Background: Palliative and End of Life Care (PEoLC) policy is increasingly acknowledging technology-mediated approaches to advance care planning (ACP) as a crucial enabler of care delivery that is concordant with patient wishes. However, there is a dearth of evidence on the extent of implementation and types of technology-based systems available

Aim: To map the implementation and use of Electronic Palliative Care Coordination Systems (EPaCCS) in health services across England.

Methods: We conducted a national online questionnaire survey of end-of-life care commissioners. We enquired about the current implementation status of EPaCCS, their role in information sharing, and their intended impact and monitoring measures, alongside requesting routine patient-level data relating to their use.

Results: Out of 135 geographical commissioning regions, 85 (63.0%) responded, with 57 (67.1%) having operational EPaCCS. Most operational systems (67%) did not support information sharing with care homes and social care providers. Most systems (68%) sought to facilitate goal-concordant care, although there was inconsonance between intended impacts and monitoring measures used. Common implementation challenges included healthcare professionals’ limited engagement and a lack of interoperability preventing sharing of ACP documentation. Only one-third of patients had an EPaCCS record at death. Where records were created, there was a limited recording of patient preferences and an over-representation of records created for people with cancer.

Conclusions: Widespread variation in technology-mediated ACP could exacerbate existing inequalities in PEoLC, with only a limited proportion of those who may be eligible for an EPaCCS record receiving one before death. Furthermore, current monitoring approaches impede efforts to understand the impact of EPaCCS and which characteristics of systems can best support care delivery. Future research is essential to understand if and how technology-mediated ACP can be implemented optimally in the delivery of PEoLC