A Yet Unrealized Promise: Structured Advance Care Planning Elements in the Electronic Health Record
Joshua R. Lakin, Daniel A. Gundersen, Charlotta Lindvall, Michael K. Paasche‐Orlow, James A. Tulsky, Elise N. Brannen, Kathryn I. Pollak, Danielle Kennedy, Jody‐Ann McLeggon, Jeremiah Stout, Angelo E. Volandes, The ACP-PEACE Investigators, S. Yousuf Zafar, Maria Torroella Carney, Diana Martins-Welch, Camille Chan, Craig Devoe, Michael Qiu, Jon C. Tilburt, Charles L. Loprinzi, Parvez Rahman, Aretha Delight Davis, Areej El‐Jawahri
Abstract
Background: Electronic health records (EHRs) may help enable reliable, rapid data management for many uses, such as facilitating communication of advance care planning (ACP). However, issues with validity and accuracy of EHRs hinder the use of ACP information for practical applications. Design: We present a cross-sectional pilot study of 433 older adults with cancer from three large health care systems, participating in an ongoing multisite pragmatic trial (4UH3AG060626-02). We compared data extracted from dedicated structured EHR fields for ACP to a chart review of corresponding ACP documentation contained in the medical chart. Results: Structured ACP data existed for 43.2% of patients and varied by site (25.7% −48.9%). Of the identified structured ACP data elements, 59.2% of recorded elements were correct, 23.7% were incorrect, and 17.1% were duplicates with heterogeneity across sites. Conclusion: Structured ACP data in EHRs were frequently incorrect. This represents a problem for patients and their families, as well as quality improvement and research efforts. Clinical Trials Registration: NCT03609177.