate into the clinical workflow and share health information across the continuum of care to ensure that providers are empowered with the appropriate tools and accurate information to ensure patients’ wishes are honored.

Stella Technology is the technology partner for the San Diego pilot location. Stella Technology is leading provider of integration and collaboration solutions for the next generation, “healthcare-connected” network.

The California Poison Control System will serve as the 24-hour POLST eRegistry Back-Up Call Center for emergency medical providers. The University of California San Francisco, School of Pharmacy – Department of Clinical Pharmacy provides administrative services for the California Poison Control System (CPCS). Trained health care professionals, who have many years of valuable experience handling poison cases, staff all answering sites.

Oregon Health & Science University (OHSU) and Public Health Institute will serve as the pilot project’s evaluation team.

 

About POLST

POLST was established in California in 2009 under Assembly Bill 3000, and updated in 2016 under Assembly Bill 637.

Key aspects of POLST include:

  • POLST is not a check-box form.  POLST should be completed in conjunction with a rich conversation between the patient and his/her healthcare provider regarding the patient’s current medical condition, treatment options, goals and values.
  • Licensed health care providers are required by law to honor a valid POLST, even if the ordering physician/NP/PA does not have admitting privileges at the facility.
  • POLST law protects healthcare providers who comply in good faith with POLST orders.
  • The POLST form is not considered valid until it is signed by both the patient (or his/her decisionmaker) AND a physician, nurse practitioner or physician assistant.
  • A patient can request different treatment or void the POLST form at any time.
  • POLST does NOT replace an advance directive. An advance directive is still the best way to appoint a legal healthcare decisionmaker, and is recommended for all adults, regardless of age or health status.

Currently, most California POLSTs are completed by hand using a standardized paper form. The original signed copy of the POLST belongs to the patient and must be presented when the patient enters the health system or transfers between care settings.  A copy may also be scanned into the patient’s medical chart or maintained by a decisionmaker.  Unfortunately, this system of storage and retrieval is inefficient and unreliable.  During a medical emergency, when POLST information is most needed, the POLST form may not be readily available, which can hinder care or result in medical treatment that is not aligned with the patient’s wishes.

Forty-seven states have adopted POLST, but only New York, Idaho, Oregon, Utah, and West Virginia have established electronic registries that store, manage, and provide electronic access to POLST information. 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.

Learn more about POLST and download the POLST form at caPOLST.org.

 

News & Information

California POLST eRegistry In the News

Reports & Analysis

Media Inquires
For media inquires, contact Kelley Queale at Coalition for Compassionate Care at 916.993.7741; kqueale@coalitionccc.org.

 

Related Legislation & Public Policy