Advance Care Planning

CRISP DC is excited to offer a cloud-based advance care planning (ACP) solution to all District providers at no cost. Leveraging the interoperability of the CRISP DC HIE and A|D Vault’s industry leading MyDirectives for Clinicians, advance care planning has never been this easy or effective.

The advance care planning initiative is a partnership between DC Health and the DC Department of Health Care Finance and made possible through the DC designated Health Information Exchange, CRISP DC, and ADVault, Inc.’s product, MyDirectives for Clinicians.

MyDirectives for Clinicians™ is a responsive web application integrated into the HIE to create and upload advance care plans and make them available for viewing within CRISP

  • User-friendly, intuitively designed forms allow clinicians to easily complete forms with patients at the point of care.
  • Document uploads
    • Scan pre-existing ACP documents and portable medical orders with device camera
    • Upload and categorize any digital advance care planning form
  • View and/or download the advance care planning documents in the CRISP DC HIE
  • Ensure other care teams, such as DC Fire and EMS responders and ambulatory providers, can use them to honor the patient’s care decisions

Available forms:

    • DC MOST
      • The MOST program provides a more comprehensive approach, empowering terminally-ill patients the right to make decisions on their end-of-life care options, in consultation with their DC-licensed authorized healthcare provider (Physician (MD/DO) or Advanced Practice Registered Nurse (APRN) only).
    • National POLST
      • POLST is for people who are seriously ill or have advanced frailty. If you are healthy, an advance directive is for you. POLST forms and advance directives are both advance care plans but they are not the same. POLST forms must be filled out and signed by health care provider.
    • Psychiatric Advance Directive
    • Universal Advance Digital Directive

In-Person using Digital Forms  ​

  • Digital forms available: Universal Advance Digital Directive (uADD), National POLST, DC MOST, DC Psychiatric Advance Directive  
  • Upcoming: Hand-off from Licensed Healthcare Provider to an Authorized Signatory (MD, DO, or APRN/NP) 

Telehealth via Remote Signature Request ​

  • Compatible Form: Universal Advance Digital Directive (uADD)
  • Upcoming: National POLST 

Upload Existing Form  ​

  • Supported File Types:  .pdf, .png, .jpg, .bmp, .gif, .tif 

Patient Referral to MyDirectives.com for Self-Service​

  • Patient Self-Service Options: 
    • Complete the Universal Advance Digital Directive (uADD)
    • Upload an existing form
  • Patient Workflow Resources:
    • Check-In One-pager 
    • Exam Room/Bulletin Board Flyer
    • Patient Email Blast
  • Sub-workflow: using the MyDirectives app, staff can send a direct invitation to the patient

Document Patient Decline​

  • For those leveraging the tracking and reporting functionality, you are able to record a patient decline.

Onboarding Steps

  • Identify the users in your organization that will engage in Advance Care Planning discussions
  • Email CRISP DC at dcoutreach@crisphealth.org with the names and email addresses of users at your organization
  • Users will receive a confirmation email to set up their MyDirectives for Clinicians profile
  • Schedule training and/or education sessions, if needed
    • Training and reference documents are available under the “Resources” section of this webpage

Resources

Frequently Asked Questions

Refer to the MyDirectives User Guide under ‘Resources’ or by clicking here.

We encourage all providers to leverage MyDirectives for Clinicians available at no cost within the HIE. If you choose to complete a form outside of the HIE, you are still able to gain access and upload their form.

For instructions on how to upload an existing document, please view the instructions in the user guide.

If you are not a CRISP participating provider, we would be happy to provide you access for you to use this tool as well as our full suite of solutions. Please reach out to us at dcoutreach@crispealth.org.

If you are not and do not want to become a CRISP participating provider, your patients are able to create a free account at MyDirectives.com (link to MyDirectives) to create and/or upload their advance care planning forms.

Once created in MyDirectives for Clinicians, providers can download a copy and upload it into their EMR/EHR. The documents are accessible via the CRISP DC HIE. From the Clinical Information tile navigate to Care Coordination and select the Advance Directives tab then select the Folder icon of the desired document.

ADVault has a Query and Retrieval API product for purchase. Please visit advaultinc.com for more information. If needed, CRISP DC can connect you to an ADVault representative.

Forms created in a provider’s EHR system would need to be exported or downloaded from the EHR and uploaded through the MyDirectives for Clinicians app in the CRISP DC HIE. See the upload instructions here.

Alternatively, ADVault offers a Query and Retrieval API to automate the process of retrieving documents from an EMR/EHR to be securely stored by ADVault and, therefore, viewable within the HIE. This is a separate product for purchase directly from ADVault. Please visit their site for more information: advaultinc.com. If interested, CRISP DC can connect you with an ADVault representative.

Please consult with your organization’s leadership team to determine who is considered a qualified health practitioner at your facility.

This form can be completed by the patient on MyDirectives.com or persons designated by an organization to perform advance care planning sessions. Please consult with your organization’s leadership team to determine who is qualified to create the form.

DC Medical Orders for Scope of Treatment (MOST) forms must be completed in consultation with their DC-licensed authorized healthcare provider (Physician (MD/DO) or Advanced Practice Registered Nurse (APRN) only).  Please consult with your organization’s leadership to determine if you are qualified.

The National Physician Orders for Life Sustaining Treatment (POLST) must be filled out and signed by a health care provider, according to the National POLST Office. Please consult with your organization’s leadership to determine if you are qualified.

All staff can create a patient profile in advance of an advance care planning discussion with a healthcare practitioner or to upload forms completed outside of MyDirectives for Clinicians.

PMOs require a physician to complete the form in its entirety. ADVault is working on the capability to allow an organization to designate staff to work through the form ahead of the appointment with the physician for them to discuss and sign off on. Use of this feature is up to the organization and their legal team’s approval. The feature is expected to be available by the end of 2022.

  • CRISP users from all affiliates: DC, MD, WV, CT, AK
  • DC Fire and EMS
  • All DC hospital systems

For the Universal Advance Digital Directive (uADD), there is a checkbox that can be used to note that a Facilitator has received verbal consent to execute the signing of the document.

For the DC MOST, National POLST, and Psychiatric Advance Directive, these currently require the patient to be present and sign using the provider’s device. ADVault is working on a “Remote Signature” feature that will allow document review and signature by parties that are not physically present. This feature is intended to be implemented by the end of 2022.

It is up to each outside jurisdiction to determine whether they will accept the DC MOST form as valid, depending on what their state, county, or local law provides.

ADVault reporting tools provide all the performance data you need to measure your ACP Program’s performance and effectiveness. MyDirectives for Clinicians also logs every ACP interaction automatically so that you can show regulators that you’re in compliance and provide backup for any billings. For more details on the reporting tools, please visit https://www.advaultinc.com/how-we-help/mydirectives-reports-and-analytics/.

Group and individual training and continued support are available from the following organizations:

  • CRISP DC
  • DC Primary Care Association
  • DC Hospital Association
  • Medical Society of DC

Please reach out to your contact at these organizations or the CRISP DC team at dcoutreach@crisphealth.org

As part of the Integrated Care DC program, Health Management Associates offers individual practice coaching to receive tailored, site-specific support to achieve goals to provide integrated care. Please visit the following site for additional information: https://www.integratedcaredc.com/.

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