Compassion and Support
JUNE 2017
Please Support eMOLST Legislation

Senator Rich Funke and Assembly Majority Leader Joe Morelle have introduced legislation (S.966/A.2316) that establishes a statewide eMOLST registry. S.966 is co-sponsored by Senator Joe Robach.

“By ensuring statewide access to eMOLST forms throughout the healthcare community, we can take an important step toward improving end-of-life care and ease the burden placed on patients and their loved ones at an otherwise difficult and emotional time," Morelle said. "I thank Excellus BCBS and IPRO for their efforts to raise awareness and expand access to these valuable tools, and for their continued commitment to improving patient care and outcomes."

Beyond a registry, the eMOLST system is also a secure on-line completion system for creating eMOLST forms that are accurate using a standardized communication process and compliance with New York State Public Health Law (PHL). Currently, four public health laws govern end-of-life decision making, providing protections for patient rights as well as providers; PHL applies with or without MOLST. The eMOLST system allows for documentation of ongoing communication and changes in eMOLST, as patient’s goals and preferences for treatment may change at the end of life.

“My careers in journalism and public service have reinforced the importance of clear communication and there’s no time when that’s more important than in end-of-life planning,” Funke said. “I am proud that our legislation would standardize a statewide registry for eMOLST to ensure that a patient’s wishes are crystal clear and widely available, no matter who is providing care or where it is being provided. I thank Majority Leader Morelle for his partnership and Dr. Bomba for her leadership as we push to advance this common sense proposal.”

In establishing the eMOLST registry, the bill seeks to accelerate the digital transformation to improve quality and legal outcomes. This registry would require practitioners who complete a MOLST form to submit to the eMOLST registry within 14 days. This registry will help ensure current orders and a copy of the discussion are available in an emergency so end-of-life preferences will be followed as a patient moves through the health care system.

If passed, Bill S.966 (Funke)/A.2316 (Morelle) would make changes to PHL, so that the words "Medical Orders for Life Sustaining Treatment (MOLST)" would exist in PHL. Since June 1, 2010, MOLST is a NYSDOH form and is included in it's regulations. The DOH approved use of MOLST in hospitals and nursing homes in 2005.

The introduction of this bill is a huge step forward and your help is needed! Please encourage state lawmakers to pass (S.966/A.2316). Please send a letter of support to your local Senators and Assembly Members and send a copy to me at patricia.bomba@lifethc.com. Here is a draft letter of support.

Featured Resource:
eMOLST Overview video

eMOLST is a web-based version of the current paper-based New York State Department of Health-5003 MOLST form. By moving the MOLST form to a readily accessible electronic format, health care providers, including EMS, can have access to MOLST forms at all sites of care including hospitals, nursing homes and the community. In the long term the eMOLST application and registry will become a statewide service by leveraging a connection with the Statewide Health Information Network for New York (SHIN-NY).

MOLST FAQ:
Why is mandatory submission to the registry important?

Early adoption has already shown eMOLST achieves the quadruple aim: enhanced patient experience, improved population health, reduced costs and improved work life of health care providers. By requiring health care professionals to submit completed MOLST forms to the registry, eMOLST provides the treating provider with current eMOLST orders as well as a copy of the MOLST Chart Documentation Form that includes the discussion between the physician and other clinicians that outlines why the patient chose those preferences.


eMOLST Champion: Excellus BlueCross BlueShield

For more than two decades, Rochester, New York-based Excellus BlueCross BlueShield has advocated for better end-of-life care so that patients could have more say in writing their own final chapter. The health insurer carried this mantle when few would listen, and continues to do so now that these issues are at the forefront.

As the legislative session comes to a close each June, it provides an opportunity to reflect on the legislative changes to New York State Public Health Law that shaped and continue to influence NY’s MOLST and eMOLST programs. Since 2004, Excellus BCBS has, and continues to lead legislative advocacy to support MOLST.

June marks the 9th anniversary of the passage of the MOLST legislation in 2008, after a 3 year legislative community pilot to test the ability of EMS to follow MOLST, particularly related to both Do Not Resuscitate and Do Not Intubate. When MOLST was signed into public health law, the scope of practice for EMS was forever changed.

