Questions About MOLST? Consider ECHO MOLST + ECHO eMOLST!

By Meg Greco, MPA
Geriatrics & Palliative Care Coordinator;

Do you have questions about the MOLST process and form? Are you a PA or NP wondering how recent legislative changes affect you? Would you like to have a positive impact on end-of-life care for New Yorkers? Are you looking to earn free CME credit? If you answered “Yes” to any of these questions, ECHO MOLST + ECHO eMOLST is right for you! The ECHO MOLST + ECHO eMOLST clinic series kicks off on March 4, 2020. Weekly clinics are held via videoconference on Wednesdays over the lunch hour. Interested in getting in on the action? Email me at

What is ECHO, you ask? ECHO, which stands for Extension for Community Healthcare Outcomes, is an all-teach-all-learn telementoring model that uses case-based learning. Learn more about Project ECHO and the ECHO model in the accompanying article.

So how does this apply to MOLST? The aims of ECHO MOLST + ECHO eMOLST are to provide sustainable MOLST education and to improve the quality of thoughtful MOLST discussions and documentation to ensure patient preferences are honored. Upon completion of the 8-week ECHO MOLST clinic series, attendees will:

• Use MOLST for appropriate populations
• Describe the differences between advance directives and MOLST
• Utilize a standardized 8-Step MOLST protocol
• Improve comfort level with end-of-life conversations – and much more!

We’re also excited to announce the launch of ECHO eMOLST! Upon completion of the ECHO MOLST clinic series, attendees are encouraged to continue on to the 4-week ECHO eMOLST clinic series, where they will:

• Describe the benefit of eMOLST in terms of quality and patient safety
• Manage correct usage of eMOLST, including administrative functions
• Facilitate discussion and establish a plan for organization-level eMOLST implementation – and much more!

Additionally, we offer free CME credits to attendees! Each ECHO MOLST + ECHO eMOLST clinic session has been approved for 1.0 AMA PRA Category 1 Credit™. For more information, including dates, topics and who should attend, view our flyer and web page.

Don’t miss out on this unique educational opportunity! Attendees from previous clinics are encouraged to re-enroll and to recruit colleagues to join them. These case-based sessions will provide fresh and different learning opportunities for veterans and newcomers alike. Ready to get started? Email me today at

Featured Resource: Updated Equianalgesic Pain Trifolds

Equianalgesic Tables for Adults and Pediatrics are available to order for free through the shopping cart on

The trifolds provide half-life, duration, dosing and guidelines of pain medications for providers when opioid use is indicated.

The Equianalgesic Tables make up part of the Complete Pain Toolkit and were revised and approved by the Community Principles of Pain Management (CPPM) in June 2019.

FAQ: Are MOLST Forms Available to Order?

The NYSDOH distribution center has a limited quantity of MOLST forms but are unable to keep up with demand and are currently working to fill back orders. If you are a consumer looking to order 5 or fewer copies of the form, please follow these instructions to order from the DOH.

If you need MOLST forms immediately or are looking to order forms for your organization and require more than 5 copies, we encourage you to download the MOLST form and print on pulsar pink paper. We also encourage you and your organizations to implement eMOLST in your setting and encourage use in the communities you serve.

eMOLST Champion:
St. Lawrence Health System

St. Lawrence Health System (SLHS), a multi-hospital health system based in St. Lawrence County, NY, began eMOLST implementation discussions as far back as 2017. They set a goal to implement by Spring 2020 and as a result, set in motion an effective project team to execute on this vision. On February 3, 2020 SLHS went live with their eMOLST program at Canton-Potsdam Hospital (94 beds), Gouverneur Hospital (critical access, 25 beds), and across the health system’s primary care groups and in several key specialty practices. Massena Hospital, the newest member of SLHS effective Jan 1, 2020, will have its own eMOLST rollout at a later date.

SLHS’s decision to go live as an entire health system is fairly unique among organizations that have implemented eMOLST and shows the emphasis and effort they put in to a uniform rollout and accountability for all levels of care in offering appropriate eMOLST discussions.

