MyDirectives @MyDirectives

What does it actually take to get clinicians to use advance care planning documents at the point of care? Not more training. Not another policy. A better workflow. When ACP documents are buried in the EHR or locked in a filing cabinet, clinicians can't use them. When they're visible within the clinical workflow—one click, color-coded, and no extra navigation—utilization follows. In organizations that have made ACP readily accessible at the point of care, document review rates have increased from single digits to more than 50%—without adding staff or changing clinical roles. The workflow is the intervention. For organizations using PointClickCare, MyDirectives for Clinicians is available in the PointClickCare Marketplace. Patient and resident demographics automatically populate ACP documents, completed documents upload to the chart in real time, and patient preferences travel with the individual through MyDirectives' nationwide registry across care settings—whenever and wherever care decisions are made. The workflow already exists. The question is whether you've turned it on. na2.hubs.ly/H06xq070 #AdvanceCarePlanning #PointClickCare #LongTermCare #SeniorCare #CareCoordination #HealthcareIT

As we celebrate Independence Day, we're reminded that one of the most personal expressions of freedom is the ability to make our own healthcare decisions. Advance care planning helps ensure those wishes can be known and respected, even if we're ever unable to communicate them ourselves. From all of us at MyDirectives, we wish you, your families, and your communities a safe and meaningful Independence Day. Happy Fourth of July! #IndependenceDay #AdvanceCarePlanning #PatientVoice #MyDirectives

Here’s a number worth paying attention to: $4,400 That’s the average cost avoidance per patient identified in an internal analysis of 811 patients at a large health system that examined the impact of advance care planning integrated into palliative care. The difference isn’t about withholding care. It's about clarity of care. When residents’ wishes are documented and accessible, clinicians and families are better equipped to make informed decisions during transitions of care and medical emergencies. That can mean fewer unnecessary or non-beneficial interventions, fewer inappropriate EMS calls or emergency department transfers, and fewer procedures that nobody wanted in the first place — especially the patient. For skilled nursing and assisted living communities, your residents are already making these decisions. The question is whether those decisions are documented, accessible, and followed when it counts. If you’re using PointClickCare, the workflow and infrastructure to make this happen is already available. Learn more: na2.hubs.ly/H06jMn-0 #AdvanceCarePlanning #SeniorCare #PointClickCare #LongTermCare

One billion health records exchanged through TEFCA is more than a milestone. It's evidence that nationwide interoperability is becoming a reality. As healthcare becomes more connected, success isn't measured simply by moving more data. It's measured by ensuring the right information is available at the right time to support better care. That includes advance directives, portable medical orders (POLST), mental health advance directives, and other advance care planning documents that guide critical decisions during emergencies and care transitions. Interoperability isn't the destination. Better patient care is. At MyDirectives, we believe advance care planning is essential healthcare infrastructure. As secure nationwide exchange continues to expand, ensuring every person's care preferences are accessible wherever care is delivered will become increasingly important. Congratulations to the teams at the U.S. Department of Health and Human Services for reaching this significant milestone and continuing to advance secure, patient-centered health information exchange. #TEFCA #Interoperability #HealthIT #DigitalHealth #AdvanceCarePlanning #PatientAccess #HealthData #HealthcareInnovation

Every care plan starts with a conversation. Advance care planning (ACP) conversations aren't always easy. Many people simply don't want to think about them until a serious illness, hospitalization, or family crisis forces the discussion. That's why healthcare organizations are embedding ACP into clinical workflows rather than treating it as a one-time event or an administrative task. If meaningful conversations depend on someone remembering to have them, too many patients will never have one. When these conversations become part of clinical workflows instead of being left to chance, patients have more time to reflect on their values, families have greater clarity, and care teams are better prepared to honor patient wishes. Because meaningful ACP doesn't begin with paperwork. It begins with a conversation. #AdvanceCarePlanning #CareCoordination #PatientExperience #PersonCenteredCare #HealthcareInnovation #HealthcareIT #MyDirectives

Advance care planning is often associated with forms, documents, and signatures. Those things matter. But the most important part of advance care planning is often the conversation itself. Conversations help patients reflect on their values, discuss what's important to them, and share their wishes with the people who may one day need to make decisions on their behalf. That's why many organizations are looking for ways to make advance care planning conversations a more natural part of clinical workflows rather than a separate administrative task. Documents help ensure those wishes can be communicated, accessed, and honored. Both matter. Because advance care planning is ultimately about people, not paperwork. #AdvanceCarePlanning #CareCoordination #PatientExperience #PersonCenteredCare #HealthcareInnovation #HealthcareIT #MyDirectives

