Posted on: December 5, 2014
Written by: Coalition for Compassionate Care of California
In 2008, California passed a key bill in the state’s history on healthcare decisions and life-sustaining treatment. Assembly Bill 3000 established Physician Orders for Life Sustaining Treatment (POLST) into law and gave patients a voice in deciding whether or not they want life-sustaining treatments when they are seriously-ill or approaching the end of life.
Now, six years later, POLST is widely used across California’s continuum of care and is immediately recognized by Emergency Medical Services and other health providers throughout the state. But while POLST use is widespread, more can be done to increase its effectiveness and a registry is the logical next step.
Exploring a POLST registry
On December 3, 2014, the California HealthCare Foundation hosted a legislative briefing to explore the concept of a POLST registry in California. Along with myself, the briefing included a respected panel of POLST experts:
- Robert Moore, MD, MPH, chief medical director for Partnership Health Plan, a Medi-Cal managed care plan with 500,000 members in 14 Northern California counties
- Susan Tolle, MD, founding member of the Oregon POLST program, director of the Center for Ethics in Health Care at the Oregon Health & Science University, and a professor and practicing internist
- Neil Wenger, MD, MPH, director of the Health Ethics Center at UCLA, a professor in the school of medicine, and a practicing internist who focuses on patients with complex illnesses
Key points emerged during the briefing:
- As demonstrated by other healthcare registries (think: organ donor database or cancer registry), a POLST registry could include safeguards to ensure each form is completed correctly before being entered into the system, enhancing the quality and reliability of the information.
- A registry would make POLST forms more easily accessible during health emergencies. Emergency medical professionals could access the database 24-hours per day, reducing anxiety when a physical form can’t be found.
- POLST is particularly ripe for a registry because it is a standardized form designed for use in a split second, and targeted to a specific population (those likely to need medical intervention).
- A strong POLST community is a key component of registry success, and California has the necessary structure already in place under the umbrella of the Coalition of Compassionate Care of California, with 25 local POLST coalitions, a Physician Leadership Council, and a POLST Task Force which pulls together representatives of key stakeholders from across the continuum of care.
Initial research into a California POLST registry has been completed. The California HealthCare Foundation, which has been a key partner in the establishment of the POLST program in California since the beginning, has completed a feasibility study, with an issue brief and scoping effort on the horizon.
POLST can learn from other registries
In California there is an existing registry for advance healthcare directives with the Secretary of State’s Office, but it is not widely known and the information is only accessible during normal business hours. There are several proprietary registries, but they do not have widespread adoption. Several other states have advance directives registries, but they are not integrated into state health systems.
Oregon is the best example of a successful POLST registry. The Oregon POLST registry currently houses more than 200,000 POLST forms which are accessible by EMTs and other health professionals 24 hours per day. The Oregon registry just celebrated its 5th anniversary.
Wolk introduces SB 19, a POLST registry bill
On December 1, 2014—the first day of bill introduction for the 2015-2016 legislative session—California Senator Lois Wolk introduced POLST registry legislation through Senate Bill 19.
SB 19 intends to create a statewide POLST registry administered by the Health and Human Services Agency. Additional bills including provisions for a POLST registry may be introduced over the next few months.
On the horizon
Of course, challenges exist.
- Technology: We will need to figure the right technology that can accurately match patients with forms in the registry.
- Operations: California does not have a centralized EMS system. California’s multiple EMS providers answer to different protocols and have varying levels of technology capability. In contrast, Oregon has one EMS for the entire state.
- Sustainability: Where will the funding come from to establish and maintain a statewide POLST registry?
Thanks to the passage of AB 3000, it is mandatory for providers to honor POLST and take steps to ensure patients get the care they want—and avoid the care they don’t want. A POLST registry is the logical next step to help ensure these preferences can be easily accessed across all care settings.
Judy Thomas, JD, is executive director of the Coalition for Compassionate Care of California. Follow her on Twitter at @JudyThomasJD.