, Volume 4, Issue 3, pp 324-332
Date: 19 Mar 2014

Using the electronic health record to connect primary care patients to evidence-based telephonic tobacco quitline services: a closed-loop demonstration project

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Few smokers receive evidence-based tobacco treatment during healthcare visits. Electronic health records (EHRs) present an opportunity to efficiently identify and refer smokers to state tobacco quitlines. The purpose of this case study is to develop and evaluate a secure, closed-loop EHR referral system linking patients visiting healthcare clinics with a state tobacco quitline. A regional health system, EHR vendor, tobacco cessation telephone quitline vendor, and university research center collaborated to modify a health system’s EHR to create an eReferral system. Modifications included the following: clinic workflow adjustments, EHR prompts, and return of treatment delivery information from the quitline to the patient’s EHR. A markedly higher percentage of adult tobacco users were referred to the quitline using eReferral than using the previous paper fax referral (14 vs. 0.3 %). The eReferral system increased the referral of tobacco users to quitline treatment. This case study suggests the feasibility and effectiveness of a secure, closed-loop EHR-based eReferral system.


Practice: Electronic health records (EHRs) can be used to identify patients who use tobacco and to securely and electronically link these patients to external telephone-based tobacco cessation treatment, with services provided electronically transmitted back to the referred patient’s EHR.
Policy: EHRs are becoming ubiquitous in healthcare and provide a unique opportunity to efficiently refer patients to external prevention services, including tobacco cessation.
Research: EHR-based, closed-loop referral systems can be effectively tested and implemented in healthcare systems.