It’s 2am. A resident arrives at the emergency department. The care team needs to know her wishes. Her family is in the waiting room. There’s a DNR on file somewhere — maybe in a filing cabinet at the skilled nursing facility, maybe in an EHR, maybe in her purse. Nobody can find it.  So they intubate.  Not because they ignored her wishes. Not because someone made a mistake. Because the care team was forced to make critical decisions without access to the resident’s documented treatment preferences. This isn’t a hypothetical. This happens every day in skilled nursing, assisted living, and memory care communities. Not because people don’t care, but because critical documents often don’t move with the patient across care settings. The advance directive exists. The POLST exists. The DNR exists. They just can’t be found when and where they’re needed. For communities using PointClickCare, there’s a better way. MyDirectives for Clinicians is available in the PointClickCare Marketplace, helping make advance care planning information more accessible across care settings when critical decisions need to be made. Learn more: na2.hubs.ly/H06hvyB0 #AdvanceCarePlanning #SeniorCare #PointClickCare #LongTermCare #PostAcuteCare #CareCoordination #Interoperability

Advance care planning often focuses on completion. And completion matters. But completing an advance directive or portable medical order isn't the finish line. It's the handoff. The real goal is ensuring that a patient's wishes can be accessed, shared, and honored when critical healthcare decisions need to be made. Creating advance care planning documents is important. Making sure they're available when and where they're needed is essential. #AdvanceCarePlanning #CareCoordination #Interoperability #HealthcareIT #PatientExperience #PersonCenteredCare #MyDirectives

Every person deserves the opportunity to make their healthcare wishes known. As we recognize Juneteenth, we reflect on the importance of ensuring that all individuals have access to the resources, conversations, and support needed to document and communicate their healthcare preferences. At MyDirectives, we believe healthcare works best when every voice can be heard, every person's wishes can be respected, and critical information is available when and where it is needed. #Juneteenth #PatientVoice #AdvanceCarePlanning #HealthcareEquity #MyDirectives

A patient doesn't experience healthcare the way healthcare organizations do. They don't think in terms of hospitals, physician practices, rehabilitation facilities, skilled nursing, home health, hospice, EMS, EHRs, or health information exchanges. They simply experience their care as one journey. Every transition between care settings creates another opportunity for important information to become unavailable, delayed, or overlooked. When that happens, care teams may not have access to the information needed to fully understand or honor a patient's wishes. As healthcare becomes increasingly connected, we still have work to do to ensure critical information follows the patient throughout that journey. Because from the patient's perspective, it has always been one journey. #AdvanceCarePlanning #Interoperability #CareCoordination #HealthcareIT #PatientExperience #MyDirectives

CMS’s newly announced Office of Health Technology and Products (OHTP) may prove to be far more significant than a routine organizational update. The announcement places major emphasis on healthcare technology modernization, interoperability, API-based exchange, digital platforms, and what CMS repeatedly describes as “national healthcare infrastructure services.” Healthcare today is highly distributed, and critical information must be able to follow patients across care settings. At MyDirectives, we’ve long believed advance care planning is not simply a documentation challenge. It’s also an accessibility, interoperability, and infrastructure challenge. While the CMS announcement does not specifically reference ACP, many of the broader themes reflected in the new OHTP structure align closely with ongoing healthcare conversations around connected care ecosystems and interoperable healthcare infrastructure. Scott Brown, President & CEO, shares his thoughts in our latest blog post. 🚀 Read the full blog: na2.hubs.ly/H068msm0 #HealthcareIT #Interoperability #AdvanceCarePlanning #FHIR #DigitalHealth

CNAs, skilled nursing staff, hospice aides, home health teams, and other frontline caregivers already navigate incredibly difficult environments while supporting patients and families through some of the most challenging moments in healthcare. Missing advance directives or other advance care planning (ACP) information should not add to that burden. As we recognize National Nursing Assistants Week, it’s a reminder that improving ACP accessibility is not just about compliance or technology. It’s also about helping ensure frontline caregivers have timely access to the information they need to help honor patient wishes across the continuum of care. #NationalNursingAssistantsWeek #AdvanceCarePlanning #CareCoordination #HealthcareIT #PatientCare #MyDirectives

