I am sort of ashamed to admit it, but I’m the sort of person who recently pointed my husband to this New York Times story and this Daily Mail (UK) story, and told him that if I should ever be comatose, he should not jump with glee and pull the plug, but instead try giving me Ambien.
Jokes aside, advance directives are things I think about fairly frequently, and yet… I’ve done squat about it. Like many of us – relatively young and relatively healthy people – I assume that I have a reasonable amount of time before such things become absolutely necessary. Which is why it so reassuring to read this AMED News story about some states giving physicians’ online access to an Advance Directives directory. According to the story, Virginia will now allow physicians to access advanced directives of patients online, without having to request the patients’ families or care providers.
I dug up Virginia’s advanced directives website. Turns out you have to fill out an online form where you specify who acts as your primary agent and is authorized to take decisions on your behalf. You can also specify if and how long you want treatments of any sort to continue if anything untoward should happen.
I’m trying to think of how physician access to advance directives can be a bad thing, but I can’t see doctors willfully misusing this info. Maybe I’ve just been blessed to have been taken care of by some really decent doctors on the rare occasions that I’ve been sick. Maybe I don’t know enough rogue doctors.
But the one deterrent I see here with Virginia’s current implementation is that the patient identification is based on parameters such as name, phone number and address. I’m not saying it will happen, but I can totally imagine a situation where a wrong John Smith’s directives are accessed and followed, to the detriment of the actual John Smith. No, it’s not a stretch. If John Smith and his son, John Smith Jr. share the same physical address and phone number (think landline), you can easily visualize the sorts of problems that are just one medical misstep away from happening.
I guess what I’m saying is that I don’t expect doctors to willfully misuse the information, but I do believe that accidental mistakes can happen. For this reason, I believe we have to start thinking in terms of a Patient ID, which will not only be useful for things like advanced directives, but also for ease of identification and data portability. It makes sense why John wants a True Patient Identifier.
All that said, if you’re a lucky resident of Virginia, Idaho, Montana or West Virginia, please go fill out your state’s advanced directive form. From what I’m seeing of Virginia’s forms, it’s relatively straightforward.
I wonder if EHR vendors with presences in these states will start pulling in advanced directive information into their EHR software for easy access by physicians. If it’s not automatically pulled in for the doctor, it is likely that some advanced directives will be missed. I wonder what other outside services could be pulled into the EHR automatically in the future as well.
