By Eric Andrew Kristof, RN, CAHIMS | Healthcare IT Professional | HIMSS Arkansas Chapter Member
About This Series: The HIMSS Word of the Day is a running blog series drawing from the HIMSS Dictionary of Health Information and Technology Terms, Acronyms, and Organizations, 6th Edition (2025) — the authoritative reference for healthcare IT professionals and the primary study resource for CAHIMS and CPHIMS certification. Each post paraphrases the term in plain language, grounds it in real-world healthcare IT context, and adds a bedside nursing perspective you won’t find in a textbook.
📖 The Term: Advance Directive
Source: HIMSS Dictionary of Health Information and Technology Terms, Acronyms, and Organizations, 6th Edition (2025)
🔍 Plain-Language Definition
An advance directive is a legal document in which a person records health care wishes, names someone to make decisions on their behalf, or both, in case they later cannot make or communicate those decisions themselves.
The HIMSS Dictionary describes an advance directive as a document through which someone plans for health care decisions in the event they lose the ability to decide. It names two principal forms, a living will and a durable power of attorney for health care, and notes that hybrid documents blend elements of each.
| Document | What It Does | Who Signs It | When It Applies |
|---|---|---|---|
| Living Will | States which treatments the person would want or refuse, such as mechanical ventilation or tube feeding | The patient | When the patient cannot communicate decisions |
| Durable Power of Attorney for Health Care | Names a health care agent or proxy to make decisions | The patient | When the patient lacks decision-making capacity |
| Combined Directive | Includes both treatment wishes and an agent | The patient | When the patient cannot decide |
| POLST (Portable Medical Order) | Converts current wishes into actionable medical orders for seriously ill or frail patients | A clinician, with the patient or decision-maker | Immediately, across settings |
| Code Status Order | Directs the care team on resuscitation in the current encounter | A provider | During the current admission or episode of care |
⚠️ Exam Alert: An advance directive is a legal document completed by the patient. A POLST form is a medical order signed by a clinician, intended for people with serious illness or frailty. A code status or DNR order is an order in the current record, often informed by the advance directive but separate from it. Advance care planning is the process of discussing and documenting future care preferences. Expect a scenario asking which one clinicians can act on immediately.
🌐 Why It Matters: Real-World Healthcare IT Context
Advance directives only work if they exist, are current, and can be found when needed. Many adults have never completed one: a 2017 study in Health Affairs by Kuldeep Yadav and colleagues estimated that only about one in three U.S. adults has completed any type of advance directive for end-of-life care.
Federal rules set baseline duties for organizations. Under the Patient Self-Determination Act, implemented in Medicare regulations at 42 CFR 489.102, hospitals, skilled nursing facilities, home health agencies, hospices, and certain other providers must maintain written policies on advance directives, inform adult patients of their rights under state law, document in a prominent part of the record whether the patient has executed an advance directive, and not condition care on whether one exists.
Health IT determines whether those documents are useful. A scanned PDF filed under a generic category in an encounter from years ago is technically “in the chart” but practically invisible during a rapid response. Strong designs make advance directive status visible in the patient header, link to the current document, and connect it with code status orders and advance care planning notes. Patient portals can let patients upload documents themselves, and some states and organizations offer registries. Standards work is also underway to make advance directive information exchangeable between systems rather than locked in scanned images.
Common problems with advance directives in practice:
- Documents completed but never given to the hospital or primary care practice
- Scanned files with unclear labels or buried in old encounters
- Outdated documents that no longer reflect the patient’s wishes
- Code status orders that conflict with the patient’s documented wishes
- Health care agent contact information missing or outdated
- No process to carry documents across care transitions
Characteristics of strong advance directive workflows:
- A clear indicator in the patient header showing whether a directive is on file
- Consistent document types and scanning standards
- Structured fields for health care agent name and contact information
- Advance care planning notes that are easy to find and update
- Regular review of code status at admission and with major changes in condition
- Patient portal options for uploading and reviewing documents
🏥 The Nurse’s Perspective: Clinical, Bedside, & Workflow
Nurses are often the ones who first ask about advance directives and the ones who must find them when time is short.
