By Patricia Bomba, MD, MACP
Chair, MOLST Statewide Implementation Team

The MOLST Team Executive Committee is conducting a survey to gather feedback from physicians and nurse practitioners who use MOLST and eMOLST regularly. If you use MOLST and/or eMOLST regularly and are interested in reviewing the draft revised MOLST form, please contact me at Patricia.Bomba@lifethc.com

Proposed revisions to the DOH-5003 (6/10) MOLST form that are currently under review by the New York State Department of Health (NYSDOH). The proposed revisions reflect changes in Public Health Law and recommended changes in language to improve quality and reduce patient harm. The proposed clinical changes, including the need to add MOLST Instructions, are a direct result of feedback collected from physicians, nurse practitioners and others who regularly use MOLST and eMOLST for the past 8 years.

While the DOH review process is ongoing, we were recently made aware that the Department is considering making only the changes that directly result from changes in the Public Health Law to the MOLST form at this time, while reviewing the proposed clinical revisions at a later time. We firmly believe that the opportunity to revise the form should include the necessary clinical changes identified over the past 8 years. Physicians, nurse practitioners and patients would not benefit from the form being changed again in a short period of time. As a result, we are strongly advocating for DOH to include all of the proposed revisions to the form in one action.

In response to our request for letters of support from interested members of the Statewide Implementation as well as those physicians, clinicians and others who graciously reviewed and provided feedback on the proposed revisions, the MOLST Team received comments from some who were not part of the review process. In response, the MOLST Team Executive Committee is conducting the survey in order to obtain feedback from others who use MOLST and eMOLST regularly.

We appreciate you sharing your time and expertise in responding to this survey. The reasons for the proposed changes are included in the survey. The MOLST Team Executive Committee welcomes additional feedback. We anticipate the survey will take approximately 15 minutes to complete.

To ensure broad statewide representation, the survey is not anonymous, but responses will be kept anonymous.

For additional background information, view the MOLST form on MOLST.org.

We are excited to share a new online process for ordering materials! As of June 21, 2018, we are no longer accepting any orders via fax or email. Please visit CompassionAndSupport.org or MOLST.org click the Shopping Cart icon in the upper right corner to place your orders.

The MOLST form and Advance Care Planning (ACP) booklets remain out of stock while we wait for the NYSDOH to approve proposed revisions to the MOLST form. At this point we don’t have a timeline for when the revisions will be approved.

The proposed revisions reflect changes in Public Health Law and recommended changes in language to improve quality and reduce patient harm. The clinical changes, including the need to add MOLST Instructions, are a direct result of feedback collected from physicians, NPs and others who regularly use MOLST and eMOLST.

The MOLST form is included in the ACP Booklet. The ACP booklet will be revised once we have an approved MOLST form.

In the meantime, you can print more MOLST forms directly on pink paper, or use eMOLST. You can also directly print ACP booklets.

By Patricia Bomba, MD, MACP
ECHO® MOLST Program Director

At long last, the first ECHO® MOLST: Honoring Patient Preferences at End-of-life clinic will be held on September 13. The initial series will run for eight sessions through November 8. The weekly ECHO® clinics, which are like virtual grand rounds, combine mentoring and patient case presentations. See details on the ECHO MOLST flyer.

Space is limited to the first 50 “spokes.” A spoke is a single site that can include multiple physicians, nurse practitioners and other clinicians. Sign up to participate by emailing Meg Greco at Meg.Greco@Excellus.com. By registering now, you will be guaranteed a spot on the spoke and will receive onboarding training to make the most of ECHO MOLST.

Free CME will be provided. The University of New Mexico School of Medicine, Office of Continuing Medical Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Office of Continuing Medical Education designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

ECHO MOLST provides seasoned physicians and nurse practitioners the opportunity to present challenging clinical cases and pose clinical, ethical and legal questions to the participants. MOLST experts will serve as mentors and colleagues, sharing their medical knowledge and expertise with physicians, nurse practitioners and other clinicians using the “All teach. All Learn.” ECHO model.

The launch of ECHO MOLST was delayed to the fall while awaiting new legislative changes and approval of the proposed revised MOLST form. The key target audience includes physicians and nurse practitioners who will be impacted by the new NYSPHL and MOLST form changes. The topics for the initial series is based on the “Core Elements for MOLST & eMOLST Education,” approved by the MOLST Statewide Implementation Team in 2014, that outline the educational needs based on clinical roles and the 8-Step MOLST Protocol. Combining the case-based ECHO model with the “Core Elements” will meet the needs of the target audience.

Project ECHO was identified as a platform for continued sustainable MOLST education in 2017. The core MOLST team from Excellus BlueCross BlueShield attended ECHO immersion training in October 2017.

The ECHO MOLST planning group was formed in 2018 to launch ECHO MOLST: Honoring Patient Preferences at End-of-life. Members include the core MOLST team from Excellus BCBS: Patricia Bomba, MD, MACP, Katie Orem, MPH, Meg Greco, MPA, Allison Zambito and key leaders from IPRO, one of the nation’s premier quality evaluation organizations: Sara Butterfield, RN, BSN, CPHQ; Carolyn Kazdan, MHSA, NHA; L. Christine Stegel RN, MSN, CPHQ, Fred Ratto Jr., BA, CPH and Lynn Wilson, MS.