Healthcare is incredibly fluid. Patients move across emergency departments, hospitals, rehabilitation facilities, skilled nursing, home health, hospice, physician offices, EMS encounters, and long-term care settings — sometimes repeatedly within short periods of time. But too often, advance directives, portable medical orders, and other ACP documents do not move with them. When preferences and treatment decisions are fragmented across paper files, disconnected systems, portals, fax machines, and isolated workflows, clinicians, caregivers, patients, and families are often left making critical decisions without the information they need. Advance care planning is not just about document creation. It is also about accessibility, interoperability, workflow integration, and ensuring patient preferences remain available throughout the continuum of care. #AdvanceCarePlanning #Interoperability #HealthcareIT #DigitalHealth #CareCoordination #HIE #MyDirectives

Healthcare is incredibly fluid. Patients move across emergency departments, hospitals, rehabilitation facilities, skilled nursing, home health, hospice, physician offices, EMS encounters, and long-term care settings — sometimes repeatedly within short periods of time. But too often, advance directives, portable medical orders, and other ACP documents do not move with them. When preferences and treatment decisions are fragmented across paper files, disconnected systems, portals, fax machines, and isolated workflows, clinicians, caregivers, patients, and families are often left making critical decisions without the information they need. Advance care planning is not just about document creation. It is also about accessibility, interoperability, workflow integration, and ensuring patient preferences remain available throughout the continuum of care. #AdvanceCarePlanning #Interoperability #HealthcareIT #DigitalHealth #CareCoordination #HIE #MyDirectives

Advance care planning cannot succeed as a disconnected workflow. If ACP requires clinicians to leave the EHR, search for documents manually, rely on faxed forms, or navigate fragmented systems, adoption will always struggle, regardless of how important the conversations may be. For ACP to scale meaningfully across healthcare, it must become part of normal clinical workflows. Accessible. Integrated. Actionable. The future of advance care planning depends not only on encouraging conversations, but on reducing the operational friction surrounding them. #AdvanceCarePlanning #HealthcareInteroperability #HealthIT #ClinicalWorkflow #DigitalHealth

A simple question: If a patient has already completed an advance directive, designated a healthcare agent, and discussed their wishes with family... ...but none of that information is available when a critical healthcare decision must be made, has the healthcare system truly benefited from that planning? Accessibility is not a convenience. It's a requirement. #AdvanceCarePlanning #PatientCenteredCare #HealthcareInteroperability

During EMS Week, it’s worth recognizing that EMS professionals make critical decisions in minutes, often before a patient reaches the hospital. Portable medical orders like POLST forms and DNRs only work if they are accessible in the field. Too often, EMS teams still face fragmented workflows, paper documents, faxed forms, and disconnected systems that make patient goals and medical orders difficult to access when time matters most. Advance care planning infrastructure has to extend beyond the hospital, beyond the EHR, and into the moments when critical decisions are actually being made. Because ACP isn’t just documentation. ACP is infrastructure. Real-time healthcare requires real-time access to patient intent. #EMSWeek #AdvanceCarePlanning #Interoperability #HealthIT #DigitalHealth

Healthcare is rapidly moving toward real-time, connected workflows. APIs, interoperability, and embedded EHR experiences are changing how healthcare organizations exchange information and coordinate care. Advance care planning infrastructure needs to evolve with the rest of healthcare. Too many advance directives and portable medical orders still exist in fragmented workflows, trapped in scanned PDFs, faxed documents, disconnected systems, and processes that make critical information difficult to access when decisions need to be made quickly. ACP doesn’t fail when it’s created. It fails when patient goals, preferences, and medical orders aren’t accessible at the point of care. Real-time healthcare requires real-time access to patient intent. #AdvanceCarePlanning #Interoperability #HealthIT #DigitalHealth #PatientCenteredCare

For years, EMS has been told to look for a POLST form on the refrigerator. Think about that. In the moments that matter most—when a patient can’t speak, when seconds count—we’ve relied on a paper search to guide critical decisions. That’s not a reliable system. It’s a workaround. EMS clinicians don’t need better instructions on where to look. They need immediate access to clear, actionable medical orders at the point of care. When POLST forms, DNR orders, and other portable medical orders are available directly within ePCR systems, everything changes. EMS can see the information they need in real time, act with confidence, and deliver care that reflects the patient’s wishes without delay. This isn’t about replacing POLST. It’s about making it function the way it was intended—accessible, actionable, and present when it matters most. Because in emergency care, not finding the document isn’t a minor gap. It’s a system failure. #POLST #EMS #AdvanceCarePlanning #Interoperability #HealthIT #PatientCenteredCare

Today is National Healthcare Decisions Day. We’ve made real progress in advance care planning. More conversations are happening. More documents are being completed. But completion isn’t the finish line. If those preferences aren’t accessible when decisions are being made, they don’t guide care. That’s the gap. Create the plan. Make it accessible. #NHDD #AdvanceCarePlanning