At the Bedside
On admission, nurses ask whether the patient has an advance directive and whether a copy is available. That question meets the documentation requirement, but it also opens a conversation. Nurses can explain the difference between a living will and a health care agent, encourage patients to bring copies, and notify the appropriate team when a patient wants to complete or update a directive.
During a sudden decline, the question becomes urgent. Nurses need to see the current code status order instantly and know whether a health care agent should be contacted. A header banner that shows code status and directive status can save critical minutes.
In Clinical Workflow
Conflicts between documents and orders need attention. If the advance directive refuses intubation but the code status order says full code, or the family describes wishes that differ from the document, nurses escalate to the provider and, when needed, to palliative care, ethics, or social work.
Care transitions carry risk as well. When a patient moves to a nursing facility or home with hospice, the POLST form, advance directive, and code status need to travel with the patient so the next team can honor the same wishes.
In EHR Implementation (Go-Live Perspective)
During an Epic Go-Live, advance directive documents scanned in the legacy system must be migrated or made available, and teams decide how directive status, code status, and health care agent information appear in the new header and navigators. If those decisions are not tested, nurses may find that documents exist but are hard to locate.
At-the-elbow support analysts often help nurses find the advance directive section, scan new documents into the correct category, and update code status through the right order. Clear tip sheets for these tasks are among the most useful Go-Live materials for nursing units.
🎓 CAHIMS / CPHIMS & HIMSS Perspective
CAHIMS Exam Domain Mapping
Advance directives connect patient rights, documentation, and interoperability:
| CAHIMS Domain | How Advance Directives Appear |
|---|---|
| Healthcare & Technology Environments | Patient Self-Determination Act; patient rights; state law variation; end-of-life care trends |
| Clinical Informatics | Code status workflows; advance care planning documentation; header and alert design |
| Healthcare Information & Systems Management | Document management, scanning standards, data migration, exchange across settings |
| Management & Leadership | Policy compliance, ethics and palliative care partnerships, quality monitoring |
Key Terms to Know Alongside Advance Directive
- Living Will — a document stating which medical treatments a person would or would not want if unable to communicate
- Durable Power of Attorney for Health Care — a document naming a health care agent to make decisions when the person cannot
- POLST — a portable medical order that translates a seriously ill patient’s treatment preferences into actionable orders
- Code Status — the order that defines whether and how resuscitation should be attempted
- Advance Care Planning — the process of discussing and documenting a person’s values and future care preferences
- Patient Self-Determination Act (PSDA) — the 1990 federal law requiring many providers to inform patients of their rights regarding advance directives
HIMSS Organizational Position
HIMSS addresses advance directives as part of patient-centered care and interoperability, including the challenge of making patient preferences available across settings. Its Nursing Informatics Community focuses on documentation that supports patient wishes at the bedside. Members can find related education and research through the HIMSS Resource Center.
🔗 Explore Further: External References
- National Institute on Aging — Advance Care Planning: Advance Directives for Health Care https://www.nia.nih.gov/health/advance-care-planning/advance-care-planning-advance-directives-health-care
- National POLST Collaborative https://polst.org/
- eCFR — 42 CFR 489.102, Requirements for Providers (Advance Directives) https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-489/subpart-I/section-489.102
- Yadav et al. (2017), Health Affairs — Approximately One in Three US Adults Completes Any Type of Advance Directive https://pubmed.ncbi.nlm.nih.gov/28679811/
- HIMSS — Nursing Informatics Community https://www.himss.org/networking/communities/nursing-informatics/
Term source: HIMSS Dictionary of Health Information and Technology Terms, Acronyms, and Organizations, 6th Edition (2025). All definitions in this series are paraphrased for editorial purposes. Readers are encouraged to consult the primary source for exact language.
Eric Andrew Kristof, RN, CAHIMS is a Healthcare IT professional and HIMSS Arkansas Chapter member based in Hot Springs Village, AR, with hands-on Epic Go-Live experience and a diverse healthcare and IT background. He writes at kristof.org at the intersection of clinical care and healthcare technology.
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