Massachusetts e-MOLST Web Portal
In partnership with Ariadne Labs and Honoring Choices Massachusetts, and powered by Vynca, the Coalition has created an e-MOLST Web Portal to support providers in engaging in advance care planning with patients in the current, largely virtual care world. On the portal, clinicians and patients or surrogates can remotely complete and digitally sign MOLST forms, an important step in ensuring everyone in Massachusetts receives health care that reflects their care choices.Login to the Portal
To support providers and patients in understanding what matters most to the patient as they make these important care decisions and complete a MOLST together, the portal includes both the Ariadne Labs Serious Illness Conversation Guide and the Ariadne Labs COVID Conversation Guide for Outpatient Care as optional resources.
The portal also provides information to help patients identify a friend, family member, or other trusted person as their Health Care Agent to make medical decisions in the event they can’t make decisions for themselves. Visit the Honoring Choices site for more information.
Frequently Asked Questions
1. What is the MA e-MOLST Web Portal?
The MA e-MOLST Web Portal offers Massachusetts health care providers and their seriously ill, high risk and frail patients, an effective communication approach to engage in proactive care planning conversations and document patient care choices. The web portal helps health care providers start a serious illness conversation using Ariadne Labs Serious Illness Conversation Guides, complete an electronic MA MOLST form (Medical Orders for Life-Sustaining Treatment), and offers links to information to help patients complete an Honoring Choices MA Health Care Proxy (available in 10 languages).
2. Who can use the MA e-MOLST web portal?
The web portal can be used by health care providers such as a Physician, Nurse Practitioner, and Physician Assistant, all authorized as signing clinicians on the MA MOLST form. The web portal also allows a signing clinician to authorize their care team members (nurses, social workers, care managers etc.) to initiate planning conversations with a patient, in alignment with their care facilities’ protocols and procedures. For example, an authorized care team member can sign into the web portal and begin a conversation with a patient about a Health Care Proxy and use the Serious Illness Conversation Guides to initiate informational discussions. A health care provider must pre-register to establish a web portal account.
The signing clinician is responsible for ensuring that the form reflects conversation(s) with patients/agent/guardians and accurately documents the patients care wishes.
- If a signing clinician chooses, the conversations leading up to the clinician’s signature on the MOLST form may be completed in whole or in part by other members of the care team, under the supervision of or in collaboration with, the signing clinician. How care teams work together should be determined by the individual facilities, practices and institutions.
- In order for care team members to participate, the signing clinician must first set up a user account for the organization. If you would like to enroll as a ‘preparer’, please ensure that the signing clinician(s) on your care team has enrolled in the e-MOLST web portal and include their name(s) and clinical organization in your request.
3. How do health care providers establish a user account to get started?
It’s simple to establish a user account. Just send your full name, licensure/role, institution, work address, work email, and phone number to: email@example.com. You will receive an email invitation to create a password and log in within two business days.
4. How does the MA e-MOLST web portal work?
As a registered web portal user, a health care provider can start a care planning conversation with a patient, Health Care Agent and Guardian, via telehealth or in-person as follows:
- Sign into the web portal and search for your patient. If your patient is not already in the portal, click the button to add a new patient.
- Health care providers can choose to do the following:
- Click on the Serious Illness Conversation Guides (SICG) tab for a step-by-step communication approach to understand patient goals, values and choices, and then translate patient information to an e-MOLST form; OR,
- Click on the e-MOLST tab if you have already initiated a serious illness conversation with a patient / legal advocate, and h/she chooses to complete a MOLST form (it’s voluntary).
- Ask your patient, "Do you have a Health Care Agent?"; Offer help to update or complete a Health Care Proxy. While this cannot be done remotely at this time, information on how to complete a Health Care Proxy is available from Honoring Choices MA here.
- If the patient chooses to complete an e-MOLST, the clinician and patient can sign digitally using their smartphone, tablet, or computer, or by selecting the option to document witnessed verbal consent. See additional information below on signing using these methods.
- Download the competed MOLST form and send a copy to the patient/advocate;
- Document patient choices in the EMR; upload the completed MOLST to EMR;
- Revisit conversations and revise e-MOLST form as needed on the web portal.
5. Are digital or e-signatures authorized for e-MOLST forms?
Yes. The state has authorized use of digital or e-signatures specifically for this web portal.
6. How does a patient, Health Care Agent and Guardian digitally sign an e-MOLST form?
When the signing clinician (Physician, Nurse Practitioner, Physician Assistant) and patient are done completing the e-MOLST form, the clinician will be prompted to help the patient/ legal advocate provide a digital signature either using their smartphone/tablet or via email. If the clinician or patient/legal advocate runs into challenges with the digital signature, the signing clinician can also use witnessed verbal consent to complete the form. See additional information below for more information on the witnessed verbal consent process.
7. What is witnessed verbal consent for MOLST? How does it work?
As of April 9, 2020, and for the duration of the COVID-19 State of Emergency, the state has suspended the standard requirement of a patient’s written consent signature on a MOLST form and allows for witnessed verbal consent by signing clinicians and a witness, to be reliably honored by all EMS personnel and licensed practitioners in hospitals, long-term care facilities and across all health care settings. This offers an important remedy for clinicians and patients where face-to-face MOLST conversations are not possible. Clinicians can initiate proactive planning conversations via telephone or virtual means with high risk patients, their Health Care Agents and Guardians, to discuss goals of care and complete or revise a MOLST form using witnessed verbal consent. On the e-MOLST signature page, there is a section that allows signing clinicians to document witnessed verbal consent. Each health care provider must follow the requirements set out in the Emergency Update to the EMS Protocol 7.3 to create a valid MOLST form. Read more here. In the event that the COVID-19 State of Emergency is rescinded, witnessed verbal consent may no longer be allowed to take the place of a patient’s written consent signature.
8. Is the MA e- MOLST Web Portal different than an e-registry?
Yes. The e-MOLST web portal is not designed to be an electronic registry, but a digital completion tool. Forms will be stored and saved on the portal, so if another clinician logs in to complete a new MOLST, they will be able to see any forms previously completed on this platform or uploaded to the platform. However, EMS and other providers will NOT be checking the portal in a medical emergency. As such, you should continue to use your previous workflows and practices for storage and use of MOLST forms.
To request portal access, please send your full name, licensure/role, institution, work address, work email, and phone number to: firstname.lastname@example.org. You will receive an email invitation to create a password and log in within 2 business days.
The Massachusetts Electronic MOLST Completion Web Portal is a joint pilot project of the Massachusetts Coalition for Serious Illness Care, Ariadne Labs and Honoring Choices Massachusetts with support from Vynca, Inc. The web portal is intended for the purpose of providing health care providers and their care teams with a communication framework for serious illness conversations, and to document patient choices on a paper and electronic MOLST form. Health care providers can use the web portal at no cost with the authorization of their respective organizations and in accordance with their organization’s policies and procedures. While we make every effort to post accurate and reliable information, the web portal may contain inaccuracies, errors or omissions and we expressly exclude liability. The user or viewer’s use of any information or materials on the web portal is entirely at your own risk, for which we shall not be liable.