The Medical Orders for Life-Sustaining Treatment, or MOLST, program aims to improve care for seriously ill patients and tailor treatment to their end-of-life preferences. Based on communication between the patient and their physician or NP, the eight-step protocol guides treatment for palliative care and during advanced illness and in emergencies.

In New York, a statewide MOLST registry guides care teams to help ensure end-of-life care and DNR/DNI orders are consistent with patient goals. But that hugely important information was not always easily accessible to clinicians at the point of care.

At HIMSS22, Dr. Jonathan Austrian, associate chief medical information officer for inpatient clinical informatics at NYU Langone Health, will describe how he and clinical and IT staff worked with Epic and New York's eMOLST registry and Healthix HIE to bring that data into patients' electronic health records.

The health system architected a tool to deliver electronic medical orders for life-sustaining therapy, or eMOLST status for its patients – enabling seamless visibility to care teams and helping ensure care delivery is concordant with patient goals.

The power of MOLST is that it "helps patients in the state, regardless of where they have received care," said Austrian. "There are other states that have digital registries – many states call them POLST, or physician orders for life-sustaining therapy. And there's a movement to develop more statewide registries. Ultimately, the vision would be a national registry."

But while these registries "have been great at collecting information," he said, "the risk is that the information is siloed there and not easily available to care teams."

So, NYU Langone in recent years has been working with Epic, its state registry and, crucially, New York's statewide health information exchange "to develop a scalable workflow that enables the right information to be there for our care teams within the EHR," said Austrian.

Enlisting Healthix as a third partner was key, he said.

"We were originally attempting to do this integration directly with the MOLST registry. And as we wanted to do more sophisticated interoperability, we needed an additional member that has expertise in patient matching," Austrian explained.

"We did not want to develop a custom solution just for our institution," he said. "The power of the state registry is that it's available for all patients, and it's intended for all care team members. So, we were very intentional in ensuring that we're using standard tools and standard architecture because the benefit for our patients is that their information is available everywhere. And that made it a little more challenging.

"And powerful," he added. "It's important to share because the more people and health institutions that are contributing to the state registry, the more that all our health systems will benefit and help ensure that we're all consistent in providing care that meets patients' preferences, particularly at the end of life."

The initiative has been an "evolving collaboration that we've iterated over many years," said Austrian. "It's been a progressive, deeper integration. We started with just having a single sign-on to the eMOLST registry, directly from our EHR. And also passing some patient information to the EHR to help with searching. Then we've gradually become more sophisticated, where not only is it easy to upload, but also view the eMOLST.

"Phase two, which was in May 2021, is when we actually began receiving an alert that an eMOLST was present for our patient that originated from any health system in the state," he added.

The next phase – scheduled for early 2022 – will be aimed at "bringing in the structured individual orders from the state registry and leveraging those orders to provide decision support to our clinicians to help ensure that the code status orders in our EHR and other related orders are consistent with the patient's preferences as documented in the eMOLST," said Austrian.

The benefits for providers and patients are clear, he said.

"For our physicians, it is just much easier for them to view the patient's eMOLST. The feedback we received prior to this was that it's a real barrier and cumbersome to view the data. But now, it's much more integrated and readily available."

Now, said Austrian, "there's a comfort and confidence that when they see that the eMOLST banner is pink, they know that NYU is getting that information from around the state, and so, we're more confident that we have the information we need to help patients with their end-of-life preferences and goals."

Dr. Jonathan Austrian will explain more during his HIMSS22 session, "Eliminating Goals of Care Blindspots in New York State," at HIMSS22 in Orlando. It's scheduled for Tuesday, March 15, from noon to 1 p.m, in Room WF3 of the Orange County Convention Center.