How ePOLST will improve shared, informed medical decision-making: applying the eMOLST experience in New York

Abstract

The Physician Orders for Life-Sustaining Treatment (POLST) Paradigm Program is designed to improve the quality of care seriously ill patients receive at the end of life. The process results in documentation of medical orders on a brightly colored form that health care professionals must follow. POLST is a standardized community-wide form that transitions with patients across all care settings. Medical Orders for Life-Sustaining Treatment (MOLST) is New York State's approved POLST Paradigm Program.

The electronic Medical Orders for Life-Sustaining Treatment (eMOLST) is a secure web-based application that assists providers in having the MOLST discussion, documenting the clinical steps and fulfilling legal requirements under New York State Public Health Law.

eMOLST improves quality outcomes and meets the six aims of the Institute of Medicine's Crossing the Quality Chasm, as it is safe, effective, patient-centered, timely, efficient and equitable:

• ▶ Safe - built-in quality controls for correct orders; does not allow for inconsistent medical orders

• ▶ Effective - enables providers to follow clinical steps and meet legal requirements

• ▶ Patient-centered - goals for care guide choice of interventions

• ▶ Timely - web-based; assures accessibility across care transitions, including documentation of discussion

• ▶ Efficient - more time for discussion; less time for documentation, while ensuring accuracy

• ▶ Equitable -integrates needs of adults, minors, developmentally disabled who lack medical decision-making capacity; can be used in all clinical care settings