Compassion and Support
JANUARY 2018
Combined Health Care Proxy and eMOLST Registry Bill Introduced

by Patricia A. Bomba, MD, MACP & Michael Paulsen, Esq.

Assemblyman Joseph Morelle has introduced new legislation (A9063) related to the eMOLST Registry, combining the prior eMOLST Registry legislation with a proposal to require the Department of Health (DOH) to develop an health care proxy registry. The bill defines “Medical Orders for Life Sustaining Treatment (MOLST)" under the Public Health Law and directs the Department to establish an electronic registry for health care decision medical orders and documents, placing both the eMOLST program and registry for health care proxies under one Health Care Decisions Document Registry. The bill has been referred to the Assembly Health Committee and currently has 14 co-sponsors, including a number of members on the Assembly Health Committee. Efforts to obtain sponsors in the Senate are underway. The introduction of this legislation is a significant step forward and will need the help of all MOLST supporters to continue to advance! In the coming months, we will be asking you to send letters of support to your local Senators and Assembly members.

The bill contains a critical provision that would require practitioners who complete a MOLST form to submit to the Registry within 14 days. By requiring health care professionals to submit completed MOLST forms to the registry, the bill will ensure the most current MOLST form is accessible in an electronic format, allowing for a patient’s end-of-life preferences to be followed as he or she moves through the health care system, facility to facility, physician to physician. Other states that have established MOLST (or POLST) registries have included mandatory submission as a necessary component of operating the registry. In efforts to support the submission of MOLST forms, the MOLST program has already developed optical scanning recognition system that simplifies the process for practitioners to submit paper versions of the MOLST to eMOLST.

Requiring the DOH to create a health care proxy registry is an important step. Promoting early advance care planning discussions and completion of health care proxies for all New Yorkers 18 years of age and older complements the thoughtful MOLST discussions and completion of the MOLST for seriously ill patients who might die in the next year. Access to a properly completed health care proxy is vital in completing a MOLST for patients who lack the capacity to make decisions that are well informed using a shared decision making model. It assures that end-of-life decisions are being made by the person the incapacitated patient trusts and is made by known wishes.

Featured Resource:
CompassionAndSupport YouTube Channel

These videos support New York’s population health approach to advance care planning. Playlists focus on the Five Easy Steps and personal stories to motivate early discussions and proper health care proxy completion for all adults 18 years and older. Additional Playlists focus on MOLST and eMOLST for seriously ill patients. The MOLST video provides a basic overview, while others illustrate the proper completion of the MOLST using the 8-Step MOLST Protocol and how to complete each item on the MOLST form.

MOLST FAQs

The MOLST FAQs were revised in collaboration with the NYSDOH to address the common questions related to MOLST and NYS Public Health Law (NYSPHL) after Family Health Care Decisions Act became law. Additional questions related to the clinical application of the MOLST program are often raised in emails and phone calls. Please review the FAQs. Share what is confusing and or missing from both an ethical-legal and clinical perspective. Email Patricia.Bomba@lifethc.com.


eMOLST Champion: Call9

Call9 delivers bedside emergency medicine and palliative care to patients in skilled nursing facilities; Call9 is currently focused on serving facilities in NYC, Long Island and the Hudson Valley and is rapidly expanding. The company has treated more than 4,000 patients since its founding in July 2015. Shortly after Call9 began delivering care, the leadership realized they needed to build out a palliative care team. Dr. Claritza Rios, a triple Board Certified physician (palliative, emergency and internal medicine), was hired as the Director of Palliative Care and identified eMOLST as a critical tool to employ when serving Call9’s patients. Dr. Rios understood that eMOLST is an excellent tool for palliative care discussions that are done via telemedicine, which is part of Call9’s care model.

"The eMOLST registry allows the provider to focus on supporting patients and families as they navigate a complicated system while experiencing chronic illness," said Rios. "The user-friendly registry supports real time documentation and the opportunity for medical orders to be seen and followed by all providers with access to the system. Simply put, the registry makes it easy to do the right thing."

“Working with the Call9 team to implement eMOLST in SNFs on Long Island enabled us to see firsthand how effectively eMOLST can be used in Palliative Care consultations conducted via telemedicine, adds Carolyn Kazdan, MHSA, NHA, Assistant Director, Health Care Quality Improvement, IPRO. “Partnering with Call9 on education of leadership and facility staff helped break down silos and build cohesive teams focused on capturing what matters most to patients at or approaching the end of life.”

eMOLST has been used with hundreds of seriously ill Call9 patients in nursing homes across downstate NY. In December, Call9 moved into ArchCare at Ferncliff Nursing Home and Rehabilitation Center in Rhinebeck, NY, and the company is expanding its footprint throughout the state. As they grow, Call9 is committed to utilizing eMOLST for appropriate patients to improve their lives and the lives of their loved ones.

Next Steps on New Nurse Practitioner Law

by Patricia A. Bomba, MD, MACP

The MOLST form and program have been reviewed annually with the New York State Department of Health since 2005. Significant changes have been made to the MOLST form since the MOLST program was first implemented in 2004. The MOLST form has been modified over time to comply with New York State Public Health Law and to meet current patient and provider needs based on feedback from physicians and other clinicians across New York.

The Nurse Practitioner law goes into effect on May 28, 2018; for additional information on the Nurse Practitioner law, please read the December 2017 NY MOLST Update. The amended New York State Public Health Law will require a review and modification of the MOLST form and supporting educational and implementation materials, as well as eMOLST. This provides an opportunity to examine feedback from those who participate in thoughtful MOLST discussions within scope of practice and complete the MOLST, as well as clinicians who interpret the MOLST in an emergency.

The New York State Department of Health MOLST form (DOH-5003) updated in June of 2010 uses plain language to make it more user-friendly and to conform to the procedures and decision making standards set forth in the Family Health Care Decisions Act (FHCDA.) The current MOLST form includes seriously ill patient preferences for life-sustaining treatment in an emergency, including resuscitation preferences, intubation and mechanical ventilation, and hospitalization. MOLST also addresses treatment preferences that permit treatment of the patient in their preferred site of care 24/7 supported by a person-centered, family-oriented palliative care plan.

At the same time, the New York State Department of Health MOLST Checklists, OPWDD MOLST Legal Requirements Checklist for Individuals with Developmental Disabilities, MOLST Adult General Instructions & Glossary and Frequently Asked Questions were developed. MOLST Chart Documentation Forms were designed to align with the New York State Department of Health MOLST Checklists and provide space to document ethical-legal requirements listed with each specific Public Health Law. The Department of Health MOLST web page was created and the MOLST Training Center located on CompassionAndSupport.org was revised. eMOLST was redeveloped to include the 8-Step MOLST Protocol and MOLST Chart Documentation Forms. MOLST brochures, model policies and procedures for different clinical settings were updated. Subsequently, the Advance Care Planning and MOLST Toolkit for use in different clinical settings was developed to support the multidimensional approach needed for sustainable implementation.

Feedback received will be included in this next review process. Please email your suggestions to Dr. Patricia Bomba, MOLST & eMOLST Program Director at Patricia.Bomba@lifethc.com

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