FAQ by Hospitals and Health Care Providers
These are questions frequently
asked by Health Care Providers, for more general FAQ, click
here.
Questions Frequently Asked By Health Care Providers:
1.
How did the Registry come about?
Over the course of his professional career, Dr.
Barmakian noticed how many times family members agonized over
end-of-life decisions for their loved ones.
In many instances, an advance directive had been prepared,
but it could not be found or was not available when it was needed.
Unable to make a decision, most families told the doctor to
“do everything you can.”
This course of action usually resulted in a prolonged, often
painful, death for their loved one. Because laws regarding advance directives vary from state to
state, there is no single agency or organization responsible for
maintaining a centralized registry.
Frustrated by these circumstances, Dr. Barmakian started the
U.S. Living Will Registry® in 1996.
After extensive legal background work and in consultation
with attorneys who represent hospitals, the Registry was developed
and thoroughly tested before actually beginning operations.
During the past fifteen years, feedback has been
obtained from hospital attorneys, community attorneys, patient
representatives, social workers, chaplains, admissions officers,
medical records directors, nurses, doctors, organ transplant
organizations, registrants, family members of registrants, nursing
home directors, hospice directors, directors of home health
organizations, visiting nurses, and hospital administrators as well
as people interested in improving end-of-life care in America.
Based upon this feedback, improvements in the Registry and in
the registration process have been implemented, including full
Internet service and the Living Vault®
service (see below).
In so doing, the Registry is now optimally situated to fulfill its
mission of making people’s health care choices available whenever
and wherever they are needed.
2.
How does the Registry help health care providers
comply with federal
regulations regarding advance directives?
Health care providers (hospitals, doctors, skilled nursing
facilities, nursing facilities, home health agencies, providers of
home health care, and hospices) are required by
federal law to inquire as to whether any patient has an advance
directive and, if so, to obtain a copy of the document and place it
in the medical record. Providers are also required to supply
information to patients and to the community about advance
directives. The law specifically allows health care providers to use
outside agents to help comply with these regulations.
Health care providers have had a difficult time managing
advance directives at their institutions.
Filing, storing, retrieving, updating and trying to determine
if an old document is still valid, are among the problems
confronting providers.
U.S. Living Will Registry solves all of these problems.
The Registry provides a way for providers to obtain up to
date advance directives 24 hours a day through its automated
service. In addition, the Registry provides educational material
about advance directives and helps providers satisfy the community
education requirement of the federal law. The Registry also
eliminates the need for health care providers to maintain their own
storage systems for advance directives, and because the Registry
contacts each registrant annually to confirm that their choices have
not changed, hospitals can be assured that the document they receive
is up to date. The Registry also provides emergency contact
information and in most instances, organ donor information, both of
which can be very helpful to hospital personnel. The Registry will
log all access to documents and will provide reports to satisfy your
compliance requirements.
3.
What do lawyers think about the Registry?
Lawyers who review the Policies & Procedures and the Registration
Agreement are always very enthusiastic about the service. The
Registry answers the question most frequently asked attorneys about
advance directives: "Where should I keep my advance directive?"
Lawyers view this service as complementary to the service they
provide in helping people prepare their directives; they consider it
a value-added service they can offer to their clients. You can
read comments from attorneys who use the Registry by going to the "Testimonials"
page.
4. What about
people who speak only Spanish?
The Registry has prepared Spanish translations of the information
packet and the Registration Agreement. Those who register with
the Spanish Registration Agreement, automatically receive Spanish
versions of the confirmation letter and annual update letters.
Visit Español
to view the Spanish version of the educational pamphlet and to
download a pdf version of this translation.
5. What is the Living Vault®,
and how does it work?
The Living Vault® service allows
member Health Care Providers to store and retrieve advance
directives not accompanied by a Registration Agreement. The
Registration Agreement is an agreement between the U.S. Living Will
Registry and the registrant, that authorizes the Registry to send a
copy of their advance directive to ANY health care provider.
Documents without a Registration Agreement submitted to the Registry
by Providers are stored in that Provider's Living Vault®.
These documents are stored so that they are only accessible by the
originating Provider. Thus, the Living Vault®
is like an extension of the Provider's medical record department.
Members of the same health system are considered the same Provider,
making it easy for different facilities within the same system to
share advance directives. The Living Vault®
also allows Providers to manage ALL of their advance directives
through the Registry. They can register the backlog of advance
directives they already have stored in their records department, and
can also submit documents they receive from the admitting
department, regardless of whether or not the patient signs the
Registration Agreement. The Living Vault®
service allows Providers to utilize the Registry as a comprehensive
and economical way to manage ALL of their advance directives.
