We envision a future in which all Californians with advanced serious illness or frailty have their wishes for medical treatment at the end of life elicited and honored and where ensuring person-centered care and honoring patient wishes is always of highest priority within health care.
When a POLST form is completed based on a quality conversation between a patient and provider about the patient’s medical condition, treatment options, and goals of care, it becomes a valuable tool for person-centered care. In order to be effective in guiding person-centered care, POLST information must be quickly and easily accessible by healthcare providers, particularly emergency medical services providers. 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.
With funding and support from the California Health Care Foundation (CHCF), the Coalition for Compassionate Care of California (CCCC) began this work in 2015 with stakeholder groups to explore opportunities and address the challenges related to statewide access to POLST information (see below for additional information on the pilot project).
On July 12, 2021, CCCC achieved a long-held goal to secure funding in the state budget to support a statewide POLST registry and enhance the POLST ecosystem. The 2021-2022 state budget contains a one-time allocation of $10 million to establish a statewide POLST registry and an annual appropriation of $750,000 to prepare POLST providers and consumers for the registry. The Emergency Medical Services Authority (EMSA) has been named the state agency in charge of the funding and project.
In late July, shortly after Governor Newsom signed the budget trailer bill (AB 133), EMSA was already reaching out to CCCC for background information and statistics regarding the California POLST program. During this initial phase of work, EMSA will be determining project staffing, fleshing out the budget, developing work plans, and determining how the registry project fits within the framework of other EMSA projects and responsibilities. The budget allocation does not specify a registry vendor or even a proposed structure – those aspects will be determined at a later date by EMSA in consultation with stakeholders like CCCC.
Preparing the POLST Eco-System
The POLST registry pilot program taught us that a registry is not just a technology solution. POLST quality must also be addressed before and after a registry is created to ensure that the information entered into the registry is current, actionable, and accurately reflects the wishes of the patient.
POLST is designed to travel across different care settings – home, assisted living, nursing home, clinic, physician’s office, the ER, hospital and hospice. Along the various points of contact, there are numerous opportunities to demonstrate and impact quality, including conversations around serious illness and POLST, electronic POLST form standards, provider training curriculum, community outreach and engagement, reimbursement, and regulatory guidelines. CCCC is the only entity that intersects with all aspects of the POLST eco-system, and we anticipate working closely with EMSA to prepare the POLST eco-system for the registry. There will also be many opportunities for providers to play an active role in strengthening POLST in California, and CCCC will look to serve as a conduit for that work.
Stay tuned! CCCC will provide updates and information on this project as they become available.
Electronic registries for the exchange of POLST information are currently operational in four California communities, including Contra Costa, Inland Empire, Ventura, and San Diego. Each registry operates independently. Other California communities stand at the threshold of developing their own POLST eRegistries, and a variety of related information-sharing technologies and services are being developed in this rapidly evolving market.
To lay a foundation for future statewide exchange of POLST information, CCCC recently worked with stakeholders to:
- Create and communicate a shared vision for POLST eRegistry in California.
- Explore opportunities and challenges related to POLST eRegistry expansion in California.
- Create a set of Recommended Practices to guide key areas of POLST Registry development, including electronic registries, interoperability, and electronic health records.
With funding from the California Health Care Foundation and authorization from California Senate Bill 19, the Coalition for Compassionate Care of California (CCCC) and California Emergency Medical Services Authority (EMSA) pilot-tested POLST registries in Contra Costa County and San Diego.
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. SB 19 sunset on January 1, 2020.
The feasibility, functionality, quality, and acceptability of an electronic POLST registry was tested with the goal of informing and supporting the future development of statewide electronic access to POLST. The project yielded valuable information and lessons learned which will be used to guide future efforts.
At the conclusion of the project, CHCF published a report, California’s POLST Electronic Registry Pilot: Lessons for All States, including insights and considerations for entities interested in pursuing POLST registries.
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.
While the work specific to the POLST eRegistry Pilot Project has concluded, the Contra Costa and San Diego registries continue to operate independently. The Contra Costa POLST registry is operated by Vynca, and the San Diego POLST registry is operated by San Diego Health Connect.