we don't have information, that's always what we're going to do."

Tebaldi said although the Legislature did not specify a statutory launch date for the Web site, the DOH hopes the system will be operational by spring 2007.

Small Town, Big Ideas

Many in the health field recognize Missoula, Mont., and its Choices Bank as pioneers of the advance directive movement. Choices Bank is a registry that lets people deposit advance directives and makes them available via a secure Web site.

Choices Bank was developed in 1992 by the St. Patrick Hospital and Health Sciences Center's Information Services Department. "It's been hugely successful," said Judy Gustafson, coordinator of Pain and Palliative Care Services at St. Patrick, adding that thanks to a strong push for community education, the registry now counts more than 5,000 directives.

Individuals can register by bringing their advance directives to any of 20 locations in west Montana. The bank accepts all directives as long as they conform to state law.

"In Montana, a directive is recognized as a legal document if it is witnessed by two individuals who aren't otherwise named in the document," Gustafson explained, adding that theoretically Choices Bank would accept a directive on a napkin as long as it respected signature requirements. Those who don't wish to go to these lengths can download a basic advance directive form -- the My Choices Form -- from the Choices Bank Web site.

Once received, the directive is scanned into a database, along with a deposit and release form, and the original document and signatures can be viewed online shortly thereafter.

"It takes maybe 5 minutes," said Gustafson of the scanning process, "then the original document is sent back to the individual depositing the directive along with the wallet card, and directions."

The wallet card bears a code physicians enter in the Web site to rapidly access an advance directive, and it is recommended that individuals keep the card with them at all times.

The deposit and release form addresses security concerns by offering two levels of privacy. At the standard level, Gustafson explained, advance directives are accessible via the Web site to anyone with a person's mother's maiden name, date of birth and Social Security number, or with the wallet card information. The higher privacy level allows only those with the wallet card information to access the directive.

Moreover, to allow access in case of a missing or damaged card, doctors and health-care providers of participating hospitals can log on to the database with a special permission code and match a patient with some pertinent information -- Social Security number, address, etc.

In addition, Gustafson said if an unauthorized person accessed the database -- which is encrypted by the same technology that banks use to maintain customer privacy -- he or she would not be able to make any changes. The latter can only be made by submitting a new directive, deposit and release form via the same channels as the original registration.

"The beauty of having an Internet site is if the person were traveling out of state and were in some kind of car accident, as long as they had their wallet card with them -- and say they're in California, but their residence is Montana -- the hospital in California could pull out that wallet card and have access to that advance directive," Gustafson said. She added that although the database was originally designed for Missoula residents, it has welcomed several out-of-state participants.

In light of the bank's positive results, other states have looked to Missoula when considering implementation of similar programs.

Vermont, for instance, recently signed legislation to launch an online registry, and directed its health department to

Corine Stofle  |  Staff Writer