Compassion and Support
JANUARY 2016
eMOLST Growth & Enhancements in 2015

By Katie Orem, MPH, eMOLST Administrator

In 2015 we deployed many important updates to the eMOLST application available at NYSeMOLSTregistry.com. Several were improvements to guarantee the security and accessibility of the application; we also provided many enhancements based on user experience. We are thrilled to continually improve eMOLST based on our users' feedback. Some of the most-requested improvements that were made in 2015 include:

1. Improved speed. A major update in the summer of 2015 made eMOLST perform faster. Our users love it. We also installed an additional monitoring device on the website to ensure we can more easily identify areas where performance can be continually improved.

2. Better workflow. Providers wanted the ability to quickly and easily share patients with their clinical team. We first launched some workflow tools in 2014 and in 2015 we upgraded them to help streamline the team-based approach that’s used for eMOLST completion. See our refresher video on the workflow tools here.

3. Fuzzy Search. Providers wanted to make sure that they weren't overlooking a patient's possible eMOLST orders because they slightly mis-typed the person's name. Implementing fuzzy search allows clinicians to see if a patient that closely matches their search and determine if that patient is the correct one. As always, providers maintain the ability to create a new patient in eMOLST if their patient is not listed in the search results.

4. Embedded education. eMOLST provides just-in-time education. In 2015 we added links to short excerpts from the 2015 Revised MOLST Video at various points in the application where they are relevant - mainly key areas of the discussion and MOLST orders sections. All of these videos are also available in our MOLST Videos - Revised 2015 YouTube Playlist.

If you're a current user with questions or a suggestion, or are interested in getting started with eMOLST, please email Dr. Bomba and me at patricia.bomba@lifethc.com and katie.orem@excellus.com

For more information and to review eMOLST startup documents, please visit NYSeMOLSTregistry.com.

Thank you for your continued use and support of eMOLST!

Featured Resource: Webinar for Providers on New CPT Codes for ACP

New CPT codes have been established for advance care planning & end-of-life/MOLST discussions with patients & families. Learn the required elements of these conversations and how to bill for them in a webinar hosted by Excellus BlueCross BlueShield on February 2, 2016 from 8:00-9:00am. Register for the webinar here.

MOLST FAQ: What Are the New CPT Codes for ACP?

On 1/1/16, CMS began reimbursing for ACP discussions using these 2 CPT codes:

99497 for an initial 30 minute voluntary advance care planning consultation
99498 as an add-on code for additional 30 minute time blocks needed

For more information on these codes, view the Advance Care Planning code section of CMS' final rule, or register for the webinar mentioned above taking place on 2/2/16 from 8-9am.


eMOLST Champion:
Iroquois Nursing Home

Iroquois Nursing Home, based outside of Syracuse, has been utilizing electronic medical records for several years. By mid-2014, the MOLST was one of the few remaining aspects of the paper chart. As part of our commitment to fully electronic charts, and to embrace technological advances in the field, Iroquois decided to implement eMOLST for both their long-term and rehab residents during the summer and fall of 2014.

In an effort championed by Leigh Hilgenberg, LMSW, Director of Social Services, Dr. Richard Lockwood, Iroquois' Medical Director, Dr. Ajaz Shawl, Attending Physician, the Iroquois' Leadership Team, and the Nursing and Health Information Management Departments rallied together to commit to eMOLST implementation.

Leigh Hilgenberg said, “Iroquois’ has a strong commitment to ensuring that residents' end-of-life wishes are discussed and honored, and that they are documented timely, accurately, and correctly. eMOLST has helped Iroquois facilitate an optimal process for end-of-life discussions and completion of MOLST orders.”

Dr. Lockwood, stated "The eMOLST is a game changer. It is clear and comprehensive. It is available anywhere and doesn't get lost."

Dr. Shawl echoed Dr. Lockwood’s comments and added, “eMOLST also can be incorporated in the EMR. It is easy to make changes to the orders and everything is time and date stamped. It’s very secure and being web-based means it is accessible anywhere there’s internet access. Eventually we hope it will also be a part of the statewide RHIO network, so it can be accessed everywhere.”

Katie Orem, eMOLST administrator, noted that “Iroquois has been an awesome partner in this work. They are focused on using eMOLST to have good discussions. They have also been great at identifying areas for improvements to the eMOLST application. We always appreciate hearing about the experience of our end users so we can optimize the application.”

IPRO Launches Successful "Transforming End-of-Life Care Initiative"

By Patricia A Bomba, MD, FACP

IPRO hosted a successful launch of the "Transforming End-of-Life Care Initiative" on January 19. The IPRO Learning & Action Network Conference, “Transforming End of Life Care: Implementing MOLST and eMOLST Across the Healthcare Continuum” was attended by 130 clinicians from Nassau and Suffolk counties. I was honored to educate attendees on the MOLST program and introduce eMOLST. Janet Dolgin, Esq. described the CHAT Project (Conversations: Health and Treatment.) Attorney Dolgin is Director, Gitenstein Institute for Health Law and Policy, Hofstra University School of Law.

As a follow-up to the conference, IPRO is hosting a free two hour webinar, “Digital Transformation of NY MOLST: An End-of-life Care Transitions Program on February 2. The webinar will provide an overview and demonstration of eMOLST. Attendees are encouraged to invite colleagues and facility leaders to participate in the learning session to view the demonstration of eMOLST to support the team in moving forward with a community-wide approach to advance care planning.

Both the Nassau District and Suffolk District of the New York Chapter of the American College of Physicians (NYACP) are partnering with IPRO to each present an educational program, “Care of the Elderly.” Each session will begin with registration and a viewing of the PBS Frontline Documentary Being Mortal with Atul Gawande MD MPH and include my presentation “Digital Transformation of New York MOLST: An End-of-life Care Transitions Program.” Julie Winokur, Executive Director, Talking Eyes Media will speak on “The Sandwich Generation” as part of the Nassau District meeting.

A palliative care panel discussion will follow. District members of NYACP will serve as panelists. In Nassau County, joining me are Maria Carney, MD, FACP and Julie Winokur. Panelists in Suffolk County include Jeffrey Berger, MD, FACP, Jay Slotkin, MD, FACP, David Siskind, MD, DABFP, CMD, Lynn Hallarman, MD and Jennifer Heinemann, LMSW.

Maria Carney, MD, FACP, Chief, Division of Geriatric and Palliative Medicine, Northwell Health and member of the Executive Committee of the MOLST Statewide Implementation Team. Jeffrey Berger, MD, FACP is Director of Clinical Ethics, Winthrop-University Hospital. Jay Slotkin, MD, FACP, Physician, East End Geriatric & Adult Medicine. David Siskind, MD, DABFP, CMD is Medical Director, Gurwin Jewish Nursing & Rehabilitation Center. Lynn Hallarman, MD is Director of Palliative Medicine Services and Jennifer Heinemann, LMSW is a Palliative Medicine Social Worker; both are at Stony Brook Medicine.

IPRO, NY-based leader of the Atlantic Quality Improvement Network (AQIN), has received special funding from the Centers for Medicare & Medicaid Services (CMS) for the “Transforming End-of-Life Care Initiative,” a two-year project that will provide technical support to healthcare providers throughout the length of the project, in order to facilitate the adoption, training in and implementation of eMOLST.

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