By Mike Ruben, The State Journal
Original publication date: Jan. 28

West Virginians will be able soon to convey their end-of-life choices electronically with paramedics, emergency room physicians and other health care providers.

A project being coordinated by the West Virginia Center for End of Life Care and the West Virginia Health Information Network, or WVHIN, is now in the development stage with pilot programs scheduled to begin later this year.

Along with Oregon and New York, West Virginia is among the first states developing systems using an electronic database to convey Physician Orders for Life Sustaining Treatment, or POLST.

The information will direct health care providers about the type of care seriously ill patients want to receive. POLST forms typically offer three primary options: comfort care (administering medicine and oxygen, but no hospitalization), limited intervention (also administering intravenous fluids and hospitalization, excluding mechanical ventilation and intensive care treatment) and full treatment.

Paper-based systems are being used in 33 states, according to a Wall Street Journal report citing the Center for Ethics in Health Care. Oregon, however, is the first state to use an electronic system.

Patients complete the necessary forms on a voluntary basis in consultation with their doctor, including living will and medical power of attorney directives. The document is then entered into a database accessible by staff at Oregon’s emergency communications center, which coordinates statewide medical emergencies.

West Virginia’s program will be more advanced, according to Dr. Alvin H. Moss, project director.

“What we’re doing is even more cutting edge than Oregon,” said Moss, director of the bioethics program at the West Virginia University School of Medicine. “The Oregon system depends on a first responder system where a paramedic would call in to the center where they would go online and then read the patient orders over the telephone.

“The system here will be online with any health care provider with a need to know,” Moss continued. “They will be able go online and access the patient’s orders. It will also be smart phone accessible. We’re well ahead of the curve on this, and it’s good that it’s happening in West Virginia.”

Based on the first-year response in Oregon, Moss is anticipating 30,000 to 40,000 West Virginians will participate in the electronic registry.

Approximately 20 percent of state residents had completed a living will or medical power of attorney form prior to the Center for End of Life Care being established in 2000. Participation has nearly doubled during the past decade, according to Moss. It has increased sharply since December when the Public Employee Insurance Agency, or PEIA, announced monthly premium discounts for participation.

“We had been getting about 100 phone calls per month,” he said. “We received more than 900 phone calls in December. It (the percentage of participants) is going to go up quickly.”

The Morgantown-based center recently added a fourth staff member to help accommodate the demand. Evan Falkenstine is the new project manager for the e-directive registry.

Thomson-Reuters has been contracted to implement the technology to drive the program. Samantha Stamper, business development manager at WVHIN, said a pilot program could be ready for preliminary tests this summer or early fall in the Wheeling and Morgantown areas.

West Virginia will be receiving $7.8 million in federal funds to incorporate the program over a six-year period, according to Stamper. In addition to end-of-life choices, the registry will include vital medical information such as existing conditions and immunization records.

Participating health care providers will have access to the electronic database.

“It will be a very efficient way to exchange patient data more quickly than with a paper-based system,” said Stamper.

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