Carl Bergman, writing in the EMR & EHR web formum, made a very important point in terms of the accessibility of advance medical directives in EHRs (see: Medical Directives and EHRs),. Here's an excerpt form his note:
If the EHR treats a [medical] directive as a miscellaneous document, odds are it won’t be known, let alone followed when needed. To be used effectively, an EHR needs a specific place for directives and they should be readily available. For example, PracticeFusion recently added an advance directives function. That’s not always the case. To see how about twenty popular EHRs treat directives, I did a Google site search, on the term directive. I got hits for a directives function only from four EHRs: Athenahealthcare, Cerner, Meditech, PracticeFusion. All the others, Allscripts, Amazing Charts, eClinicalWorks, eMDs, McKesson, etc., were no shows. Some listed the MU1 requirement, but didn’t show any particular implementation. This quick Google search shows that the EHR industry, with a few exceptions, doesn’t treat directives with the care they deserve. It should also serve as a personal warning. If you already have directives or do have that talk with your family, you’ll need to give the directives to your PCP. However, you should also give your family copies and ask them to go over them with your caregivers. Some day, EHRs may handle medical directives with care, but that day is still far off. Until then, a bit of old school is advisable.
Here's a useful explanation of advance directives (see: Advance Directives):
What kind of medical care would you want if you were too ill or hurt to express your wishes? Advance directives are legal documents that allow you to spell out your decisions about end-of-life care ahead of time. They give you a way to tell your wishes to family, friends, and health care professionals and to avoid confusion later on.
A living will tells which treatments you want if you are dying or permanently unconscious. You can accept or refuse medical care. You might want to include instructions on:
- The use of dialysis and breathing machines
- If you want to be resuscitated if your breathing or heartbeat stops
- Tube feeding
- Organ or tissue donation
A durable power of attorney for health care is a document that names your health care proxy. Your proxy is someone you trust to make health decisions for you if you are unable to do so.
All of these insructions obviously need to be readily accessible in an EHR because there is a high likelihood that you may be in a hospital when your living will instructions need to be carried out.