December 15, 2017

Ms. Debbie Condrey, Chief Information Officer
Virginia Department of Health
109 Governor Street
Richmond, Virginia 23219

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

Dear Ms. Condrey:

Thank you for the opportunity to comment on the Virginia Board of Health periodic review and small business impact review of 12 VAC 5-67, Advance Health Care Directive Registry. As discussed in greater detail below, the Virginia Hospital & Healthcare Association (VHHA) submits that this regulation should be retained.
Advance care planning is important to patients and their health care providers because it builds trust and teamwork among the patient, his/her health care providers and the patient’s agent and it helps avoid future confusion and conflict regarding the patient’s wishes when the patient can no longer make his/her own decisions. VHHA’s members constantly work with their patients and the public to explain advance care planning and assist with creating advance care directives. While providers and other community members are working to ensure everyone has an advance care directive, there is still work to be done in making sure health care providers and patients’ agents have access to a patient’s advance care directive when necessary.
Virginia’s Advance Health Care Directive Registry (Registry) is one way Virginians can ensure their advance care directives are available to those who need them. The Registry provides Virginians a place to store their advance care directives so that anyone with access to the registry will be able to honor their wishes. Patients must designate who can view their advance care directive by providing those individuals with a registration number and source. Healthcare providers that do not have this information cannot access a patient’s advance care directive. However, the regulations do allow a licensed health care provider to have access to the Registry for “patients who are comatose, incapacitated, or otherwise mentally or physically incapable of communication.” 12 VAC 5-67-30. In these cases, the provider must call a 1-800 number to gain access to the advance care directive which can be time-consuming and burdensome.

Virginia needs a robust registry with easy access for providers in order to continue the progress our members and others have made regarding advance care planning. Currently health care providers do not have electronic access to the Registry which severely limits their use of the Registry. With the advent of electronic health records (EHR) computers are available in most patient care areas. Electronic access to a patient’s advance care directive and a mechanism to add or link the advance care directive to the patient’s EHR would guarantee provider use of the Registry and ensure patient’s wishes are honored. The lack of easy access to the contents of the Registry will continue to be an impediment to its use. The Virginia Board of Health should explore ways to increase access to and use of the Registry.

VHHA appreciates the work the Board has done to establish an electronic registry for advance care directives and supports the retention of the Advance Health Care Directive Registry regulations at 12 VAC 5-67.
Thank you again for this opportunity to comment.

Sincerely,
R. Brent Rawlings
Vice President & General Counsel