SLHS’s implementation was prioritized by Andrew Williams, MD, Associate Medical Director, Jan Carroll, RN, MSN, MPH, Chief Nursing officer and Vice President of Patient Care Services & Quality, and Kathy Ward, DNP, RN, Director of Quality Management. Jaime Odendahl, BSN, RN, Clinical Outcome Specialist was the project manager. A multidisciplinary approach was used that included the support of Quality Management, Medical Staff, Patient Care Services, Information Technology, as well as many disciplines in the Outpatient Clinical Practices.

SLHS has used the eMOLST project as an opportunity to identify other aspects of advance care planning that can be improved within the health system and to further their digital transformation. Their effective identification of appropriate patients and systematic rollout resulted in a smooth go live.

SLHS expects that with its implementation across all clinical settings that other hospitals across the North Country will also be encouraged to systematically implement eMOLST. For the remainder of 2020 and into 2021 SLHS will be focused on eMOLST across care transitions, QA/QI activities, and encouraging their immediate community partners to implement eMOLST, including several skilled nursing facilities and the regional hospice organization.

ECHO MOLST + ECHO eMOLST: A Proven Education Model on End-Of-Life Care

Project ECHO (Extension for Community Healthcare Outcomes) is a guided-practice model that aims to increase workforce capacity by sharing knowledge. Specialists and experts at the “hub” site meet regularly with providers from hospitals, post-acute long-term care facilities and physician practices in local communities via video conferencing to support these providers in the delivery of specialty care services.

Project ECHO was launched in 2003 as a healthcare initiative from one doctor’s vision. Sanjeev Arora, MD, a liver disease specialist at the University of New Mexico in Albuquerque, was frustrated that he could serve only a fraction of the hepatitis C patients in the state. He wanted to serve as many patients with hep C as possible, so he created a free, educational model and mentored community providers across New Mexico in how to treat the condition.

The ECHO model is based around “telementoring,” providing clinicians with the knowledge and support they need to manage patients with complex conditions in the patients’ own communities. This dramatically increases access to high quality, specialty treatment, particularly in rural and underserved areas. To learn more about the ECHO model and its history, watch this short video by Dr. Arora and visit

The aims of ECHO MOLST + ECHO eMOLST are to provide sustainable MOLST education and to improve the quality of thoughtful MOLST discussions and documentation to ensure patient preferences are honored. Following the ECHO model, weekly lunch hour video conferencing clinics begin with brief introductions and a short 15-minute MOLST didactic presentation. This is followed by a 35 to 40-minute real patient case presentation given by a “spoke” using a Q&A and discussion format.

Data collected using a pre-test, post-test method from each clinic series proves that ECHO MOLST + ECHO eMOLST works. In the Fall 2019 series, participants overall MOLST knowledge increased by 16 percent. Before the Fall 2018 clinic series, only 34 percent of respondents could identify that MOLST is not an advance directive. After the clinic series, that number increased to 72 percent. Similarly, the percentage of Spring 2019 participants able to correctly interpret a tough end-of-life scenario jumped from 50 percent to 80 percent. This is likely a direct result of learning through the case-based nature of ECHO programs. Through participation in the clinic series, attendees recognize the importance of their own advance care planning, with health care proxy completion rates among participants rising, on average, by 22 percent.

To date, ECHO MOLST has provided end-of-life education to 545 participants from 87 health care organizations across New York State. Furthermore, more than 80 percent of participants are directly involved in patient care, suggesting that quality improvements to patient care through education are immediate. Through evaluations, we know that participants have made changes to their practices to provide their patients with higher quality end-of-life care.

The next ECHO MOLST + ECHO eMOLST clinic series begins on March 4, 2020. Each clinic session has been approved for 1.0 AMA PRA Category 1 Credit™. Contact for more information and to enroll in the next ECHO MOLST + ECHO eMOLST clinic series.