The PACIO Advance Directive Interoperability (ADI) Connectathon track covers Portable Medical Orders (such as POLST) in preparation for an STU2 version of the standard.
Physician Authored Portable Medical Orders - Practitioner-created portable medical orders created with the patient and/or their advocate or proxy if they lack capacity. These are medical orders that contain concepts for the person's decisions to receive or not receive CPR, and the initial treatment orders related to life-sustaining treatment meant to restore, prolong, or sustain the life of the patient. These orders inform emergency responders and EMS staff and are commonly utilized in an emergency or during an urgent health crisis. These orders are communicated in the form of a document and typically contain information related to multiple medical intervention decisions.
Patient Generated Personal Advance Care Plan - Systems used to create and update patient-generated advance care plans through a patient-directed process need a way for individuals to communicate information about their advance medical care goals, preferences, and priorities. Individuals need a way to generate and update information related to their advance directives so that their current wishes can inform provider-generated care plans. Interoperable exchange of the advance directive documentation supports more effective sharing of this information across transitions of care and enables practitioners to create person-centered care plans that align with a patient’s values, goals of care, treatment preferences, and quality of life priorities when a patient can no longer communicate for themselves.
Advance directive interoperability is a complex area that involves many stakeholders. The HL7 sponsor for this IG is the Patient Empowerment work group. HL7 Co-sponsor workgroups include Patient Care, Community Based Care and Privacy, and Orders & Observations. In order to reach out to a broader community, the Post-Acute Care Interoperability (PACIO) Community has adopted the PACIO Advance Directives Interoperability IG as a project use case. The PACIO Community has a strong interest in the topic of advance directives and will support the community engagement and technical FHIR IG development needed for advance directives interoperability. PACIO is supported by MITRE, CMS, ONC and many other stakeholders (clinical, technical, and industry associations).
FHIR profiles are being developed for several existing FHIR resources to represent advance directive content such as: living will, durable medical power of attorney, personal health goals at end of life, care experience preferences, patient instructions (obligation, prohibitions, and consent), and portable medical orders for life sustaining treatments.
The current version of this FHIR IG covers the use of RESTful API interactions for creating, sharing, query/access, and verification of advance directive documentation between systems. It is intended to address advance directive interoperability needs where the author is the individual that is making medical intervention goals, preferences, priorities known in advance.
Future versions of the PACIO Advance Directives Interoperability IG will address encounter-centric patient instructions and portable medical orders for life-sustaining treatment.
Test an Implementation Guide
Track Lead Email(s)
PACIO Advance Directive Interoperability w/FHIR IG: https://build.fhir.org/ig/HL7/fhir-pacio-adi/branches/STU2_draft/
Call for participants
EHRs, EMRs and Electronic Clinical Record Systems
Portable Medical Order Registries & Repositories
Consumer focus applications (e.g. PHRs)
|Track Kick off Call|
Wednesday 21, 2022 2:00pm - 3:00pm ET
Join ZoomGov Meeting
Kick off recording: 2022-12-21-PACIO-ADI-Track-Kickoff-video1025774132.mp4
|Clinical Input Required?||N/A|
|Related Tracks?||None yet identified|
The ADI Track will test the exchange of patient authored advanced directive information and build upon the prior testing done in the January 2021 and May 2021 Connectathons. The additional focus will be on the use cases of updating content  and verifying the current version of advanced directive content .
Focus areas include:
ADI Document Types
Complete Patient Story
Scene 0: Background
Scene 1: Create Portable Medical Order (PMO)
Scene 2: Share a Portable Medical Order
Scene 3: Query and access of the Portable Medical Order
Scene 4: Updating the Portable Medical Order
Scene 5: Sharing the updated Portable Medical Order
Scene 6: Query and access of the updated PMO
Bonus Scenes (Separate Patient)
Bonus Scene 1: Revoke Portable Medical Order
Bonus Scene 2: Query and access of the Portable Medical Order
AD Information Creator (Client)
AD Information Receiver (Server)
AD Information Repository (Server)
AD Information Requester