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PACIO: Advance Directives Interoperability (in FHIR) (PSS in Confluence)

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Basics

PACIO: Advance Directives Interoperability (in FHIR) (PSS in Confluence)

1652
Ballot - STU to Normative


FHIR Implementation Guide

Implementation Guide

Details

This project will create FHIR implementation IG(s) for Advance Directives Interoperability (ADI).

It is a complex area that involves many stakeholders. The Post-Acute Care Interoperability (PACIO) Community has a strong interest in the topic of advance directives and will support the community engagement and technical FHIR IG development needed for Advance Directives Interoperability. PACIO is supported by MITRE, CMS, ONC and many other stakeholders (both clinical and technical).

FHIR profiles will be developed for several existing FHIR resources to represent advance directive content such as: living will, durable medical power of attorney, personal health goals at end of life, care experience preferences, patient instructions (obligation, prohibitions, and consent), and portable medical orders for life sustaining treatments.

The FHIR IG will cover the use of RESTful API interactions for query, retrieve and verification of advance directive information between systems.

The guidance will be consistent with FHIR US Core IG and will build upon existing standards such as: HL7 CDA R2 Implementation Guide: Personal Advance Care Plan (PACP) Document, Release 1 - US Realm STU Release 2 August 2020 and HL7 CDA® R2 Implementation Guide: C-CDA R2.1: Advance Directives Templates, Release 1 - US Realm


Systems used to create and update patient-generated advance directive information through a patient-directed process need a way for individuals to communicate information about their advance medical care goals, preferences, and priorities.

Individuals need a way to generate and update information related to their advance directives so that their current wishes can inform provider-generated care plans.

Interoperable exchange of the advance directive information supports more effective sharing of advance directive information across transitions in care and enables practitioners to create person-centered care plans that align with a patient’s values, goals of care, treatment preferences, and quality of life priorities when a patient cannot communicate for themselves.



FHIR IG Proposal - Target: November 2020 Connectathon 1 - Target: January 2021 Connectathon 2 - Target: March 2021 Ballot an STU 1 IG - Target: May 2021 Connectathon 3 - Target: June 2021 Connectathon 4 - Target: September 2021 Publish FHIR IG STU1 V1.0.0 - Target: September 2021


https://confluence.hl7.org/display/PE/PACIO+Project%3A+PSS+for+Advance+Directives PACIO page (TBD) (https://confluence.hl7.org/display/PE/PACIO%20page%20(TBD))

Center for Medicare and Medicaid Services (CMS), Office of the National Coordinator (ONC), Department of Veteran Affairs (VA)

PACIO Community schedules and participation

Quality Reporting Agencies, Standards Development Organizations (SDOs), Payors, Other (specify in Misc. Notes below),Emergency Services; Healthcare Institutions (hospitals, long term care, home care, mental health),EHR, PHR; Health Care IT; Clinical Decision Support Systems; Other (specify in Misc. Notes below)

ADVault, Inc. MaxMD Patient Centric Solutions, Inc.

The aging population receiving healthcare in skilled nursing facilities and assisted living communities have been under forced isolation to reduce the risk of contracting COVID-19. During COVID as well, those requiring medical care have found themselves during a transition in care without anyone to accompany them to influence medical care or be at their side. The impact is a sense of disempowerment, isolation, and a disconnection with the world they can no longer safely interact freely with. Never before has the availability of verifiable digital advance directive information been so essential to delivering care. The role of technology and expanded adoption by the aging population, providers, and care teams has brought to the forefront the expectation of seamless accessibility of advance directive information. An additional factor is an increased understanding that a person’s goals, preferences, and priorities for care are a critical element in a person-centered healthcare system.

advance directives, personal advance care plan, patient preferences/consent, portable medical order (POLST, MOLST, etc.)

Profiles in this FHIR IG will be consistent with USCore Profiles

Yes

N/A

No

2025 December: TSC approved an STU Extension Request for HL7 FHIR® Implementation Guide: PACIO Advance Directive Interoperability, Edition 1 - US Realm for 2 years 2023 December: TSC approved STU Publication Request for HL7 FHIR Implementation Guide: PACIO Advance Directive Interoperability Release, Edition 1 - US Realm for 2 years 2021 August: VLorenzi: . Optimistically, we will have their first ballot cycle in January 2022. And the project end date will be about 6 months after. Other Stakeholders: Patients, Providers Other Vendors: Advance Directive Registries, HIEs, ACOs
Organization & Realm

Realm Specific - Enter "U.S." or name of HL7 Affiliate below

U.S.
People

Maria D. Moen



Patient Empowerment Work Group

Community-Based Care and Privacy (CBCP) Work Group; Orders and Observations Work Group; Patient Care Work Group

Status & Dates

Active

STU - Test Period/Accepting Comments

10/01/2020

05/01/2028

2028 May WGM/Ballot

05/01/2027

2027 May WGM/Ballot

2025 Sep Ballot Cycle Info: STU Ballot Results: Met basic vote requirements. 2 Negatives to reconcile Document Name: HL7 FHIR Implementation Guide: Advance Directives Interoperability (ADI), Release 1 - US Realm 2022 Jan Ballot Cycle Info: STU Ballot Results: Did not meet basic vote requirements. 21 Negatives to reconcile Document Name: HL7 FHIR Implementation Guide: Advance Directives Interoperability (ADI), Release 1 - US Realm (See Jira Ballot Dashboard)
Approvals

12/21/2020


Received


All Received




System Info



View Ballot Items (with NIBs)



04/09/2026

Anne Wizauer
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