A Statewide Advance Care Planning Ecosystem Built on Nationwide Infrastructure
All too often, advance care planning (ACP) documents are unavailable during emergencies and transitions of care, meaning a patient’s treatment preferences and goals of care may not be known when decisions matter most. MyDirectives works with states to deploy interoperable ACP infrastructure that supports statewide registries within a trusted, nationwide ecosystem. Together, we align secure registry infrastructure, workflow-integrated clinical access, operationalizing engagement education and consumer capabilities that enable individuals to create, upload, store, and share ACP documents. Advance directives, portable medical orders such as POLST and DNRs, and mental health advance directives (MHADs) are accessible to clinicians, EMS, emergency care teams, and community paramedicine organizations delivering care in the field at the moment care decisions are made.
When Advance Care Planning Is Built in Silos, States Fall Behind
For over 25 years, states have invested in ACP with strong intent, but almost all of them still struggle to ensure ACP documents are available whenever and wherever care decisions are made.
Common challenges include:
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Statewide registries that are either nonexistent or built as standalone, closed systems reliant on toll-free numbers and fax machines, with limited interoperability
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ACP documents that are inaccessible during transitions of care
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Inconsistent document availability for EMS, Fire, and emergency care teams
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Fragmented adoption across hospitals, post-acute care providers, and community settings
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Little to no buy-in or support from health plans, who are best equipped to drive behavioral change across both their members and healthcare providers
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Programs that do not scale beyond initial funding or pilot phases
As expectations from CMS and the broader healthcare ecosystem continue to rise, these gaps create growing clinical, operational, and policy risk.
How MyDirectives Changes That
MyDirectives provides interoperable, statewide ACP infrastructure built on a trusted, nationwide ecosystem. Leveraging the combined power of the A|D Vault Exchange™, MyDirectives for Clinicians™, MyDirectives Academy™, MyDirectives.com digital consumer platform, and MyDirectives Reports & Analytics™, this approach allows states to move beyond siloed registries and ensure ACP documents are accessible across care settings, during transitions of care, and in emergencies.
Interoperable Connected Registry
A modern statewide ACP document registry built on trusted, nationwide infrastructure. For over 15 years, the A|D Vault Exchange has enabled secure storage and seamless, industry standards-based exchange of ACP documents, including advance directives, portable medical orders such as POLST and DNR forms, and MHADs, without creating siloed systems.
Point-of-Decision Availability
Ensures ACP documents are available when and where care decisions are made, including during transitions of care and emergencies. Through MyDirectives’ multi-layered integrations with EHRs, state, regional, and national health information exchanges, 9-1-1 dispatch infrastructure, and electronic patient care records (ePCRs), ACP documents are accessible within clinical workflows to clinicians, emergency care teams, EMS, Fire, and community paramedicine organizations delivering care in the field, supporting timely, patient goal-concordant and medical order-concordant decisions.
Equity and Access Across the Care Continuum
The MyDirectives.com digital consumer platform allows individuals to create, upload, store, and share ACP documents, ensuring their personal treatment and intervention preferences and goals of care are accessible across care settings throughout the state and beyond. This helps reduce gaps in availability that disproportionately affect rural and underserved populations.
What MyDirectives Delivers for States
Statewide ACP infrastructure that works in the real world.
Reliable Statewide Access
- Secure statewide registry for ACP documents that is HIPAA compliant, HITRUST and TX-RAMP certified, and SOC 2 Type II audited
- Access across care settings and transitions
- Available to EMS, Fire, emergency care teams, and community paramedicine organizations delivering care in the field
Interoperability Without Fragmentation
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Standards-based integration with EHRs, ePCRs, 9-1-1 dispatch infrastructure, and HIEs
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No siloed or duplicative systems
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Nationwide infrastructure with statewide control
Sustainable Governance and Oversight
- Supports HIE-led or state agency-directed models
- Preserves policy oversight and flexibility
- Reporting to support accountability and funding alignment
Funding and Implementation Support
- Alignment with federal and state digital health funding opportunities
- Implementation guidance to reduce risk and accelerate adoption
- Materials and presentations to support stakeholder engagement
The Financial and Operational Impact
States implementing infrastructure built on nationwide, standards-based architecture can:
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Avoid costly replacement of siloed, outdated, or underperforming registry systems
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Reduce long-term integration and maintenance burdens
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Align infrastructure with federal and state digital health funding priorities and opportunities
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Improve statewide adoption and accelerate return on investment through connected, workflow-integrated access
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Support accountability with reporting that demonstrates utilization and impact
Building interoperable infrastructure at the outset reduces implementation risk, accelerates stakeholder alignment, and protects funding by avoiding systems that cannot scale.
Built on Nationwide Infrastructure, Designed for Your State
MyDirectives delivers a trusted, complete nationwide ACP ecosystem that’s been market validated. States implement proven, interoperable infrastructure that delivers statewide registries while leveraging shared, standards-based architecture that connects across care settings and state lines.
The A|D Vault Exchange provides the secure registry infrastructure, MyDirectives for Clinicians enables workflow-integrated clinical access, and MyDirectives Academy supports clinical and community teams needing guidance on operationalizing ACP. The MyDirectives.com digital consumer platform supports consumer engagement and document creation, while MyDirectives Reports & Analytics helps health plans engage members, measure program effectiveness and network provider engagement, and ultimately test the impact of technology-driven ACP on cost and quality of care.
States should not build isolated systems if they want to achieve statewide impact. By combining nationwide infrastructure with state-level governance, MyDirectives enables durable, connected ACP ecosystems that are built to scale.
Explore a Statewide ACP Ecosystem
States can engage MyDirectives directly or through their state or regional health information exchange to explore implementation models aligned with policy, funding, and governance priorities.
Secure, Interoperable, Accessible.
MyDirectives offers the only digital ACP tools and interoperable cloud-based storage that is HITRUST Risk-Based, 2-Year Certified.
