Short Description

The PACIO Advance Directive Interoperability (ADI) Connectathon track covers a new IG that provides a standard way to enable the ability to create and share Advance Directive Information to be used for care planning and delivery.

Long Description


  • Testing Ballot changes to STU1 and additions for POLST for STU2 development
  • Test and gather feedback on the design and implementation feasibility of the PACIO Advance Directive Interoperability Implementation Guide and its feasibility and applicability for real world use.
  • Identify areas of improvement and expansion of the current use cases and advance directive content type of person authored advance directive information.
  • Facilitate discussion around planned content types including encounter specific patient instructions and portable medical orders for life-sustaining treatments.
  • Foster mindshare and innovation ideas on potential applications of advance directive interoperability in the real world


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 directives interoperability is a complex area that involves many stakeholders. The HL7 sponsor for this IG is Patient Empowerment. 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. This version of the IG is not intended to cover medical intervention goals, preferences, priorities for individuals who are not able to make their own wishes known.

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(s)

Brian Meshell (Technical)

Maria Moen (Use Case Lead)

Matt Elrod (Technical SME)

Corey Spears (Technical Support)

Tina Wilkins (Support)

Track Lead Email(s);;;;

Specification Information

PACIO Advance Directive Interoperability IG:

Call for participants


Consumer focus applications (e.g. e.g. PHRs)

Zulip stream 

Implementer Connection Call

Thursday June 16, 2022 2:00pm-3:00pm ET

Join ZoomGov Meeting
Meeting ID: 160 599 3741  One tap mobile  +16692545252,,1605993741# US (San Jose)

Implementers Connection Call (6/16/2022) Presentation:

Recording: 2022-06-16-ADI-Connection-Call-audio1142034541.m4a

Testing Scenario:


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 [4] and verifying the current version of advanced directive content [5].

Focus areas include:

  • Person Authored Data - Personal Advance Care Plan (PACP)
  • Portable Medical Order - Scanned document or CDA
  • Document Sharing
    • Authenticated/authorized access (security)
    • Contained document (Snapshot) communication

ADI Document Types


Scene 0: Review of Prior Connectathon Accomplishments

  • Create Advanced Directive Information (ADI) in digital form
    • Create a combined Power Of Attorney (POA) and Living Will (LW) scanned document (PACP) designating preferences and designated.
  • Share ADI content by sending it to a FHIR Server

Scene 1: Creating a Portable Medical Order  

  • New PCP retrieves the current Michigan LW + POA and PACP Documents
  • Due to patient's declining health, the provider creates a Portable Medical Order, which is scanned.
    • The scanned document is sent to a FHIR server.
  •  Based on a new Portable Medical Order, it is determined the patient needs a new PACP. 
    • Updated preferences based on order.
    • Observation in PACP identifying that a portable medical order exists.
    • The FHIR document is submitted to the FHIR server replacing the original scanned PACP

Scene 2:  Updating PACP and Michigan POA + LW

  • Patient updates PACP and Michigan POA + LW using consumer facing app
  • PACP is imported to a document repository
  • Advance Directive document repository sends updated PACP to Michigan's state HIE

Scene 3:  Retrieval of AD Information

  • Patient facing app used to access advance care documents
  • PCP reviews updated Michigan POA + LW, PACP and portable medical order
  • Home Health Agency retrieves all 3 documents from the Michigan HIE to help inform the patient's care plan

System Roles

AD Information Creator (Client)

  • A system that creates an ADI IG Conformant set of FHIR resources, stores, and pushes to another system (An ADI Information Receiver)
  • Advance Preparation: The system will be able to create advance directive documents (FHIR Document Reference) and send them through a FHIR interface.

AD Information Receiver (Server)

  • A system, acting as a FHIR Server, that receives an ADI IG Conformant set of FHIR resources. These resources may be utilized for display or made available for query (Acting as an ADI Information Repository)
  • Advance Preparation: The system will be able to receive and store AD DocumentReference resources through a FHIR interface.

AD Information Repository (Server)

  • A system that stores and makes available for query, ADI IG Conformant FHIR resources.
  • Advance Preparation: The system will be able to store AD DocumentReference resources and make them available for query through a FHIR interface.

AD Information Requester

  • A system that queries an AD Information Repository for advance directive FHIR resources and displays or otherwise uses the information contained within.

Advance Preparation: The system will have the ability to query for AD DocumentReference resources through a FHIR interface.

Track Highlights: