Objectives ✓ Review paper-based data system challenges for patients and health care professionals ✓ Provide overview of the LaPOST Registry: ✓ Technology ✓ Key Benefits ✓ Features ✓ Review LaPOST registry user roles and capabilities ✓ Resources for implementation of LaPOST Registry ✓ Demonstrate registry
LaPOST and ACP Documents • Currently exist as paper forms • Must be readily and reliably available to health care professionals whenever and wherever they are needed to ensure continuity of care as patients: – Transition between health settings – Experience a change in their health condition – Change their treatment preferences
Paper-Based Data System Challenges for Patients and Health Care Professionals Accessibility Delays may result in unwanted/ineffective treatment • Misplaced, misfiled, difficult to locate • Especially important in emergency medical situations Incomplete, inconsistent information May result in contradictory care Version Control Duplication
LaPOST Registry The LaPOST Registry is a secure, statewide electronic registry that provides a single source of LaPOST and advance care planning documentation instantly accessible online to authorized health care professionals in any care setting.
LaPOST Registry • Powered by Vynca • Enables LaPOST forms to be accessible by other registered health care professionals/organizations • Allows providers with a valid Louisiana medical license to register for an account to complete and submit LaPOST forms to a centrally accessible database
LaPOST Registry Solution Statewide Electronic End-of-Life Medical Orders Registry ACO Family Hospital State Physician Registry Practice LaPOST Registry Emergency Home Medical Health Services Skilled Nursing Hospice Facility Payers
Components of Advance Care Planning Technology CAPTURE ACCESS STORE Web & Mobile Individual Provider • View • Void • Download • Print EHR Integration EHR Integration Machine Learning Patient Matching Analytics & Storage HIE Integration Data Verification & Error Checking Registry Functionality
LaPOST Registry – Key Benefits • Offers a web-based means for health care providers to electronically complete and submit a legally valid LaPOST form and other ACP documents using a simple, intuitive user interface to a centralized registry • Creates a sustainable, statewide LaPOST registry network • Increases accessibility to LaPOST and ACP documents • Enables accurate LaPOST completion • Renders an electronic, printable PDF of the LaPOST form
LaPOST Registry Features Create Retrieve Electronic Patient & Review Role-Based LaPOST Access LaPOST Security Forms Forms
LaPOST Registry Features Create Retrieve Electronic Patient & Review Role-Based LaPOST Access LaPOST Security Forms Forms • Uploader • Preparer • Signer • Patient • Viewer
LaPOST Registry User Roles Signer Viewer Preparer Uploader • Physicians only • Physicians • Clerical Staff and • Clerical, Administrative Clinical Providers and Clinical Staff who • Advanced Practice without credentials to handle and maintain Professionals prepare/sign LaPOST patient medical records • Social Workers document but have job • Nurses requirement to view patient records
LaPOST Registry Features Create Retrieve Electronic Patient & Review Role-Based LaPOST Access LaPOST Security Forms Forms • • Uploader Patient search • Preparer • Dashboard • displaying content Signer of most recent form • Patient • • Color-coded format Viewer for sections A, B & C
LaPOST Registry – Patient Search Search for a patient and access their Advance Care Planning Dashboard
LaPOST Registry Features Create Retrieve Electronic Patient & Review Role-Based LaPOST Access LaPOST Security Forms Forms • • • Uploader Patient search Simple, intuitive user interface • Preparer • Dashboard • Legally valid • displaying content Signer of most recent form • Embedded logic • Patient • • Multi-language • Color-coded format Viewer for sections A, B & C • Embedded support regarding LaPOST questions ( “?” & media) • Proprietary smartphone eSignature • For preparers & signers
Electronic Health Record (EHR) Integration LaPOST: YES Adv Dir: NONE
Health Information Exchange (HIE) Integration LaPOST
Advance Care Planning Dashboard Single Source of Truth for LaPOST documents
Sample LaPOST with Void Status
LaPOST Registry – Multi-Language Feature
LaPOST Registry – Vietnamese
LaPOST Registry Features – Pop-up Reminders
LaPOST Registry Features – Media Support
LaPOST Registry Features – eSignature Enables electronic signature of LaPOST by physicians, patients and/or PHCRs via computer or smartphone
Smartphone eSignature Steps 1 2 Enter your phone Check your number or e-mail smartphone for a to link to your confirmation code smartphone 3 4 Enter the The registry will confirmation code confirm that your on your desktop smartphone is computer connected
Smartphone eSignature Steps 5 Your signature Use your finger or a will automatically stylus on your show up in the smartphone to sign registry on the the document desktop
LaPOST Registry Features – Signature Check
LaPOST Registry Features Create Retrieve Electronic Patient & Review Role-Based LaPOST Access LaPOST Security Forms Forms • • • Patient portal to • Uploader Patient search Simple, intuitive view, print & user interface • Preparer • Dashboard request to void • Legally valid • displaying content Signer form of most recent form • Embedded logic • Patient • Optional – share • • Multi-language • Color-coded format Viewer forms with family for sections A, B & C • Embedded support & providers regarding LaPOST questions ( “?” & media) • Proprietary smartphone eSignature • For preparers & signers
Using the LaPOST Registry to Improve Care LaPOST Complete Conversation form reviewed/ LaPOST form Patient with Ability revised/voided via registry receives provider to review as needed desired advance treatment directive Patient with life-limiting & irreversible condition Ability to EMS/Hospital review/void access registry Develop & provide previous Review appropriate care plan LaPOST Medical interventions ACP docs in reflecting forms issue registry LaPOST orders
Case Study: Vynca Impact Across Multiple Health Systems BACKGROUND: IMPACT (April 2015 - July 2017) • Review of all health systems using Vynca • 5,711 ED visits analyzed from April 2015 - July 2017 37 % ADMISSIONS: 5,711 • Hospital admission rate reduction in hospital admissions – 40% when Vynca was not accessed when Vynca was – 25% when Vynca was accessed ED visits in accessed patients who had • ICU admission rate 59 % POLST forms in – 9% when Vynca was not accessed Vynca – 3.7% when Vynca was accessed reduction in ICU admissions when Vynca was accessed [1] http://www.ohsu.edu/xd/about/news_events/upload/OHSU-At-A-Glance-web-format-15-2.pdf
LaPOST Registry Training Tools • MP4 Videos • Preparer • Physician Signer • Viewer • Uploader • Connect-to-Mobile • Organization Registry Administrator
LaPOST Registry Training Tools • Tipsheets • Preparer • Physician Signer • Viewer • Uploader • Connect-to-Mobile • Organization Registry Administrator
LaPOST Registry Training Tools • MP4 Video PowerPoint Slides with Notes • Preparer • Physician Signer • Viewer • Uploader • Connect-to-Mobile • Organization Registry Administrator
What’s Needed to Gain What’s the cost to the Access to the Registry? organization? • Organization must execute • No cost for web-based access • Participation Agreement • Annual cost for EHR or HIE integration • Business Associate Agreement • One-time cost for Vynca to bulk load • Complete LaPOST Registry Organization paper LaPOST documents Form • No cost if facility uploads their paper documents or visit la-post.org for more information
Visit la-post.org for more information.
Questions? Monique Tyler Please direct questions to: LaPOST Project Coordinator mtyler@lhcqf.org or visit la-post.org for more information
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