The investigators seek to conduct a pragmatic trial including 2 sister clinical sites to test an innovation using a patient portal framework for Advance Care Planning. The intervention site implemented the intervention (secure patient portal delivered pre-visit planning framework for Advance Care Planning communication). The presence of ACP and the quality of documentation will be assessed through post-intervention chart review. Practice level enrollment was sought for the trial, and the framework will be delivered to all patients during a period of roll out. About 250 patients will receive the intervention.

The control site delivered usual care during the same period of roll out.

The intervention tested a pre-visit ACP workflow centered around a framework sent via secure Electronic Health Record (EHR)-linked patient portal in a real world clinical setting. The primary objectives were to determine its impact on frequency and quality of ACP documentation.

Presence of Electronic Health Record problem list based ACP documentation or presence of Electronic Health Record scanned completed Advance Directive document