explore best practices and funding options. The department conducted a survey among Choices Bank users and compiled the results in a January 2005 report.

The report indicated that 42 percent of the participants filed their first advance directives with the bank, and 97 percent of depositors were very to extremely satisfied with its services.

State Variations

Inspired by the success of this private-sector effort, Montana launched the End-of-Life Registry Program on March 14, 2006. In accordance with the Montana Legislature, the state Department of Justice (DOJ) oversees maintenance of the statewide database.

Joan Eliel, program specialist for the Office of Consumer Protection and Victim Services, a division of the DOJ, said the experience is both rewarding and refreshing for her department, which usually deals with the criminal element. "People are very excited about it, just very positive and thankful that we have provided this service," Eliel said.

Within the first month, nearly 270 people registered with the program -- a relatively large number considering Montana's small population.

The End-of-Life Registry applies the same principles as Choices Bank, in terms of process, security measures, availability of online forms and open search possibilities; however, it adapted the concept statewide.

In addition to the Web site, representatives are available to answer questions 24 hours a day. "During the day, most of the time, those types of phone calls would come in to myself," said Eliel. "When I am not here, I have a backup person; and when we're gone for the evening, it goes to our 24-hour help desk."

The Legislature appropriated the DOJ $80,000 for the project. Half of the funding went to designing the Web site, a task assigned to Montana Interactive, the exclusive provider of Web portals for the state. As a result, the End-of-Life Registry is integrated in the state's home page. The other half of the funding was allocated to community education and training doctors.

The registry, however, is facing unexpected expenses, Eliel explained. "[The registry] appeals more to probably an older population, and not everyone has a computer or can download the forms," she said. "So we are seeing an expense going out from the office, having to mail a lot of the forms. We're trying to determine what the costs of operation will be to continue this service," she said, adding that the DOJ was committed to the program and will go back to the Legislature for additional monies as needed.

In Arizona, the Advance Directive Registry was launched in May 2004 -- within a month of Gov. Janet Napolitano signing the bill mandating its creation. Two years later, the registry has more than 5,100 participants. The Office of the Secretary of State, responsible for the program, opted for a public-private partnership with the Hospice of the Valley to fund the state's database and avoid hard costs to taxpayers, according to Patricia Ohlerking, assistant director of Business Services within the Office of the Secretary of State.

"[The Hospice of the Valley is] helping to fund the position that's processing and doing the paperwork for this program," she said, adding that Hawaii-based vendor Healthcare Directive Partners manages the actual advance directive database and the scanning of directives for Arizona and several other states. According to the Arizona Secretary of State's Web site, the program costs approximately $60,000 annually.

The Arizona database functions much like Montana's, except that it does not provide an open search option to physicians dealing with a missing or damaged wallet card. Ohlerking explained that to ensure privacy, the Office of the Secretary of State decided that advance directives should only be viewed online by those with the wallet card information.

Although Arizona and Montana offer the service to individuals and

Corine Stofle  |  Staff Writer