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April 16 is National Healthcare Decisions Day (NHDD), which began in 2007 as a day to educate the public and healthcare providers about the importance of Advance Care Planning (ACP) and inspire and empower action.

This year, we’re celebrating NHDD by highlighting recent and important Epic ACP documentation enhancements. 

What is Advance Care Planning? 

ACP is a critical process that helps adults of any age or health status understand and prepare for medical decisions they may face in the future. This involves reflecting on personal experiences, values, goals, and care preferences, and discussing them with loved ones and healthcare professionals. ACP documents serve as legal expressions of these choices and preferences.  

The ACP process should start well before a health crisis occurs and be revisited throughout a patient’s lifetime. The place to begin ACP is with a conversation about surrogate decision making and helping patients identify and appoint an effective health care decision maker. To learn more, visit Overview and considerations when first thinking about making an Advance Care Plan (Advance Directive).

ACP Information in Epic Storyboard 

Effective mid-March, UVA Health implemented multiple Epic enhancements to ensure that ACP documentation is reliable, visible, and accessible in the medical record. Hovering over the ACP line in the patient Storyboard displays and links to information about a patient’s legally authorized healthcare decision maker and any ACP notes and ACP documents.  

The hover report also links to reference documents, “ACP Document Types,” “Virginia Decision Making Hierarchy,” and guide to “Adult Patients’ Supporting Roles.” The information in the hover report is pulled from the ACP Navigator. The ACP Navigator consolidates the documentation needed to help ensure the care we provide patients is in alignment with their known and documented care preferences.  When in a patient encounter, clicking on “ACP: Click to Review” will take a user to the ACP Navigator. 

What’s Next? Reliable ACP Documents

As early as the end of April, we will implement new, specific ACP document types instead of lumping all ACP documents together as “Advance Directives and Living Will” and displaying multiple versions of the same document type.  At the same time, a specially-trained HIM ACP team will begin reviewing all incoming ACP documents as well as the ACP documents in existing patient records.  

The result will be that only the current, valid ACP document per document type will display in the ACP Documents section.  This means that the health care team will no longer need to locate and review all the ACP documents in media to determine which document to rely.  

In addition, we will begin to scan Durable DNR and POLST orders to the medical record.  These will display and be linked in the ACP Documents section. The new ACP document types with descriptions can be found by clicking on the ACP Document Types reference document linked in the ACP hover report.   

To learn more, visit: ACP Tipsheet: Advance Care Planning (ACP) Documentation. 

ACP and UVA Health Patients

These ACP documentation enhancements create a solid foundation to build ACP structures and processes. In addition to ACP documentation improvements, we are also developing and piloting ACP workflows and referral pathways in inpatient, ambulatory, and procedural settings. 

These workflows will allow us to engage patients in consistent, high-quality ACP conversations that promote patient autonomy, and facilitate better communication and decision-making among everyone involved in patient care. ACP helps ensure that medical care aligns with known and documented values and preferences, and aligns with our priorities related to patient progression, readmissions, and patient and clinician satisfaction.