In keeping with our focus on quitlines and systems change, NAQC thought it would be wise to check in with Rob Adsit, MEd, Director of Education and Outreach at the University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention. Rob has been focusing on supporting systems change, outreach and education to Wisconsin hospitals and health systems for quite some time and we thought he would have some words of wisdom about how the quitline community can move most effectively from fax-referral to e-referral and what the benefits of such a change would be. Guess what? He did! Here is what Rob had to share with us:

In the quickly changing landscape of healthcare in the United States, the morbidity and mortality from tobacco use remains relatively constant. Great strides are being made in the adoption of electronic health records (EHR) over the last several years, yet healthcare systems, including clinics and hospitals, are not consistently identifying and treating their patients who use tobacco. In fact, while 70% of smokers visit a primary care clinician annually, and 80% of smokers report wanting to quit, only 25% of tobacco-users leave their primary care visit with an evidence-based tobacco dependence treatment intervention. The electronic health record, the adoption of which is being accelerated by healthcare reform and meaningful use as defined in The American Recovery and Reinvestment Act of 2009, is ripe with potential to dramatically increase the identification and evidence-based treatment of tobacco users in the United States. This promise, in large part, relies not only on building evidence-based tobacco dependence treatment into the EHR, but also on incorporating the evidence-based, brief tobacco dependence treatment intervention into the roles and workflow of outpatient as well as inpatient clinicians.

Assisting healthcare systems transition from paper fax referrals to digitized, fully electronic referrals directly from the EHR is important for two reasons. The first is that over the next several years the majority of healthcare delivery systems will have or will transition to electronic health records. This will mean a paper referral form that needs to be faxed from a clinic or hospital to a tobacco quitline will be an outlier in a digitized, electronic world. And, a treatment outcome that is faxed back to a clinic or hospital via paper will have to be manually entered into a patient’s electronic record, which will be a low priority for staff in an electronic health record environment. The second important reason for moving to referrals from the EHR is the ability to help healthcare systems achieve and document meaningful use of EHRs. Identification and treatment of patients who use tobacco is core to meaningful use, and referring patients to tobacco quitlines can help healthcare providers achieve this important measure.

The transition will be challenging. It is time and cost intensive to develop electronic health record mechanisms, functionality and interfaces. It also requires expertise and a vocabulary that many of us do not yet possess, and are quickly trying to learn and understand. In addition, we cannot do this work alone. To be successful, it requires a partnership of health information technology, public health, healthcare systems, and quitlines to design, develop, build, test and implement electronic referrals directly from EHRs to tobacco quitlines and, equally important, treatment outcome data from tobacco quitlines back into patient EHRs. This closed loop is a vital component to referrals from the EHR as clinicians are reluctant to refer patients to external services if they do not receive information about the outcome of that referral.

Several states are exploring, developing and testing, or have already developed, mechanisms to refer patients to tobacco quitlines directly from electronic health records – Kentucky, Massachusetts, New Hampshire, Oklahoma, Texas, and Wisconsin.

With the NAQC Conference right around the corner, you might think about trying to connect with your quitline colleagues from these states to learn more about their work on fully electronic, bi-directional referrals from health systems to the quitline!