There is a U.S. Patent protecting the Living Vault®
methodology.
6. What happens when a health care provider other than
the originating provider tries to access a document from a Living
Vault®?
The answer to this question depends on state law. In
general, a provider other than the originating provider seeking a
document from a Living Vault® is
shown a message indicating that the document exists, but is not
accessible, and giving the inquiring provider the location of the
document so that they can contact that provider directly to obtain a
copy. Some states make it a crime to withhold an advance
directive. In these states, documents stored in a provider's
Living Vault® are released to other
providers. The system is sophisticated and flexible enough to
allow access to be restricted by state or by particular facilities
within a health system.
7. Is there a special way to access documents in a
Living Vault®?
No. Providers access all documents in the same way.
They simply input the name and birth date or social security number of the patient about
whom they are inquiring. The Registry's computer determines
whether or not a particular provider has access to a particular
document, and responds accordingly.
8. How reliable is the Registry?
The Registry's systems reside in a state of
the art, secure, climate controlled data center, complete with
multiple internet sources, multiple power sources and back-up
generator power as well as constant monitoring. Daily on-site
and off-site data backups are performed. The data center
offers "five 9s" (99.999%) reliability, and in the rare case of an
outage, documents can be accessed via telephone/fax by calling the
Registry.
9. How do medical
personnel know when to access the Registry?
Each registrant is given labels to place on their insurance card
and driver's license stating that they are registered, and a wallet
card listing their Registration number. However, medical
personnel do not need to see these labels or card in order to
utilize the Registry. Health care providers can search the
Registry's database using the patient's name and birth date or
social security number. Because the Registry provides emergency contact
information as well as advance directives, hospitals can use the
Registry in order to reach the family members of unconscious or
incoherent patients who are unable to communicate when admitted.
10. What safeguards to registrants' privacy does the Registry
have in place?
The Registry is very sensitive to the privacy
of our registrants and to the confidentiality of the information and
the documents they register with us. We are committed to maintaining
this privacy and confidentiality.
The Registry utilizes 128 bit encryption when transmitting documents
over the Internet, and access to the Registry's system is password
protected.
Once the document is transmitted to the health care provider, it
is immediately placed in the confidential medical record. Law
protects the privacy of medical records. Our agreement with each
registrant clearly states "Registry is not authorized to share my
personal information with parties other than health care providers."
The Registry does not share or sell personal information to
any outside parties.
11.
Is the Registry HIPAA compliant?
The Health Insurance Portability and Accountability Act of 1996
(HIPAA) mandated regulations that govern privacy, security, and
administrative simplification standards for health care information. The Registry is not a covered entity under the HIPAA regulations.
The Registry voluntarily complies with HIPAA regulations, and will
enter into Business Associate/Chain of Trust Agreements with member
Health Care Providers. The Registration Agreement
signed by each registrant of the U.S. Living Will Registry
authorizes the Registry to provide a copy of the registrant’s
advance directive to health care providers.
The Agreement also restricts the Registry from providing
advance directives or personal information to parties other than
health care providers.
Registry staff are required to sign a confidentiality agreement. In
addition, the Registry maintains a log of date, time, where and to
whom each document is sent. This information is available to
member Health Care Providers through a custom report feature on the
"Health Care Providers" web page. These reports are a great
way to document your facility's compliance with HIPAA, and to comply
with state and federal regulations regarding advance directives.
12.
What is the Source Code?
The Source Code is an 8 digit
number that identifies the member Health Care Provider or Community
Partner through which that particular document is being registered.
All documents must have a Source Code to be accepted by the
Registry for registration. Custom confirmation and annual
update letters are generated for each registrant based on the Source
Code. These letters specifically identify the member Health
Care Provider or Community Partner that allowed the registrant to
register free of charge. This is an ongoing source of goodwill
and marketing for your organization or business. In addition,
the Source Code allows the Registry to generate reports for each
member Health Care Provider and Community Partner, detailing how
many documents were registered through them. Member Health
Care Providers can also receive reports of specific access/retrieval
information for their facility.
13.
How does the Registry fit in with our hospital's electronic medical
record system?
While most electronic medical
records systems store the entire record, including the advance directive, there
are problems with documents stored in this manner. There is no way of
knowing if the document on file is the most recent document, or if it has been
revoked or changed. If the document is old, there is no way of being sure
that the document still reflects the patient's wishes. Individual
documents are not easily retrieved from the electronic record. The U.S.
