Advance care planning documents and the My Health Record system
What is being implemented in April 2016?
Greater use of advance care planning processes and access to advance care planning documents will assist people to have their preferences known and acted upon at the time when crucial decisions need to be made about their health care.
From April 2016, the My Health Record system will provide individuals with the ability to upload a scanned version of an advance care planning document prepared by the individual or their representative. The scanned copy of their document needs to be saved in a Portable Document Format (PDF) file. The purpose of this enhancement is to provide an additional mechanism for individuals to make existing advance care planning documents available to their healthcare providers. It is expected that existing processes for developing and sharing advance care planning documents will also continue. It is not a facility to upload advance care plans prepared by healthcare providers.
There are a range of advance care planning documents that can be developed by individuals in Australia (such as an Advance Care Directive, Substitute Decision Maker document, a document with the characteristics of both, or other types of documents developed by individuals about their future care). Documents may be prescribed in legislation or operate under common law. Individuals may develop their advance care planning documents with assistance from family members, lawyers, healthcare providers or aged care facilities.
Individuals and their representatives will be able to upload these documents via the My Health Record. Documents may also be removed by the individual or their authorised representative if needed. The system will only enable removal of an advance care planning document by the individual or by an authorised representative if they uploaded the document originally.
There are two steps for individuals to upload an advance care planning document:
In Step 1 individuals will be asked to select from their computer the PDF file to upload to their My Health Record and to provide some details about the document:
- The date the original (paper) advance care planning document was written/completed;
- The author of the (paper) document; and
- Contact details for the author of the (paper) document.
In Step 2 individuals will be presented with the PDF to be uploaded to their My Health Record and will need to confirm that this is the correct document before the document is stored in their My Health Record. Individuals will also be encouraged to add details of any person who has a paper copy of their wishes (known as an advance care document custodian).
Advance care planning documents will not be able to be changed once uploaded. To update or change an advance care planning document, the existing document should be removed and a new Advance Care Planning document uploaded.
What information will be available to healthcare providers?
The following information will be available to both individuals and healthcare providers:
- The date that the original advance care planning document was written/completed;
- The author of the advance care planning document;
- The person who uploaded the document to the record;
- The date that the document was uploaded to the record;
- A PDF copy of the advance care planning document; and
- The advance care document custodian details (if available).
Design work is also underway to ensure that healthcare providers have clear information that a record contains advance care planning information whether they are using their local clinical information system or the national provider portal.
How will this affect me as a healthcare provider?
The key purpose of enabling individuals to add their advance care planning documents to their My Health Record is to increase the availability of this critical information at the point of care when it is needed in circumstances where the individual cannot otherwise communicate. The My Health Record system will be a resource for healthcare providers to find out about, and access, advance care planning documents or contact details about who may hold paper copies. Healthcare providers who do not have access to the My Health Record system will need to rely on existing processes for accessing advance care planning documents. Guidance has been developed for individuals to let them know that not all their healthcare providers will have access to the My Health Record system so they should still make their wishes known to key contacts such as next of kin who may be involved in healthcare decision making on their behalf.
Healthcare providers should continue to apply and act according to the laws and policies in place in their jurisdiction regarding advance care planning documents.
Healthcare organisations should have clear policies and procedures in place for documenting when Advance Care Directives, clinical care plans and resuscitation plans are in place, for ensuring they are readily accessible and how they should be stored. For example, a copy of an individual’s advance care planning document sourced from their My Health Record should only be added to the local medical record if it has been validated and relied upon as part of clinical care to minimise the risk of relying on out of date or invalid wishes. Existing policies and procedures may need to be updated to consider how to encourage access to advance care planning documents through a patient’s My Health Record where an individual has one.
In addition, the National Framework for Advance Care Directives (AHMAC 2011) provides detailed guidance including:
- A Code for Ethical Practice for Advance Care Directives (section 4); and
- Best Practice Standards for Advance Care Directives (Best Practice Standards) (section 5).
Where can I refer my patient for more information about how to prepare and upload an advance care planning document to their My Health Record?
You can refer them to the My Wishes, My Plan Advance Care Planning factsheet.