MeHI is a partner with the Massachusetts Coalition for Serious Illness Care (the Coalition) on an initiative to facilitate electronic sharing of advance care planning documents, designed to help achieve the Coalition’s goals of ensuring that patients’ wishes, preferences, and goals of care are documented and made accessible regardless of place of care. The mission of the Coalition is to ensure that everyone in Massachusetts receives healthcare that is in accordance with their goals, values and preferences at all stage of life and in all steps of their care.
In addition to the Coalition, MeHI is collaborating with Massachusetts Executive Office of Elder Affairs (EOEA), the Massachusetts Department of Public Health (DPH), and other stakeholders to examine methods, architectures and technologies that can be used by providers to reliably share ACP documents electronically – across systems and platforms – to improve the ability of clinicians, emergency medical services, and other institutional and community caregivers to quickly and reliably identify a patient’s wishes and care preferences at every setting.
As we know, patients want their care preferences known, respected, and shared with all their families and care providers and clinicians want to know and honor their patients' care choices. We know there are many challenges – and many technological options available – to digitizing and sharing these documents. Our intent through this endeavor is to gather sufficient information and input in order to develop recommendations to the Commonwealth for an innovative, feasible course of action that uses technology to ensure that patients’ wishes, preferences and goals of care are both documented and made accessible regardless of place of care.
|May 24, 2017||
Inaugural Stakeholder meeting
|July 31, 2017||
MeHI issues Request for Information (RFI) for Sharing of ACP Documents to:
|September 15, 2017||
RFI responses due (received 7 responses)
Conduct ACP Landscape Analysis of:
|October 18, 2017||Meeting with BIDMC Patient-Family Advisor Focus Group|
|December 7, 2017||
Public meeting to discuss e-sharing of ACP documents in MA to:
|January - March 2018||
Synthesize comments; conduct additional research; draft recommendations
|April 26, 2018||
Stakeholder meeting to review draft recommendations, including
Future activities will include:
While the end-goal of this initiative is to digitize all forms of ACP documentation, it was generally agreed that it was crucial to start the effort with a focused, manageable, and measureable program. To that end, stakeholders identified electronic access to patient Medical Orders for Life–Sustaining Treatment (“MOLST”) forms as a critical need with a high potential to significantly improve the quality of end-of-life care.
As part of the evolution of its MOLST program, Massachusetts recently applied to join the National POLST Paradigm. This will require that the Commonwealth revise its current MOLST form and policies in order to be compliant with national paradigm requirements. The DPH, with support from the DPH Palliative Care Advisory Council, will lead this effort.
Transitioning to a new, nationally-compliant POLST form is a complicated undertaking and will require substantial outreach, training and support for providers as they transition to new forms and processes. An extensive education effort will also be needed to ensure that care providers – as well as patients and families – are aware of the revised MOLST program requirements.
Based on this proposed MOLST update, stakeholders recommended that Massachusetts introduce an e-MOLST solution in tandem with the DPH statewide rollout of an updated paper-based MOLST form. Toward that end, we will be looking to introduce an e-MOLST pilot, in a select geographical region of the Commonwealth, concurrent with introduction of the new paper-based MOLST.