January 3, 2018

RE: Public Comment for Periodic Review of 12 VAC 5-67

Dear Ms. Condrey:

The Medical Society of Virginia (MSV) appreciates the opportunity to comment on 12 VAC 5-67, Advance Health Care Directive Registry as part of the periodic review.  As the registry provides immense benefit to Virginia patients, family members, and health care providers, MSV supports retaining these regulations.

The Advance Health Care Directive Registry alerts health care providers and family members to the existence of a patient’s advance care directive.  This gives critical information that guides the provision of care in accordance with the patient’s wishes.  The registry also gives family members and health care providers access to a patient’s end of life decisions during a medical emergency, even when the patient is unable to communicate the existence or placement of such decisions.  Knowing a patient has an advance care directive is futile if the location or contents of the advance directive are unknown during a medical emergency, when quick decisions are critical.  Making advance care directives available statewide improves the health care provider and family members’ ability to follow the patient’s health care wishes, even without the physical presence of the legal document. 

For these reasons, MSV continues to support the Advance Health Care Directive Registry and respectfully submits an opportunity to improve health care provider awareness and utilization of the registry.  Given that advance directives offer end of life planning decisions that are often pertinent during a medical emergency, quick provider access to the information is critical.  Currently, only providers that have received an access code from their patient may access the patient’s advance directive online.  Without the code, providers must call a 1-800 phone number to retrieve the patient’s information.  Patients experiencing an unexpected medical emergency are not likely to be seen by their usual provider, meaning the emergency physician wouldn’t have the access code granting them online access to the registry and would instead have to call the 1-800 phone number.  As patients often require immediate medical attention, physicians may not have time to make this phone call during an emergency.  In these cases, many advance directives stored in the registry likely remain underutilized during critical initial medical treatment decisions.  To improve utilization during emergencies, the online version of the registry should be accessible to all providers.  Additionally, including a registry status in patient EHRs would further increase health care provider awareness of a patient’s advance directive stored in the registry.

MSV is thankful for this opportunity to comment and continues to support the Virginia Department of Health in its efforts to improve patient end of life care decisions.  Please contact Lauren Bates-Rowe with any questions. 

Sincerely,

Laurent Bates-Rowe

Assistant Vice President of Health Policy