June also marks the 7th anniversary of Family Health Care Decisions Act (FHCDA) that provides patient and provider protection, as well as the ethical-legal framework for making end-of-life decisions in New York when an individual does not have a health care agent. Concurrent with the launch of FHCDA, MOLST became a NYSDOH form and program. It also is the anniversary of the approval of the use of MOLST for persons with developmental disabilities who are unable to make end-of-life decisions.

And, June is the anniversary of the sunset of the initial eMOLST prototype that was developed with seed money from a HEAL grant into a new eMOLST system. The significant change in the MOLST form coupled with 4 public health laws governing end-of-life decision making prompting creation of six NYSDOH Checklists and one Office for Persons with Developmental Disabilities (OPWDD) required development of a new system. With funds exhausted from the HEAL grant, Excellus BCBS stepped in to support the development, enhancement and implementation of eMOLST across New York.

NY MOLST and eMOLST would not exist without the leadership and financial support of Excellus BCBS, under the guidance of the past three CEOs, senior leaders, board of directors and the organizational mission to make a difference in the lives of the community members it serves.

While work remains to improve end-of-life care, much has been achieved thanks to the resources and energy of Excellus BCBS.

Changing the Culture of Advanced Illness and End-of-Life Care

The spring issue of Generations, the Journal of the American Society on Aging (ASA), is devoted to “Reforming Advanced Illness and End-of-life Care: The Way Forward.” The issue is available online with unlimited access and no time limit. The issue covers the current landscape, the need to change the culture of care, and policy actions needed for the future. With 10,000 baby boomers aging into Medicare daily, the time for policy action is now! Articles on palliative care, hospice, advance care planning, the Physician Orders for Life-Sustaining Treatment (POLST) Paradigm Program, caregiving, and other related topics build on the roadmap set forth by the Institute of Medicine report, Dying in America.

I was privileged to contribute an article, “Supporting the Patient Voice: Building the Foundation of Shared Decision-Making,” a critical component of National POLST and New York’s Medical Orders for Life-Sustaining Treatment (MOLST) and eMOLST programs. Shared decision-making is critical component to help ensure a culture of care that places the person at the center of treatment decisions, from birth to death. The essence of shared decision-making moves medical decision-making from the extremes of paternalistic, physician-centered beneficent decisions and patient-autonomous decisions to a person-centered model in which the physician and patient share the process.

Shared medical decision-making for patients with advanced illness is a key component of person-centered, family-oriented healthcare—care that combines chronic disease management with the key pillars of palliative care, including advance care planning, pain and symptom management, and caregiver support integrated with psychosocial, religious, and spiritual care. It is a process in which physicians, at times in collaboration with other clinicians (such as nurse practitioners, physician assistants, social workers, etc.), and patients work together to make decisions. Early steps in this process include ensuring the patient has the capacity to make decisions about their medical care, and clearly understands his or her current health status and prognosis.

To ensure an individual’s treatment preferences are honored at the end of life, shared decision-making must be person-centered and well-informed. The shared decision-making process is especially important toward the end of life, when one’s ability to make medical decisions may diminish for a short period of time due to acute illness, delirium, etc., or permanently because of dementia. Due to the sensitivity of the decisions to be made and the risk of incapacity, the process must also be family-oriented: family members, friends, loved ones, and the person’s designated medical decision-maker or health care proxy must know the person’s values, beliefs, goals for care, and preferences for treatment.

Physicians and other clinicians must be trained, comfortable with necessary discussions, and act within their scope of practice. Similarly, the patient and-or other medical decision-maker must be prepared to actively participate in the process. A multidimensional community approach to advance care planning implementation is essential. New York integrates population health into the multidimensional community approach. All persons 18 years of age and older are encouraged to initiate advance care planning discussions early and complete a health care proxy (in other states known as a Durable Power of Attorney for Healthcare.) Persons with serious advanced illness who might die in the next year are offered the opportunity to have a thoughtful MOLST discussion, using the 8-Step MOLST Protocol that includes well informed shared decision-making as a key component.

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