Data Element

Information from the submission form

Advance Directive Observation
In the context of a Patient Summary or Encounter Summary authored by a clinician or assembled by clinician’s EMR system, observations verifying a patient’s advance directive information and medical orders for life-sustaining treatments are available and have been reviewed using established standards for recording this type of information documented by providers.In a Patient Summary or Encounter Summary, Advance Directive Observations indicate if a person has a Personal Advance Care Plan, where the current source document can be referenced, if it was verified, and optional observations about what types of wishes the patient has expressed in his or her generated advance directive information, and if the person’s advance directive documentation has been verified. The set of recognized types of content include concepts from the value set: Advance Directives Content Type SCT urn:oid:2.16.840.1.113762.1.4.1115.5 which is openly available for reference in the National Library of Medicine’s Value Set Authority Center. It can be referenced using this url:


Advance Directive Observation – PACIO support for USCDI Level 2

PACIO supports advancing the Advanced Directive Observation data element to USCDI Level 2. Established February 2019, the PACIO Project is a collaborative effort between industry, government, and other stakeholders, with the goal of establishing a framework for the development FHIR implementation guides to facilitate health information exchange. The PACIO community is open to all interested parties and currently includes over 50 individuals and organizations. On behalf of the PACIO Project leadership team, the PACIO Community voted 9/29/21 and unanimously supports the document and recommendations as posted 9/28/21 by Lisa R Nelson. PACIO members were involved in the creation of that document based on experiences in advance directive content adjudication and FHIR implementation guide development. 

Update Data Element to USCDI Level 2

The current practitioner-authored data element of “Advance Directive Observation” is critical to ensuring clinicians can record and share information about available patient-documented goals, preferences and priorities for treatments and interventions regarding future medical care that may be considered under certain circumstances.  This data element is routinely captured in the context of a Patient Summary or Encounter Summary authored by a clinician or assembled by clinician’s EMR system.  This observation is recorded when a clinician verifies the presence of a patient’s advance directive information or confirms the patient has medical orders for life-sustaining treatments and documents reviewing this information.  We strongly recommend the Advance Directive Observation data element be advanced to USCDI Level 2.

USCDIv3 ADI_Comments_20210927v3_0.pdf

Adv Directives Overall

Advance Directives are the original patient goals. They represent goals that are pervasive and used every day to help define the level of care a patient wants and to amplify their own voice in care. Whether the goals are for all extraordinary measures or comfort care, instructions and wishes, the advance directive is the original and ubiquitous personal care plan. It is encouraging to see the data elements defined in USCDIv2 L1 as being so consistent with efforts in the industry, and current industry practice. PACIO, MITRE, HL7 efforts have consistently recommended the same elements.  Adoption of Advance Directives should be considered in USCDI V2. 

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