ECHO MOLST Moving to Wednesdays for Fall 2019 Clinic Series

By Meg Greco, MPA
Geriatrics, Palliative Care & ECHO MOLST Coordinator

Coming off the heels of a successful run in Spring 2019, ECHO MOLST will be returning for another clinic series beginning 9/18/19. 1-hour clinics will now be held on Wednesdays for 8 consecutive weeks at 12pm EST, wrapping up on 11/6/19. Interested in getting in on the action? Email me at

ECHO is a tele-mentoring model that uses case-based learning. Specialists and experts at a “Hub” meet virtually with folks at “Spokes” via videoconferencing to support in the delivery of specialty care services. To learn more about the ECHO model and its history, watch this short video by Project ECHO’s founder, Dr. Sanjeev Arora.

The aims of ECHO MOLST are to provide sustainable MOLST education and to improve the quality of thoughtful MOLST discussions and documentation to ensure patient preferences are honored. 1-hour clinics begin with brief introductions and a 15-minute didactic presented by Dr. Pat Bomba. This is followed by a 35-40 minute real patient case presentation given by a spoke using a standard presentation form, Q&A and discussion. At the end of the clinic series, attendees will learn to identify MOLST-appropriate patients, utilize the 8-Step MOLST Protocol and NYSDOH Checklists to ensure accurate completion, and increase their comfort level with end-of-life conversations. Additionally, we offer free CME credits to attendees! Each ECHO MOLST clinic has been approved for 1.0 AMA PRA Category 1 Credit™ per session. For more information on ECHO MOLST, including objectives and who should attend, view the ECHO MOLST flyer and web page.

Data collected using a pre-test post-test method in Fall 2018 and Spring 2019 showed increases in overall MOLST knowledge. Before the clinic series in 2018, only 34% of respondents could correctly identify that MOLST is not an advance directive; after the clinic series, that number jumped to 72%. Similarly, we saw increases in respondents’ ability to recognize incompatible medical orders, and an increased familiarity with the 8-Step MOLST Protocol. During the Spring 2019 clinic series, the percentage of respondents able to identify the legal authority of a health care agent rose from 50% to 80%.

Don’t miss out on this unique educational opportunity! Space in the ECHO MOLST clinic series is limited and spoke reservations will be taken on a first-come-first-serve basis. These case-based sessions will provide fresh and different learning opportunities for veterans and newcomers alike! Ready to get started? Email me today!

Featured Resource: NYSOFA Advance Care Planning Video

The New York State Office for the Aging (NYSOFA) and Acting Director Greg Olsen have collaborated with the MOLST Statewide Implementation Team since inception. NYSOFA recognizes the value of sustainable efforts to educate, engage and empower older adults, their families, loved ones and caregivers on advance care planning. This video explains why advance care planning is important and clarifies the differences between traditional advance directives and MOLST. Share the NYSOFA Aging and You video posted here.

FAQ: Is Affirmative Consent required to include MOLST in an electronic registry?

HIPAA permits disclosure of MOLST to other health care professionals & electronic registry as necessary for treatment. Section 1.7.15 of the NYeHealth Collaborative’s 2014 Statewide Collaboration Process: Policies and Procedures confirms “Qualified Health IT Entities (QEs) may note whether a patient has signed a MOLST or other advance directive in a Record Locator Service or Other Compatible Directory without Affirmative Consent.”

eMOLST Champion: Lourdes

Our Lady of Lourdes Memorial Hospital, a 242-bed hospital in Binghamton, NY, began implementing eMOLST in 2018 and launched the system hospital-wide in June 2019. Lourdes is part of Ascension and in addition to the hospital the health system operates a network of primary care and specialty practices as well as Lourdes at Home & Hospice, a home care and hospice agency. Between Lourdes and United Health Services, which implemented in 2017, every hospital in the area has now implemented eMOLST making Binghamton and Broome County the first part of the state to have universal eMOLST implementation in hospital settings.

Lourdes’ eMOLST implementation was prioritized by Richard Blansky, MD, CMO, and Karen Roeske, RN, CNO, and spearheaded by the eMOLST project team. Joy Taylor-Simmons, MHA, quality specialist, is the team’s project manager. Joy is joined on the team by key representatives from numerous disciplines including palliative care (Jerome Mikloucich, DO; Alan DeMaine, DO; Dana Rose, RN), hospitalists (Signa Perkins, MD), intensive care, nursing education (Tiffanie Champang, RN), the emergency department (Sarah Creery, RN), risk (Kelly Goff), the quality and clinical documentation improvement offices (Scott McClain, RN, and Caryl Ann Mannino, RN) and Lourdes at Home & Hospice.

Lourdes used the eMOLST project as an opportunity to identify other aspects of advance care planning that could be improved within the health system and to further their digital transformation which resulted in the elimination of numerous paper forms that had previously been used. Since Lourdes launched eMOLST hospital-wide in June 2019, their clinical teams have completed 100s of end-of-life discussions and eMOLST forms in the system. With the buy-in of both health systems in the area, the majority of skilled nursing facilities in the region have begun to use eMOLST for documentation of end-of-life decisions; several others have taken steps to move forward next year. In 2020 Lourdes will be optimizing eMOLST workflow in the hospital and tackling implementation in their primary care and specialty practices as well as pursuing further IT integration with their EMR, Cerner.

Share the Voice of the Patient and Family

By Patricia Bomba, MD, MACP, FRCP
VP & Medical Director, Geriatrics

Have you or your loved one experienced serious illness? Was MOLST suggested and completed? How was the MOLST discussion? Did you understand your loved one’s medical conditions, health status and prognosis? Did the physician, nurse practitioner and medical team understand what mattered most to the patient? Did the physician and/or nurse practitioner help you to understand what could or could not be accomplished? Was there disagreement among family members? If so, was the issue identified and resolved? If needed, was a social worker engaged to help resolve the issue? Were religious, spiritual or existential issues identified? If needed, was a chaplain or faith leader engaged?

Was the MOLST used to guide care because of an emergency? Were the MOLST orders followed by EMS and in the emergency room? Were the MOLST orders reviewed because of the change in health status and revised as needed? If your loved one wanted to die at home, were they able to do so and was their family supported?

The creation of MOLST is a direct result of listening to patients, families and caregivers who shared the limitations of the living will and non-hospital DNR order. The MOLST Statewide Implementation Team Executive Committee wants to hear your story and evaluate how MOLST is working. Members recognize the need for sustainable patient, family, caregiver education. Many of us have personally experienced the value and power of the MOLST program with family members. Their voice is always heard and respected.

An Ad-hoc Committee has formed to explore the means to better integrate the voice of the patient into our work. We are exploring convening a meeting to share experiences and learn from you.

The goals of the Committee include:

• Improve Patient/Family/Caregiver Education, Engagement & Empowerment on advance care planning, advance directives and MOLST
• Provide fact-based information to encourage advance care planning and thoughtful MOLST discussions for appropriate people to ensure shared medical decision making is informed and based on the person’s health status, prognosis, values and goals for care.
• Improve access and equity to thoughtful MOLST Discussions and palliative care to support a person’s preferences for treatment expressed on the MOLST
• Align with the purpose and goals of the MOLST Statewide Implementation Team

Patient, family and caregiver education, engagement and empowerment is necessary to prepare the decision maker for shared medical decision making to ensure it is well informed. This is equally important as physician and clinician training. Addressing functional health literacy is a social justice issue. We look forward to hearing your story. Please contact me at