Compassion and Support
OCTOBER 2017
eMOLST Integration Options With EMR

1. eMOLST Single Sign On (SSO)
eMOLST utilizes SAML-based single sign on (SSO) to allow authorized identity providers, such as an EMR, Active Directory, or another known source, to pass user information to eMOLST. This allows eMOLST users to log in and skip eMOLST's username & password page. The SAML message is automatically sent to eMOLST when the user takes a specific action, such as clicking an eMOLST link in their toolbar, a dropdown menu, or even a shortcut on their desktop. Matching user information is stored on the eMOLST side to ensure correct user access. This integration is available to many organizations because SAML is a standardized language for secure user authentication across systems. This type of SSO integration is already operational with numerous health systems, nursing homes, and the Rochester RHIO and HEALTHeLINK for their provider portal users.

2. eMOLST SSO + Patient Context
When implementing SSO + Patient Context additional information about the specific patient that the user wants to see is passed to eMOLST as part of the same SAML message described in #1. This allows for seamless single click access to the eMOLST orders for a specific patient. The user also saves time and improves accuracy because the core demographics (first name, last name, date of birth and gender) are automatically transmitted, not typed. The user’s credentials (which must match to an existing eMOLST user, as in #1) and the patient’s demographics all are included in the SAML message in order for this method to identify the correct patient in the eMOLST system. This SAML message has typically been sent from an EMR because Active Directory or other identity providers often do not have specific patient information available in their systems. This type of integration is already operational with numerous health systems across NYS. The most common EMR to implement this has been Epic, but it works in other environments as well. More information about both this integration and integration option #1 can be found in our SSO + Patient Context Integration Guide.

3. eMOLST API
With the eMOLST API (API stands for Application Programming Interface) your EMR or other authorized system can ask eMOLST questions about a specific patient. In order to accomplish this the EMR or other authorized system must initiate the request (eMOLST does not “push” information at this time) and must include the eMOLST number of the patient or patients. This would allow an EMR, for example, to receive the most recent eMOLST forms, or orders from those forms, for patients who are currently inpatient in the hospital or nursing home. Another relevant example could be the EMR asking eMOLST when a patient’s form was last reviewed and which physician signed it; workflow tasks within the EMR environment could then be set up based on that information. Any discrete data in the eMOLST system can be transmitted this way. Healthix, the largest RHIO in the country, already utilizes this API. We are happy to work with health systems and EMR vendors who would like to do additional work with us to transmit valuable eMOLST data to the hands of the clinicians who need it. If you’re interested in pursuing using the eMOLST API please reach out to Katie Orem, eMOLST Administrator, at katie.orem@excellus.com.

Featured Resource:
OPWDD Checklist

The Office For People With Developmental Disabilities (OPWDD) MOLST Legal Requirements Checklist for Individuals with Developmental Disabilities outlines the process for making decisions to withhold or withdraw life-sustaining treatment set forth in the Health Care Decisions Act for persons with MR (HCDA) [SCPA § 1750-b(4)].

The OPWDD Checklist is required for individuals with developmental disabilities (DD) who lack the capacity to make their own health care decisions and do not have a health care proxy. The MOLST form must be accompanied by the OPWDD Checklist.

MOLST FAQ:
Can an individual with DD/ID complete the MOLST?

If the individual with DD/ID and is appropriate for a thoughtful MOLST discussion and:

• has capacity to make MOLST decisions, use DOH Checklist #1.

• does not have capacity but has a properly completed health care proxy, use Checklist #2

• does not have capacity and does not have a health care proxy, use OPWDD Checklist as required by Surrogate Court Procedures Act (SCPA § 1750-b) and include with the MOLST


eMOLST Champion:
United Health Services

United Health Services (UHS) is a health system based in Binghamton, NY. With 4 hospitals, 1 nursing home, and numerous primary/specialty practices, it is the largest health care provider based in the Southern Tier, and is the first organization in the region to implement eMOLST.

UHS embarked on their eMOLST project in 2016. The project was identified as a key priority by Rajesh Dave, MD, CMO, Kay Boland, RN, SVP CNO & COO, and Nancy Rongo, RN, VP & CQO. They saw the opportunity to improve end-of-life care and have prioritized this work as a leading healthcare provider in the Southern Tier.

The project has been managed by Kris Marks, LCSW-R, OSW-C. Kris is the administrative director for palliative care at UHS and is a practicing social worker on the palliative care team. Kris is joined on the team by key representatives from numerous clinical disciplines. Hospitalists, palliative care, nursing, social work, intensive care, the emergency department, anesthesiology, surgery, the nursing home, legal, performance improvement and outpatient practices all have regular representation on the committee. The clinical representatives are joined on the team by key representatives from IT, clinical systems, quality, education, and risk management. The empowered team that UHS put together and their commitment to this project are all responsible for the system’s successful implementation.

Since UHS launched eMOLST hospital-wide in June 2017 their clinical teams have completed hundreds of end-of-life conversations and eMOLST forms in the eMOLST system. Area nursing homes and physician practices have become engaged in starting their own transitions to eMOLST. This fall and winter UHS is focusing on expanding eMOLST implementation throughout their system to various primary care and specialty groups. With their engaged and empowered eMOLST project team, strong leadership, and system-wide commitment to this project their success is assured.

MOLST for Persons with Developmental Disabilities

In an effort to transform end-of-life care for individuals with developmental and intellectual disabilities, the New York State Office For People With Developmental Disabilities (OPWDD) approved use of the New York State DOH-5003 Medical Orders for Life-Sustaining Treatment (MOLST) form for the individuals served in the OPWDD system. In approving MOLST, OPWDD has prioritized improving the quality of care seriously ill persons with DD/ID receive near the end of life and that preferences for treatment are honored.

While approval was effective January 21, 2011, there is a continuing need for professional training for health care professionals caring for this vulnerable population. As part of the CMS Transforming End of Life Care Special Innovation Project led by IPRO, several intensive MOLST training sessions focused on the DD/ID population were held on Long Island this past year in collaboration with John Mather Hospital, Peconic Bay Medical Center, and the Northwell Learning Collaborative. An additional training was held hosted by the Hospice and Palliative Care of New York State (HPCANYS). An intensive pre-conference course is scheduled for the Annual NYSARC Guardianship Training Symposium on November 6.

MOLST is voluntary and NOT appropriate for all persons with DD/ID. A positive response to one or more of the following MOLST Screening Questions is a clinical quality trigger that the person with DD/ID is appropriate for a thoughtful MOLST discussion.

1. Does the person with DD/ID, their health care agent or the appropriate 1750-b Surrogate express a desire that the person with DD avoid or receive any or all life-sustaining treatment?

2. Does the person with DD/ID live in a nursing home or receive long term care services at home or in a group home?

3. Would you be surprised if the person with DD/ID dies in the next year?

4. Does this person with DD/ID have one or more advanced chronic condition (rapidly progressive dementia, end-stage COPD or CHF) or a serious new illness with a poor prognosis (metastatic pancreatic cancer)?

5. Does this person with DD/ID have decreased function, frailty, progressive weight loss, >= 2 unplanned admissions in last 12 months, have inadequate social supports, or need more help at home?

NYSeMOLSTregistry.com integrates the statutory requirements for making end-of-life medical decisions for individuals with DD/ID and the 8-Step MOLST Protocol to ensure well informed shared decision-making and availability of an accurate eMOLST form and the OPWDD MOLST Legal Requirements Checklist across care transitions.

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