Medical Orders for Scope of Treatment (M.O.S.T.) Program

On March 20, 2020, DC enacted the Electronic Medical Order for Scope of Treatment Registry Amendment Act of 2019, effective March 10, 2020 (D.C. Law 23-62, D.C. Official Code §21-2221.14.a). This later Act provides authority to establish the electronic MOST (eMOST) format in the District, to facilitate the use of cloud-based technology for electronic Medical Orders for Scope of Treatment ("MOST") Forms, to connect with health care providers at the point of care through the State-designated health information exchange (HIE). The electronic MOST form provides a more comprehensive approach, empowering terminally-ill patients the right to make decisions on their end-of-life care options, in consultation with their DC-licensed authorized healthcare provider (Physician (MD/DO) or Advanced Practice Registered Nurse (APRN) only). The advance care planning initiative is a partnership between DC Health and the DC Department of Healthcare Finance and is made possible through the DC-designated Health Information Exchange, CRISP DC, using solutions developed by A|DVault, Inc.

The MOST program is administered by the D.C. Department of Health (DC Health) Health Emergency Preparedness and Response Administration’s (HEPRA) EMS Division. As part of the implementation plan, the EMS Division has established an advisory committee of multi-disciplinary healthcare providers and stakeholders to assist in development of the MOST form as well as provide public awareness.

New Electronic Medical Orders for Scope of Treatment (eMOST) Form

Through an initiative led by the DC Department of Health Care Finance (DHCF) and DC Health, CRISP DC collaborated with A|D Vault to embed its advance care planning platform called MyDirectives for Clinicians, in the HIE.

DC Health partnered with DHCF and CRISP DC to ensure that this cloud-based solution (crispdc.org/acp/) will allow providers and any CRISP DC HIE user to create, upload, and view advance care plans, including the eMOST form, whenever and wherever it is needed across multiple care teams. This will ensure all care teams, including ambulatory providers and DC Fire and EMS responders, can view their patient’s most current thinking on future, urgent, and end-of-life care planning goals, and objectives to honor the patient’s care decisions.

Users can scan and upload existing advance care planning documents like paper DC MOST forms at MyDirectives.com. For more information and/or to get credentialed to access MyDirectives for Clinicians in CRISP and begin the onboarding process, email the CRISP DC team at [email protected].

The Medical Orders for Scope of Treatment (MOST) Form

The MOST Form is divided into four (4) sections (A-D), simplifying patient preferences for life-sustaining treatments, including: Cardio-Pulmonary Resuscitation (CPR), Medical Interventions/Treatment Options, Antibiotics, and Medically-Assisted Nutrition.  Any incomplete section of the MOST form implies full treatment for that section.  The form must be completed by the patient or their authorized representative and an authorized DC-licensed healthcare provider to be considered valid.

The DC MOST Form is also made publicly available on our website where it may be downloaded and printed. It is advised that, the form should be kept in your medical records by your Physician or Advanced Practice Nurse and the patient should keep a copy. All copies of the original MOST Form serve as a legal document. The healthcare provider must keep an original or copy in the patient medical record. The patient must have a copy on their person or in the immediate visible vicinity for it to be honored. 

Now that the electronic registry is available from the officially designated Healthcare Information Exchange for the District of Columbia (CRISP DC), DC Health recommends that healthcare providers and patients use the new cloud based platform outlined above.

What if I already have a completed and signed paper version of a MOST form in my medical records?

Patients with a current paper MOST forms can upload their forms and other advance care plans directly into the AD Vault’s My Directive portal by creating a free account (advaultinc.com and it will be accessible to Crisp DC. Any CRISP DC HIE user, including DC healthcare facilities and providers and Emergency Medical Services first responders, will be able to search and view their patient’s most current thinking on future, urgent, and end-of-life care planning goals and objectives

Portability

If your eMOST form is not on the cloud based platform and accessible to all CRISP HIE users, a copy of the patient’s MOST form should follow the patient in any setting and must be honored.  This includes, but is not limited to hospitals, long-term care facilities, clinics, hospice, private medical practices, and the patient’s home. The portability of the form provides continuity and assurance that if the patient is incapacitated and transferred to a new health care setting, the patient’s End-of-Life wishes will be easily recognized and respected.  It is required that, within seventy-two (72) hours of the patient’s transfer to a healthcare setting, that the MOST form be reviewed by an authorized DC-licensed healthcare provider. 

Revocation of MOST

The MOST form may be revoked at any time by the patient or patient’s authorized representative.  To cancel the form, write the words “VOID” across the form and put a line through “Medical Orders for Scope of Treatment” at the top of the page.  Revocation can also occur verbally to EMS responders or an authorized DC-licensed healthcare provider.  Following the revocation, the patient’s medical record should be updated accordingly. 