Translational Behavioral Medicine

, Volume 4, Issue 3, pp 324–332 | Cite as

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

  • Robert T. Adsit
  • Bradley M. Fox
  • Thanos Tsiolis
  • Carolyn Ogland
  • Michelle Simerson
  • Linda M. Vind
  • Sean M. Bell
  • Amy D. Skora
  • Timothy B. Baker
  • Michael C. Fiore
Case Study

ABSTRACT

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.

Keywords

Electronic health record Tobacco cessation Telephonic tobacco quitline Workflow Healthcare system 

References

  1. 1.
    Fiore MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Rockville, MD: U.S. Department of Health and Human Services, U.S. Public Health Service; 2008.Google Scholar
  2. 2.
    Centers for Disease Control and Prevention. Quitting smoking among adults—United States 2001–2010. MMWR. 2011;60(44):1513-1519.Google Scholar
  3. 3.
    Wewers ME, Stillman FA, Hartman AM, Shopland DR. Distribution of daily smokers by stage of change: current population survey results. Prev Med. 2003;36(6):710-720.PubMedCrossRefGoogle Scholar
  4. 4.
    Jamal A, Dube SR, Malarcher AM, Shaw L, Engstrom MC. Tobacco use screening and counseling during physician office visits among adults—National Ambulatory Medical Care Survey and National Health Interview Survey, United States, 2005–2009. MMWR. 2012;61(Suppl):38-45.PubMedGoogle Scholar
  5. 5.
    Blumenthal D, Tavenner M. The “meaningful use” regulation for electronic health records. N Engl J Med. 2010;363(6):501-504.PubMedCrossRefGoogle Scholar
  6. 6.
    Marcotte L, Seidman J, Trudel K, Berwick DM, Blumenthal D, Mostashari F, Jain SH. Achieving meaningful use of health Information technology: a guide for physicians to the EHR incentive programs. Arch Int Med. 2012;172(9):731–736.Google Scholar
  7. 7.
    Hsiao CJ, Hing E. Use and Characteristics of Electronic Health Record Systems Among Office-Based Physician Practices: United States, 2001–2012. NCHS Data Brief No. 111. Hyattsville, MD: National Center for Health Statistics; 2012.Google Scholar
  8. 8.
    Charles D, King J, Patel V, Furukawa MF. Adoption of electronic health record systems among U.S. non-federal acute care hospitals: 2008–2012. ONC Data Brief, no 9. 2013. http://www.healthit.gov/sites/default/files/oncdatabrief9final.pdf. Access verified 12 Nov 2013.
  9. 9.
    U.S. Department of Health and Human Services. Patient Protection and Affordable Care Act. 2011. http://www.gpo.gov/fdsys/pkg/FR-2011-07-15/pdf/2011-17610.pdf. Access verified 12 Nov 2013.
  10. 10.
    Koh HK, Sebelius KG. Promoting prevention through the Affordable Care Act. N Engl J Med. 2010;363(14):1296-1299.PubMedCrossRefGoogle Scholar
  11. 11.
    Lindholm C, Adsit R, Bain P, et al. A demonstration project for using the electronic health record to identify and treat tobacco users. WMJ. 2010;109(6):335-340.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Hivert MF, Grant RW, Shrader P, Meigs JB. Identifying primary care patients at risk for future diabetes and cardiovascular disease using electronic health records. BMC Health Serv Res. 2009;9:170.PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Rattay KT, Ramakrishnan M, Atkinson A, Gilson M, Drayton V. Use of an electronic medical record system to support primary care recommendations to prevent, identify, and manage childhood obesity. Pediatrics. 2009;123(Suppl 2):S100-S107.PubMedCrossRefGoogle Scholar
  14. 14.
    Bordowitz R, Morland K, Reich D. The use of an electronic medical record to improve documentation and treatment of obesity. Fam Med. 2007;39(4):274-279.PubMedGoogle Scholar
  15. 15.
    Goldberg HI, Neighbor WE, Cheadle AD, Ramsey SD, Diehr P, Gore E. A controlled time-series trial of clinical reminders: using computerized firm systems to make quality improvement research a routine part of mainstream practice. Health Serv Res. 2000;34(7):1519-1534.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Fraser D, Baker TB, Fiore MC, Adsit RA, Christiansen BA. Electronic health records as a tool for recruitment of participants in clinical effectiveness research: lessons learned from tobacco cessation. Transl Behav Med. 2013;(3):244-52.Google Scholar
  17. 17.
