The Coalition for Compassionate Care of California (CCCC) recently achieved a long-held goal to secure funding in the state budget to support a statewide POLST Registry and enhance the POLST ecosystem, but there is still a tremendous amount of work to be done before the Registry is fully operational and healthcare providers will be able to access a patient’s most current POLST from anywhere in California. 

 

CCCC is working closely with the California Emergency Management Systems Agency (EMSA), the state agency responsible for the POLST Registry, to ensure the Registry's success. CCCC will keep our members and stakeholders apprised of progress, as well as opportunities to be engaged in the process.

 

The State of California has a specific and structured process that large information technology (IT) projects go through called the Project Approved Lifecycle (PAL). The purpose of PAL is to improve the quality, value, and likelihood of success for IT projects undertaken by the State of California.

 

PAL ensures that IT projects are undertaken with clear business objectives, accurate costs, and realistic schedules. PAL has four stages: Business Analysis (Stage 1), Alternatives Analysis (Stage 2), Solution Development (Stage 3), and Project Readiness and Approval (Stage 4). Each stage requires approval to pass to the next stage.

 

The POLST Registry will need to successfully pass through the PAL process for implementation. Last week, the Registry successfully passed through Stage 1 of the PAL process, Business Analysis.

A helpful step in the POLST Registry creation process is the development and adoption of a national standard for representing POLST information electronically. The leading body for development of health IT standards is HL7, which is currently in the process of developing a Clinical Document Architecture (CDA) standard for POLST.

 

CDA standards have been widely adopted for conveying other health information, including health summaries, encounter notes, discharge summaries, referral notes, and other transitions of care in the clinical setting. CDAs are supported by most electronic health records, and are the staple of most health information exchange among providers. A CDA template for POLST information benefits from this widespread adoption and some of the key attributes of the CDA: that it is signed, managed, persisted, and internally consistent and complete.

HL7 has been working on a specification for a template for using the CDA for POLST information since July of 2021. HL7 standards are adopted by consensus. In December and January, the POLST specification completed the HL7 ballot process, which is the first step in becoming a national published standard. 

 

We anticipate the standard for POLST being available for adoption in June. Beginning in February, CCCC will be working with stakeholders on how the proposed national standard can be adapted to carry all of the information in the California POLST form as a potential standard for electronic exchange of POLST information in California. If you are interested in participating in a workgroup to discuss the CDA and California POLST, please email us at [email protected].

 

For more information about the interoperability of POLST information, please view the free recorded webinar hosted by National POLST entitled "Interoperability: Sharing POLST across systems" featuring Robert "Rim" Cothren, PhD, CCCC's IT consultant, by clicking here.

 

A key part of making it easy to submit documents to a registry is providing the ability to complete forms electronically. That applies to all parts of the form, including signatures. Current California law, however, imposes burdensome requirements whenever completing an advance directive by any means other than a pen.

 

CCCC is committed to bringing advance care planning into the electronic age. That includes not only the ability to upload and store documents in a registry, but also the ability to complete POLST and advance directives electronically and with electronic signatures. Obtaining this change in California law is a priority for CCCC in 2022.

 

Also last week, EMSA released a letter encouraging all parties who are interested in receiving updates on the POLST Registry to send an email to [email protected] and include the following information:

The CCCC newsletter is also an important and valuable way to stay up to date on what is happening with the POLST Registry. If you received this email directly from CCCC, then you're already signed up. If not, you can sign up for the CCCC newsletter by sending your name and email address to [email protected].

 

CCCC would like to acknowledge and and thank the following organizations for their generous support of CCCC's POLST Registry work:

 The COVID-19 pandemic left its mark on California’s 2021 legislative session, with committee hearings held virtually to reduce exposure to the virus, and the introduction of a large number of health and pandemic-related bills. Despite the many challenges, some exciting public policy advancements related to POLST and palliative care were achieved... Click here to read the full blog.

 

A year ago, California released its Master Plan for Aging (MPA). Part of the MPA framework is accountability. So last week, the Governor released the first annual report on the status of implementation of the MPA.

 

MPA is structured according to Five Bold Goals, 23 strategies, and more than 100 initiatives. Goal Two is Health Reimagined and includes Initiatives 49 and 50 that related to palliative care and advance care planning respectively. The MPA annual report can be viewed here.

 

MPA calls on all of California's communities to build a California for All Ages: for older Californians currently living through the many different stages of the second half of life; for younger generations who can expect to live longer lives than their elders; and for family, friends, neighbors, coworkers, and caregivers supporting older adults and people with disabilities.