Submitted by EmoryHealthcare on 2023-09-20 Advance Directives Data Class - L2 Data Elements as of 9.20.2023 Emory Healthcare appreciates ONC’s allocation of Leading Edge Acceleration Projects in Health Information Technology (LEAP in Health IT) funding in 2023 toward Area 1, Exploring the Use of Advanced Fast Health Care Interoperability Resources (FHIR®) Capabilities, in support of a more accurate exchange of advance care planning documents. As noted in our comments on draft USCDI v4, Emory Healthcare is committed to accurately documenting a patient’s wishes for their care goals and preferences in their medical record, and supports the inclusion of such documentation in USCDI. However, at this point in time, and for the purposes of clarity and accuracy, we recommend that information related to a patient’s preferences and goals related to care addressing serious illness or injury be defined as Advance Care Planning Documents. This term encompasses the breadth of related documentation that might be included in a patient’s medical record, including advance directives; living wills; powers of attorney for patient care; other designations of decision-making surrogate(s); notes containing conversations about diagnoses, prognoses, care history or experiences of loved ones that are facilitated by a health care provider; and patient-reported care preferences collected in the patient portal. Having a designated data element that encompasses all such related documentation accommodates the variability that providers and other clinical care team members encounter in the course of seeking to fulfill a patient’s wishes, and avoids unnecessary and burdensome segmentation of information. Emory Healthcare emphasizes that any data elements and data classes that exchange information or documentation related to advance care planning should support quick and easy sharing of official advance care planning documents. The official names of these documents vary by state (suggesting a need for some sort of overarching and well-defined data element term), but include "advance directive for healthcare," "living will," "POA for healthcare," "health care proxy designation" and others.