Living Will Registry operates as a menu item application that works with any
electronic medical record system. By utilizing the Registry, hospital
personnel can not only access documents stored from their own patients, they can
also access the Registry's entire database of documents.
14. Why is
the annual update important?
By their very nature, advance directives are prepared well in
advance of when they may be needed. If a document has not been
updated for several years, there could be legitimate doubts as to
whether it still reflects the patient's wishes. Hospital
attorneys were concerned about the age of the advance directives
they would receive from the Registry, and whether or not the
documents were still valid. The Registry attempts to contact each
registrant every year to confirm that their advance directive has
not been changed or revoked.
The date of this latest update is recorded on the coversheet
sent to the provider along with the advance directive. In this way,
providers can be assured that the document they receive is current,
up to date, and still reflects the patient's wishes. Personal
information and Emergency Contact Information are also updated at
this time.
15. How are different health care providers utilizing the
Registry?
With the Living Vault® service,
Providers are now able to register ALL of their advance directives.
This allows the Registry to serve as a comprehensive system that
provides an efficient and economical way to manage advance
directives at a facility and across an entire health system.
With the Living Vault®, documents
can easily be shared among all of the different institutions within
a health care system. So hospitals, nursing facilities,
hospices, ambulatory care centers, home health agencies and medical
offices can all access each others Living Vault®
documents.
16. What does our
facility have to do to start using the Registry?
Any health care provider can access the Registry to request an
advance directive by calling 1-800-LIV-WILL.
Your facility can do that now.
However, only member providers can use the automated service.
Non-member providers must leave a voice message with
information about their facility and the patient about whom they are
requesting information.
Once the information is confirmed by the Registry, the document is
manually transmitted. Member providers can access the
via secure Internet to request advance
directives and can obtain documents and emergency contact
information in a matter of seconds.
Also, only member Providers can submit documents to the Registry for
storage. To become a member provider,
click here.
17. Can
hospital personnel access the Registry easily?
Yes. Our technical staff
will set up your facility so that personnel who are authenticated
onto your hospital computer system, will automatically be
authenticated to access the Registry. A privilege level system
is available to assign different privilege levels to different
personnel. The system can also accommodate access by ancillary
facilities and doctor's offices.
18.
Can we transfer the advance directives we now have on file to
the Registry?
Yes. With the Living Vault®
service, member Health Care Providers can register documents WITHOUT
a signed Registration Agreement. This means that you can
register all of the documents you currently have filed in your
record room, as well as all new documents you receive, including
those from patients who choose not to sign the Registration
Agreement. With the Living Vault®,
you can manage ALL of your advance directives efficiently and
economically.
19. Can providers send a
copy of the Registration Agreement to the Registry along with a
copy of the advance directive?
Yes, copies of advance directives and Registration Agreements are
acceptable.
20. How do we send documents to the Registry?
Hospital staff can upload documents to the
Registry by scanning the document and entering basic identifying
information.
You can also send the documents to the Registry for uploading. There
are 3 ways you can send documents to the Registry for registration: 1)
mail--you can send us bulk mailings at the end of the day or week, 2) fax--each
person's document can be faxed to the Registry...this is a great way for the
admissions department or the medical records department to send documents as
patients are admitted or as their medical records are filed upon discharge, 3)
as an electronic submission...either as an attachment to an e-mail (the Registry
will set up a secure e-mail account so that you will maintain privacy during
document transmission), or by CD or tape. Electronic submissions must be
in pdf format with each person's document as a separate file.
This is a good way to send us documents you have in storage in your
medical records department.
21. What does the Joint Commission on Accreditation of
Health care Organizations say about using the Registry's system to
manage advance directives?
We asked the JCAHO to comment on the use of the Registry's system
as part of a hospital's overall advance directive policy. The
response from the JCAHO's attorney can be viewed by clicking here:
JCAHO.
22. Once we decide to
become a member of the Registry, what should we do?
Obtain a Membership
Agreement from the Registry by
calling,
faxing, e-mailing or writing to us. Complete the
Membership Agreement and return it with your payment. We will
provide you with an invoice, our tax ID # and any other information
you may need. We will activate your ID number
and Access Codes immediately. Our technical staff will
communicate with yours to set up the appropriate security measures
to allow for access by your employees.
Should you think of any other questions, please e-mail us at
admin@uslivingwillregistry.com
or call 908-654-1441.
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