Enhancing eReferral Capacity: A Strategy for Increasing Cessation Among Priority Populations and Encouraging Health System Change

Background

North American Quitline Consortium (NAQC), in collaboration with the Smoking Cessation Leadership Center (SCLC) and with funding from Pfizer, worked on a project to establish national capacity among state quitlines for engaging in eReferral with healthcare organizations.

This project focused on improving the competence of health professionals (i.e., quitline and healthcare professionals) and the performance of healthcare systems (i.e., enhancing the capacity of both quitlines and healthcare organizations to conduct eReferral) so that more smokers receive effective cessation treatment. This project aimed to go beyond educating health professionals to address the system changes needed within healthcare organizations to identify smokers and refer them electronically to quitlines, as well as the system changes needed within quitlines to receive an eReferral and provide an electronic feedback report. In addition to quitlines, this project included healthcare organizations that serve populations disproportionately burdened by smoking (i.e., priority populations), such as those with chronic mental illness, substance abuse disorders, other chronic diseases, low socioeconomic status (SES), and racial/ethnic minorities. These groups have been identified by Pfizer and SCLC as populations of special interest.

NAQC worked with four state teams to carry out an eReferral pilot project (Arizona, Illinois, Mississippi and South Dakota). Each state team is comprised of the following:

1.       the state funder

2.       the state quitline service provider (American Lung Association, Avera McKennan, Information and Quality Healthcare and University of Arizona) and

3.       a health care institution that serves predominately underserved populations

NAQC provided training, intensive technical support and other resources to the state teams throughout the project.  At the end of the project, lessons learned, training materials, case studies, technical tools and other resources on eReferral are available on the NAQC website and were disseminated broadly to the cessation and tobacco control communities as well as the healthcare sector. For more information on NAQC's work on eReferral, please click here.

Project Timeline:

Project Resources

• An overview of the strategic objectives of the quitline and the services offered;
• The promotional and outreach strategies employed to maximize reach;
• Barriers and challenges encountered throughout the course of the 18-month project;
• Solutions developed to address the barriers and challenges;
• Lessons learned; and
• Key elements for success.

Fact Sheet: Considerations for Selecting A Health Care Organization Partner Enhancing eReferral Capacity for Quitlines
Arizona
Illinois
Mississippi
South Dakota

Archived Training Webinars

Webinar #1: Meaningful Use and the Technical Approach to eReferral

·         Click here to access webinar slides.

·         Click here to listen to access the webinar recording.

Learning Objectives:

During this webinar, participants learned:

1.       How eReferral ties into Meaningful Use and other healthcare IT objectives.

2.       Where else eReferral is important and how health systems should be implementing eReferral across their organization.

3.       How eReferral workflows fit into current heath care operations and plans.

Webinar #2: The Structure of eReferral Messages

·         Click here to access webinar slides.

·         Click here to listen to access the webinar recording.

Learning Objectives:

During this webinar, participants learned:

1.       What “the structure of eReferral messages” means in the context of eReferral.

2.       How to describe the NAQC standard recommendation for message structure.

3.       The definition of Clinical Document Architecture (CDA) and the uses for consolidated CDA (cCDA) templates for messages.

4.       The differences between cCDA Document Templates - (Header, CCD, Progress Note)

5.       The meaning of NAQC eReferral Data Set and Qualified Registries.

6.        The structure of quitine Feedback Reports.

Webinar #3: Transmission and Delivery of eReferral Messages

·         The background material for this webinar is NAQC’s new eReferral Guide, which can be accessed here.

·         Click here to access webinar slides.

·         Click here to listen to access the webinar recording.

Learning Objectives

During this webinar, participants learned:

1.       What is encompassed in this topic of “transmission and delivery of eReferral messages”?

2.       What is a HISP?

3.       How can my quitline connect to a health system without a direct interface?

4.       What are other allowable methods for securely transmitting health information that support eReferral processes?

Webinar #4: Experiences from the Field: Implementing the NAQC eReferral Standard

·         The background material for this webinar is NAQC’s new eReferral Guide, which can be accessed here.

·         Click here to access webinar slides.

·         Click here to listen to access the webinar recording.

Learning Objectives

During the webinar participants:
1.        Learned how the Pennsylvania quitline and University of Pittsburg Medical Center partnered to implement eReferral.

2.         Discussed important lessons learned by the state funder regarding the role of the state funder in eReferral, selecting a healthcare partner, timeline for completion, cost and resources, and benefits of implementation (including the impact of eReferral on quitline utilization).

3.         Discussed important lessons learned by the quitline service provider regarding the role of the service provider in eReferral, selecting a healthcare partner, timeline for completion, cost and resources (including consideration of which activities to do in-house versus through external contracts), and benefits of implementation.

4.          Discussed important lessons learned by the healthcare organization regarding the role of the healthcare partner in eReferral, making the case for referral with the quitline to the healthcare organization, timeline for completion, cost and resources, and benefits of implementation.

Webinar #5: Refining Your eReferral System After Implementation!

·         Click here to access webinar slides.

·         Click here to listen to access the webinar recording.

Learning Objectives

After the webinar participants were able to:

1.          Summarize the experiences of the four state teams in implementing eReferral.

2.          Articulate the challenges faced by each team in connecting the quitline to electronic heath records.

3.          Apply lessons learned by the four teams to scale internal operations to support and/or enhance their organizations’ eReferral capabilities.

Contributors

This project is supported by a grant from Pfizer, in collaboration with the Smoking Cessation Leadership Center.

NAQC gratefully acknowledges the contributions to this project provided by the following technical consultants: Evan Frankel, Frankel Healthcare Consultants; Christopher Anderson, California Smokers Helpline; Robin Daigh, National Jewish Health; SG Seshadri, Roswell Park Cancer Institute.