1 eMOLST Implementation Patricia Bomba, MD, FACP Vice President and Medical Director, Geriatrics Chair, MOLST Statewide Implementation Team & eMOLST Program Director Chair, National Healthcare Decisions Day New York State Coalition Leader, Community-wide End-of-life/Palliative Care Initiative Katie Orem, MPH Geriatrics and Palliative Care Program Manager & eMOLST Administrator Member, Executive Committee, MOLST Statewide Implementation Team CompassionAndSupport.org

2 Session 1 Recap  Any additional questions about eMOLST clinical functionality?  Review NYACP eMOLST webinar & demo from 4/7 if you weren’t able to attend last week. It’s stored here: (password: benefit)  For more info on the new CPT codes for ACP discussions view the webinar recorded here: Recommended Follow-ups

3 eMOLST Demo: Workflow & Administrative Functions eMOLST Training Site:

4 eMOLST Documents  All documents are posted on NYSeMOLSTregistry.com

5 eMOLST Program Manual  Describes eMOLST application, minimal technical requirements, enrollment & disenrollment process, specific user roles (both clinical & administrative), security, etc.  Has “getting started checklist” on page 4

6 eMOLST Legal Agreement  Includes eMOLST Participation Agreement & BAA  eMOLST operates as a public health service  Data in eMOLST are not owned by any particular health system or facility  Return signed agreements to Katie

7 eMOLST Enrollment  Review enrollment template

8 eMOLST Enrollment Steps  Assign a project manager who owns the spreadsheet & collects all the data  Should have expertise with Excel & be very accurate  Export relevant user information from EMR system or HR database (if available)  Avoid typing to guarantee accuracy  Each user must have a clinical & admin role  eMOLST project team should work to assign these roles using broad categories in a health system  Sheet must be completely filled out in order to be uploaded to eMOLST  Contact Katie with

9 eMOLST Patient Import  Review patient import template

10 eMOLST Patient Import: Advantages  Bulk import relevant patient demographics directly into the eMOLST system  Generate list of eMOLST #s automatically  Help jump start the process of converting paper MOLST forms into eMOLST  Save time & improve accuracy vs. typing  Insert patients into relevant providers’ eMOLST lists for MOLST data entry & signature  Especially helpful in primary care practices, LTC facilities, home care agencies, hospices, etc.

11 eMOLST Integration Options  Link in EMR or on desktop  You will sign in with an eMOLST username & password  Single Sign On (SSO)  Pass user credentials using SAML message  Link in EMR will automatically log you in to eMOLST  You will not need to remember a separate username & password for eMOLST  SSO + Patient Context  Pass user credentials and patient demographic information inside a SAML message  Requires entering eMOLST within a patient’s screen  Allows for one-click search of the eMOLST system  SSO Integration Guide with or without patient context specifics is available

12 eMOLST Implementation: Best Practices  Get buy-in from relevant stakeholders  Develop project team, including IT, operations, clinical users, physician & system champions  Assign project manager  Have team read eMOLST Program Manual  Assign ownership to project tasks  Identify areas for early adoption  Schedule regular project meetings  Set dates for “go live” with administration

13 Additional Considerations  Advance Care Planning workflow  Current vs. Future  Advance Directives vs. MOLST  Reduce variation  Policies and Procedures  Current vs. Future  ACP as a process, Health Care Proxies, MOLST, NYSPHL  Physician and Clinician Training  Public education, engagement and empowerment  Available educational resources

14 New York eMOLST  If you would like your hospital, nursing home, physician office, palliative care/hospice program to implement and have your patients’ MOLST forms included in NY’s eMOLST registry, visit NYSeMOLSTregistry.com. NYSeMOLSTregistry.com Contacts eMOLST Program Director: eMOLST Administrator:

Additional MOLST/eMOLST Resources  eMOLST Overview (5:37)  NYSDOH Attorney's Perspective on eMOLST (1:38)  Advantages of eMOLST: A Nursing Home Physician's Perspective (7:24)  MOLST Video Revised 2015! (28:14)  "Writing Your Final Chapter: Know Your Choices. Share Your Wishes" has 5 real patient stories (2 before, 3 after MOLST); originally released in 2007 & revised to comply with FHCDA.  It is an excellent resource for staff, patient, family caregiver education; it can be used as a staff "lunch and learn."

Additional MOLST/eMOLST Resources  "New CPT Codes for Advance Care Planning and MOLST Discussions" (1:00) webinar posted on YouTube  eMOLST webinar sponsored by IPRO and includes Q & A (2:00) cba7863dab9ad1bf68ea cba7863dab9ad1bf68ea  Link to a MMLIC Dateline Special Edition, includes NYSBA Health Law Journal article co-authored by Jonathan Karmel, JD, NYSDOH, and Pat Bomba, MD, FACP; three additional cases are included: here. here

17 Additional MOLST/eMOLST Resources  Thoughtful MOLST Discussions in Hospital  Thoughtful MOLST Discussions in Nursing Home  Thoughtful MOLST Discussions in Additional Clinical Settings Planned Physician Office, Home, Vulnerable Populations

For up-to-date information, subscribe to NY MOLST Update. Contact

19 Additional Resource: ReachMD Dying in America PodcastsPodcasts