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State health staff outline digital-first MOLST rollout, EMS training and pediatric guidance
Summary
Department of Public Health staff said the witness requirement was removed from the MOLST form last legislative session and described three concurrent work streams — revised form, training and policy/procedures — moving to the Commissioner’s Office for review, with a hoped-for June rollout and a separate EMS training pathway.
Department of Public Health staff told the Palliative Care Advisory Council that the state is preparing a digital-first rollout of the Medical Orders for Life-Sustaining Treatment (MOLST) form and related training.
"Last legislative session, the witness requirement was removed from the MOLST form," a DPH staff member said. "We are currently working on...revising the training program. We are also...revised the form, and...the policy and procedures. So, we are close to finishing the work. And those 3 work streams will go to the Commissioner's Office for their review and approval before we actually execute those."
The council was told the DPH is pursuing a digital-first approach while retaining guidance for a physical copy. "We would strongly encourage that the eligible provider who is having that conversation print the form with the individual, send it home," the staff member said, adding that the agency also envisions guidance recommending the form be posted where EMS or facility staff can find it.
Why it matters: MOLST documents are used by clinicians, EMS and facilities to record orders about life-sustaining treatment. Council members emphasized that removing procedural barriers and improving training could expand use in pediatric and community settings while cautioning that EMS access and integration remain practical hurdles.
Council, staff and clinical leaders discussed implementation details and separate pediatric needs. The DPH staff said pediatric concerns have been flagged and that pediatric MOLST may need additional signals or clarifications even if the overall MOLST framework remains the same: "We have identified that there needs to be some signal or spotlight on pediatric MOLST. And is it different? And in the big picture, MOLST is MOLST is MOLST, but we do know that there are some gaps when we think about pediatric..."
Members pressed for a tailored EMS pathway; the staff noted a separate EMS training curriculum is being developed because EMS has a central role in following MOLST orders. The staff also described an aspirational goal of a statewide registry: "An aspirational goal for us is to get to maybe a point where we have a registry. Massachusetts is developing their registry. California has 1. Oregon has 1. But that's a truly aspirational goal."
Council members asked about rollout timing and operational details. The DPH staff said the work streams will be sent to the Commissioner’s Office for review and that the group is aiming for a June rollout, while acknowledging ongoing wordsmithing to reduce confusion and make the tool workable for patients, providers and EMS.
The discussion also covered ties between MOLST, physical identifiers (such as bracelets) and how those track in pediatric and adult settings; several members said bracelets present durability and acceptability problems in pediatrics and suggested parallel tracks for DNR identifiers and MOLST orders.
Ending: The advisory council and DPH staff agreed to continue work on the form, training modules and EMS pathways, and to bring finalized materials to the Commissioner’s Office before any public rollout.
