eMOLST: Urgent Access

During the era of COVID-19, interest in eMOLST is exploding with the increased adoption of telehealth. Many health systems, providers, hospital and nursing home associations have reached out for help and assistance in managing best practices regarding end-of-life discussions and MOLST completion.

We recommend eMOLST implementation and are working with health systems and providers to accelerate access to eMOLST during the COVID-19 crisis. eMOLST is available for ALL patients who are appropriate for MOLST, including individuals with I/DD.

What is eMOLST?

The NY eMOLST Registry is an electronic database centrally housing eMOLST forms & documentation of the discussion to allow 24/7 access in an emergency. eMOLST allows for accurate electronic completion of the current DOH-5003 MOLST form. By moving the MOLST form to a readily accessible electronic format and creating the NY eMOLST Registry, health care providers have access to eMOLST forms at all sites of care including hospitals, nursing homes and in the community.

eMOLST is strongly encouraged and available for all patients, including individuals with I/DD. eMOLST follows a standardized process and integrates the DOH Checklists and OPWDD Checklist. When the physician, NP or PA (as of June 17, 2020) signs eMOLST, it is immediately part of the eMOLST Registry. Only a physician, not an NP or PA, can sign eMOLST after completion of the 1750-b process outlined on the OPWDD Checklist.

A PDF of the eMOLST and the appropriate documentation of the ethical and legal requirements that aligns with the DOH Checklists and OPWDD Checklist can be printed from the eMOLST registry for use across care transitions. Using eMOLST will ensure all documentation is seamlessly completed. Learn more by reading the eMOLST Overview and visiting NYSeMOLSTregistry.com.

Value

eMOLST is the only way to ensure quality and patient safety and be sure MOLST is done correctly. eMOLST offers a streamlined process for high-quality goals for care discussions and authorizing end-of-life medical orders, including ensuring ethical and legal compliance which is essential during this crisis.

After thoughtful MOLST discussions, patients may want their resuscitation, respiratory support and/or hospitalization preferences updated considering the COVID-19 crisis. Review and renew is easiest with the eMOLST system.

Too often, discussions are poorly done or done outside scope of practice. Incompatible medical orders (CPR + DNI) exist. Skilled nursing facilities send patients against their wishes, as they do not use MOLST or check medical orders and/or have not developed an adequate care plan to support treatment in place.  This is the message we hear from health systems who are doing it correctly and using eMOLST.

Added Benefits

Importantly, we are offering our current partner organizations additional benefits during this crisis to help them manage this population of their most seriously ill patients.  For the first time ever, we are working to make the eMOLST parsed order sets available to partner health systems for their eMOLST patients en masse (vs. viewing every order individually). The eMOLST Administrator is reaching out with these data based on patient volumes and location within New York State.

• eMOLST at its core serves as a list of the very sickest patients who are most likely to suffer the worst outcomes if infected with COVID-19.
• eMOLST houses data about specific critical medical orders such as CPR/DNR, respiratory support orders, and hospitalization orders that are accessible 24/7, including across care settings. Access to the data can help streamline the review and renewal of eMOLST.
• Organizations can use this data to help target care management efforts and create care plans for those who wish to avoid hospitalization.
• Accessing the orders at the point of care ensures patients are receiving treatment in line with their preferences and avoiding unwanted interventions.
• Skilled nursing facilities, primary care, specialty practices and hospices will all need to focus energy on additional care planning for their seriously ill patients and particularly for those who would like to avoid hospitalization. eMOLST will provide a consolidated list of those orders.

We recognize that many health systems and organizations are feeling an additional sense of urgency regarding offering appropriate end-of-life discussions to seriously ill patients who may want to avoid specific life-sustaining treatments. eMOLST provides a framework for these conversations and provides guard rails to ensure the process is offered to patients who are clinically appropriate and that the decisions are made in a patient-centered, ethical and legal way. We encourage all organizations to gain access to eMOLST to retrieve orders for the tens of thousands of patients with existing orders in the system and initiate eMOLST discussions with all clinically appropriate patients that they see in their care settings.

How to Get Urgent Access

If you want urgent access to eMOLST to review & renew MOLST given COVID-19:

• Hospitals should contact Katie.
• Skilled nursing facilities should contact Katie and Meg.
• Physicians, NPs and PAs should contact Katie and Meg.

Can’t find your answer? Contact Katie.