    Bates DW, Ebell M, Gotlieb E, Zapp J, Mullins HC. A proposal for electronic medical records in U.S. primary care. J Am Med Inform Assoc. 2003;10(1):1-10.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Kemper AR, Uren RL, Clark SJ. Adoption of electronic health records in primary care pediatric practices. Pediatrics. 2006;118(1):e20-e24.PubMedCrossRefGoogle Scholar
  19. 19.
    Bentz CJ, Bayley BK, Bonin KE, et al. Provider feedback to improve 5A’s tobacco cessation in primary care: a cluster randomized clinical trial. Nicotine Tob Res. 2007;9(3):341-349.PubMedCrossRefGoogle Scholar
  20. 20.
    Linder JA, Ma J, Bates DW, Middleton B, Stafford RS. Electronic health record use and the quality of ambulatory care in the United States. Arch Intern Med. 2007;167(13):1400-1405.PubMedCrossRefGoogle Scholar
  21. 21.
    Greenwood DA, Parise CA, Macaller TA, et al. Utilizing clinical support staff and electronic health records to increase tobacco use documentation and referrals to a state quitline. J Vasc Nurs. 2012;30(4):107-111.PubMedCrossRefGoogle Scholar
  22. 22.
    Boyle R, Solberg L, Fiore M. Use of electronic health records to support smoking cessation. Cochrane Database Syst Rev. 2011 (Issue 12:1-19. Art. No.: CD008743).Google Scholar
  23. 23.
    Papadakis S, McDonald P, Mullen KA, Reid R, Skulsky K, Pipe A. Strategies to increase the delivery of smoking cessation treatments in primary care settings: a systematic review and meta-analysis. Prev Med. 2010;51(3–4):199-213.PubMedCrossRefGoogle Scholar
  24. 24.
    Quinn VP, Stevens VJ, Hollis JF, et al. Tobacco-cessation services and patient satisfaction in nine nonprofit HMOs. Am J Prev Med. 2005;29(2):77-84.PubMedCrossRefGoogle Scholar
  25. 25.
    Solberg LI, Asche SE, Boyle RG, Boucher JL, Pronk NP. Frequency of physician-directed assistance for smoking cessation in patients receiving cessation medications. Arch Intern Med. 2005;165(6):656-660.PubMedCrossRefGoogle Scholar
  26. 26.
    Gabriel ME, Furukawa MF, Vaidya V. Emerging and encouraging trends in e-prescribing adoption among providers and pharmacies. Am J Manag Care. 2013;19(9):760-4.Google Scholar
  27. 27.
    Kruse GR, Kelley JH, Linder JA, Park ER, Rigotti NA. Implementation of an electronic health record-based care management system to improve tobacco treatment. J Gen Intern Med. Aug 4 2012;(12):1690-6.Google Scholar
  28. 28.
    Cantrell J, Shelley D. Implementing a fax referral program for quitline smoking cessation services in urban health centers: a qualitative study. BMC Fam Pract. 2009;10:81.PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Holtrop JS, Malouin R, Weismantel D, Wadland WC. Clinician perceptions of factors influencing referrals to a smoking cessation program. BMC Fam Pract. 2008;9:18.PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    North American Quitline Consortium. 2011. Results from the 2010 NAQC Annual Survey of Quitlines. http://www.naquitline.org/?page=survey2010. Access verified 12 Nov 2013.
  31. 31.
    Cummins SE, Bailey L, Campbell S, Koon-Kirby C, Zhu SH. Tobacco cessation quitlines in North America: a descriptive study. Tob Control. 2007;16(Suppl 1):i9-i15.PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Ossip-Klein DJ, McIntosh S. Quitlines in North America: evidence base and applications. Am J Med Sci. 2003;326(4):201-205.PubMedCrossRefGoogle Scholar
  33. 33.
    North American Quitline Consortium. 2009. Increasing reach of tobacco cessation quitlines: a review of the literature and promising practices. (C. Bronar, MA, J.Saul, PhD). Phoenix, AZ. http://c.ymcdn.com/sites/www.naquitline.org/resource/resmgr/issue_papers/naqc_issuepaper_increasingre.pdf

Copyright information

© Society of Behavioral Medicine 2014

Authors and Affiliations

  • Robert T. Adsit
    • 1
  • Bradley M. Fox
    • 3
  • Thanos Tsiolis
    • 3
  • Carolyn Ogland
    • 2
  • Michelle Simerson
    • 2
  • Linda M. Vind
    • 2
  • Sean M. Bell
    • 4
  • Amy D. Skora
    • 1
  • Timothy B. Baker
    • 1
  • Michael C. Fiore
    • 1
  1. 1.School of Medicine and Public HealthUniversity of Wisconsin Center for Tobacco Research and InterventionMadisonUSA
  2. 2.Dean Health SystemsMadisonUSA
  3. 3.Epic Systems CorporationVeronaUSA
  4. 4.Alere WellbeingSeattleUSA

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