1. Rozanne Turner, M.Ed., BSN, RN
Expanding Access to Advance Care Plans with Health Information Exchange
Rozanne Turner, M.Ed., BSN, RN
Clinical Programs, Priority Health
First and Last Steps® ACP Facilitator
Doug Dietzman, BS
Executive Director
Great Lakes Health Connect & Making Choices Michigan

2. Speaker Introduction
Rozanne Turner, M.Ed., BSN, RN Clinical Programs, Priority Health First and Last Steps® ACP Facilitator MCM Steering Committee & former MCM Board Member

3. Speaker Introduction
Douglas Dietzman, BS Executive Director: Great Lakes Health Connect and Making Choices Michigan

4. Conflict of Interest
Rozanne Turner Has no real or apparent conflicts of interest to report. Douglas Dietzman Has no real or apparent conflicts of interest to report.

5. Disclaimer
Laws and regulations related to Advance Care Planning, and what is and is not accepted as legally binding for representing an individual’s wishes in the event that they cannot speak for themselves, varies from state to state. Today’s information reflects current Michigan statute.

6. Agenda Learning Objectives Situational Analysis Audience Survey
Define Advance Care Planning (ACP)
Challenges & Obstacles to ACP
Introducing Making Choices Michigan
Respecting Choices ® Model
4 Pillars of Community ACP
Use Case – Patient Story
Recommendations
Better Together –
MCM Joins GLHC
Growth & Future
Questions & Answers

7. Learning Objectives
Define the value and benefits of Advance Care Planning (ACP) for individuals and population health
Examine the challenges and barriers involved in gaining broad adoption of personal Advance Care Plans
Identify the four main components of a successful, freestanding, community-based ACP program
Demonstrate the value and advantages of leveraging health information exchange (HIE) for electronic storage and retrieval of Advance Directive documents

8. Situational Analysis
In 1990 the Federal Government enacted the Patient Self Determination Act (PSDA) to encourage Advance Care Planning
The PSDA requires Medicare & Medicaid funded provider organizations to inform patients of their right to an Advance Directive, and to document their wishes is the medical record
Studies demonstrate that Advance Care Planning has a positive effect on health outcomes, quality of life, reduced hospitalizations, and treatment costs, particularly for patients with serious illness

9. Situational Analysis
While there has been significant growth in personal Advance Care Planning since 1990, a 2014 HHS study indicates that just 26.3% of Americans have an Advance Directive
Several barriers persist in establishing clear communication of personal preferences for end-of-life care:
Reluctance to discuss death and dying
Fragmented healthcare delivery system
Inopportune timing in the midst of crisis
Inadequate structural support for Advance Care Planning

10. Audience Survey What is included in an Advance Directive:
Power of Attorney for Health Care (Patient Advocate)
Durable Power of Attorney
Living Will
All of the above

11. Audience Survey
2. Which is NOT required to possess “decision-making capacity”?:
Ability to weigh options
Understand information
Person, place, & time oriented
4) Can express choice

12. Audience Survey
3. True or False - The PSDA requires doctors discuss Advance Care with patients?:
TRUE
FALSE

13. Defining ACP: Power of Attorney (DPOA)
Written document appointing a trusted person to act on a person’s behalf in the event of incapacity
Includes decisions such as financial and legal affairs.
A person’s “stuff”
(money, property, etc.).

14. Defining ACP: DPOA – Healthcare
A person chosen to make medical decisions for an individual when they are unable to speak for themselves. 
Referred to as the Patient Advocate
Must accept the role in writing

15. Defining ACP: Advance Directive
Appoints your Patient Advocate (PA)/Durable Power of Attorney for Healthcare (DPOAH)
Gives your Advocate the right to participate in discussions about your care and ensures your wishes are followed

16. Defining ACP: Living Will
Gives your Patient Advocate direction for your goals of care/treatment preferences
“The Gift”
It does not “stand-alone” in Michigan

17. Challenges & Obstacles to ACP
Clinical Misperception
Technology Gap
Technological Scale

18. Making Choices Michigan
Goal: Move the ACP conversation from the healthcare environment to the community-at-large
Vision: A community culture where it is acceptable to talk about health care choices, including end of life, and to respect and honor those choices
Mission: Encourage and facilitate advance health care planning by the people of West Michigan

19. Respecting Choices® Model
Gunderson Lutheran Health System, LaCrosse, WI

20. Respecting Choices® Model
First Steps®
Healthy Adults in community-MCM
Topics:
Designate Patient Advocate
Clarify values
Next Steps®
Chronic or Life-limiting disease with complications
Triggered at diagnosis. Focused on care & tx specific to disease
Last Steps®
Life expectancy
< 12 months
DNR, hydration/nutrition. Complete MI-POST

21. 4 Pillars of Community ACP
Community Engagement & Collaboration Strategy
System for Facilitated Conversations
Common Advance Directive Documents
Means of Electronic Storage and Retrieval

22. Pillar I: Community Engagement
PUBLIC
Faith Groups
Senior Continuing Education
Residential/Assisted Senior Living
African American Health Assoc.
Health Fairs
Public Radio & Television
PROFESSIONAL
Elder Law / Advocacy
Medical Bioethics Committees
Nursing Societies
Domestic Crisis Agencies
Academic Institutions
Hospice Volunteer Groups

23. Pillar II: Facilitated Conversations
Community Education – “D3”
Discuss
Decide
Document
Volunteers

24. Pillar III: Common AD Documents

25. Pillar IIII: Electronic Storage & Retrieval
Premier Health Information Exchange in Michigan
129 Hospitals = 85% of Acute Beds
4,000 Connected Participants
(Physical, Behavioral, Social)
9.5 Million Unique Patients in Community Health Record
+ 1 BILLION Message Transactions each year

26. Pillar IIII: Electronic Storage & Retrieval
Virtual
Integrated
Patient
Record

27. Patient Care Documents in VIPR

28. Patient Care Documents in VIPR

29. Recommendations Develop an Engagement Plan
Enlist sympathetic organizations
Recruit volunteers
Provide regular training & education
Create a system for facilitated conversations

30. Recommendations Produce standardized forms & materials
Adhere to clinical & legal standards
Build a system for electronic central storage and retrieval
Establish multiple points of communication
Maintain consistent regular contact with ALL stakeholders

31. MCM & GLHC - Better Together
Formal Integration
Announced – Sept. 2017
Like minded mission & vision
Collaborative relationship
Maintain autonomy
Leverage operational economies
Support growth and impact

32. Patient Story - Brent
“ ‘The Conversation’ is going to happen…with or without you.
Do you want to be part of it?”
Brent Larson

33. Growth & Future YEAR # of RECORDS 2013 143 2014 1484 2015 3378 2016
7939
2017
18503
TOTAL
31447

34. Questions & Answers Rozanne Turner M.Ed., BSN, RN First & Last Steps
ACP Facilitator
Douglas Dietzman
Executive Director
Great Lakes Health Connect
& Making Choices Michigan