A National Database on Advanced Directives? Great Idea.

An oldish post from the Healthcare Blog had me thinking about EMRs, advance directives and national patient IDs this week. John Maa, assistant professor of surgery at UCSF, writes about a case early in his career where:
– an 85 year old woman called 911, and was brought into the ER around noon with severe abdominal pain. She was delirious and could provide her medical history
– attempts to contact her family and friends were unsuccessful
– she had some serious problems that needed immediate attention, and two surgeons documented the need for her to be taken to the operating room for “life threatening emergency situation”. She underwent a six-hour surgery, was intubated, her kidneys were recovering.
– Her children arrived at about 10 pm, and asked for withdrawal of support. Amid all the back-and-forth, and threats of legal action etc, the hospital went with the family’s wishes and withdrew support. The woman died soon after.

For Maa, this was a formative experience of sorts, happening in his second month of internship. He says he still thinks about the case.

The ethics of the situation notwithstanding (and there’s more in Maa’s post that I’m not going into), from an EMR/EHR perspective – a unique patient ID that identifies each patient and an EMR that captured the woman’s advanced directive would have really helped. As commenter John Ballard states in the discussion following Maa’s post:

“One more illustration underscoring the importance of comprehensive advance directives, properly executed and easily accessible. Why such a document is not routinely a part of medical records is an ongoing mystery to me.

Advance directives — properly executed — should be required by all insurance plans as well as Medicare/Medicaid for beneficiaries. They should expire and be subject to renewal every five years to allow for changes in the person’s health, medical advances or discoveries and changes of opinion (not to mention the passing of designated agents)”

Another commenter says “What we need is a federal mandate for advance directives and a federally run advance directive database that can be accessed from any computer.” Indeed.

About the author


Priya Ramachandran

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

1 Comment

  • Some problems with this:

    1. The death panel crowd would have a field day. That’s not a reason to avoid doing this, but the effort would have to do a lot of educating about its purpose.

    2. Correctly identifying Jane Smith isn’t easy. You immediately get into the problem of a national identifier and why we don’t have one.

    3. Who is allowed access? Which family members, medical personnel, etc.

    4. How will the data be kept current?

    5. How will it deal with varying state laws?

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