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Section 1a: Clinical Document Architecture (CDA®)
Section 3: Implementation Guides

HL7 CDA® R2 Implementation Guide: C-CDA R2.1; Advance Directives Templates, Release 1 - US Realm

DESCRIPTION

Advance Directive Templates are important components of the C-CDA standard, yet to date, use of these templates in data exchange, sharing and retrieval of patient’s clinical and care planning information has been optional. Optional requirements often are ignored by implementers and create a barrier to adoption.This implementation guide updates the design of the Advance Directives templates to align with clarifying work being conducted collaboratively with the FHIR community and to strengthen the recommendations for inclusion of Advance Directive information in C-CDA clinical and care planning documents used to coordinate care.

New focus within healthcare on patient-centered care plans, and a steady march to value-based care has raised implementer interest in care planning that incorporates advance care planning. As implementers started to include advance directive information, it became clear that additional guidance was needed and that the template designs required refinement. Also, new standards developed to represent personal advance care planning information have been developed to communicate health goals and treatment preferences expressed by the patient. The older Advance Directive templates needed revisions to take this newer work into consideration as well.

As advance care planning information began to be shared, concern increased about the possibility that clinicians might misinterpret patient wishes in a way that would result in errors that risk patient safety or that violate patient intent. Information context is crucial when it comes to interpreting advance directives. Directives should always be maintained in their original form - not chopped up and stored as structured data. There is a very high risk that the conversion from text to structure will lose critical information. Changes were needed to the templates to clarify that these observations DO NOT convert patient wishes into structured data that acts as a decision or an order. The structured data is used to document WHAT TYPE of CONTENT is present in the source document that describes the patient's wishes, health goals, and treatment preferences. Fixing this issue was a critical need. For these reasons, the earlier versions of the Consolidated CDA Advance Directive Templates needed to be clarified and revised, and some additional templates needed to be added.

ALTERNATIVE NAMES

HL7 CDA® R2 Implementation Guide: C-CDA R2.1; Advance Directives Templates, Release 1 - US Realm may also go by the following names or acronyms:

HL7 CDA® R2 IG: C-CDA R2.1 Additional Templates (Volume 3) - for Advance Directives Templates, C-CDA Advance Directives Templates, C-CDA Vol3, Advance Directives Templates

TARGETS

  • Patients
  • EHR, PHR Vendors
  • Emergency Services Providers
  • Healthcare Institutions (hospitals, long term care, home care, mental health)
  • Health Information Management Professionals

BENEFITS

  • Improves the guidance available on how to include advance care plan and advance care planning information in a C-CDA document
  • Creates additional supplemental templates for representing decisions made by the patient or the patient’s healthcare agent at the time of service (obligation instructions or prohibition instructions)
  • Creates a supplemental template for representing advance care planning services delivered to provide advance care planning education and assistance, and to review advance care plans with the patient.

 

IMPLEMENTATIONS/CASE STUDIES

  • Development sponsored by ADVault, Inc. (MyDirectives.com)

 

DEVELOPMENT BACKGROUND

Advance directive documents are documents that people have traditionally used to express their medical treatment wishes. Advance directives typically consist of two documents – the “living will,” and the “durable medical power of attorney.”  A Living Will documents if a person wants “life-sustaining treatments” or not, (e.g., artificial nutrition or hydration, dialysis or the use of a ventilator to help with breathing) should that person suffer a medical emergency and be unable to communicate with the care team.  A person uses a medical power of attorney to appoint one or more people to serve as advocates or “healthcare agents” empowered to make medical treatment decisions on behalf of the person if he or she is incapacitated and cannot communicate with medical providers. The Living Will provides information that helps the healthcare agent make treatment decisions on the person’s behalf.

 

RELATED DOCUMENTS

HL7 CDA® R2 Implementation Guide: C-CDA R2.1; Advance Directives Templates, Release 1 - US Realm

STU DOCUMENTS

HL7 CDA® R2 Implementation Guide: C-CDA R2.1; Advance Directives Templates, Release 1 STU 2 - US Realm (Submit Feedback on STU)

(Download) (930 KB)

HL7 CDA® R2 Implementation Guide: C-CDA R2.1; Advance Directives Templates, Release 1 - US Realm Expiration Jun 2022

(Download) (3.39 MB)

TOPICS

  • Medical Records
  • Patient Care

BALLOT TYPE

  • STU

STATUS DATE

2018-03-27

RESPONSIBLE WORK GROUP

Structured Documents

PRODUCT TYPE

  • Implementation Guide

STAKEHOLDERS

  • EHR, PHR Vendors
  • Emergency Services Providers
  • Healthcare Institutions

FAMILY

  • CDA

CURRENT STATE

  • Active

REALM

  • US Realm