Background Information 

Through "Meaningful Use”, the U.S. federal government is providing substantial incentives for health care systems to adopt electronic health records (EHRs) and use them in ways to improve quality, safety and efficiency. These incentives are having their desired effect – 78% of physicians in outpatient practices reported using EHRs in 2013 and 76% of U.S. hospitals reported using EHRs in 2014. The demand on health care systems to demonstrate increased efficiency of EHRs is having a spill-over effect on quitline referrals; many health care institutions now expect quitlines to accept referrals directly from smokers’ EHRs. EHRs represent an important new way for quitlines to receive referrals from the healthcare sector. NAQC has set a goal for all quitline service providers in the U.S. to have the capacity for receiving referrals from EHRs by 2016.

Since 2012, NAQC’s eReferral workgroup comprised of quitline service providers, state managers and health care institutions has been engaged in developing capacity to refer smokers from health care institutions to quitlines through the health care institution’s electronic health records (EHRs). Of the diverse topics discussed during eReferral Workgroup meetings, challenges and barriers that accompany scaling-up eReferral efforts is a topic that is frequently discussed. While ideally scaling up should be a seamless and natural progression for quitline services, there are several barriers and challenges that persist which impede efforts to accelerate progress.

The Status of eReferral among State Quitlines

September 2018 – Currently (see table), 25 state quitlines had fully implemented eReferral with at least one healthcare partner; most of those state quitlines are working with multiple health care organizations and hospitals. In addition, 6 state quitlines were actively working to implement eReferral but have not yet completed the work, and 21 quitlines had not yet embarked on the process of implementing eReferral. To learn more about implementing eReferral please see NAQC’s 2015 Guide for Implementing eReferral with Certified EHRs. To learn more about the challenges and solutions to scaling-up implementation of eReferral please see NAQC’s 2017 Barriers and Challenges to Scaling-up eReferral.

June 2018 – 25 state quitlines had fully implemented eReferral with at least one healthcare partner; most of those state quitlines are working with multiple health care organizations and hospitals. In addition, 5 state quitlines were actively working to implement eReferral but have not yet completed the work, and 22 quitlines had not yet embarked on the process of implementing eReferral.

August 2017 – 24 state quitlines had fully implemented eReferral with at least one healthcare partner. In addition, 5 state quitlines were actively working to implement eReferral but have not yet completed the work, and 23 quitlines had not yet embarked on the process of implementing eReferral.

August 2016 - 20 state quitlines had fully implemented eReferral with at least one healthcare partner. In addition, 6 state quitlines were actively working to implement eReferral but have not yet completed the work, and 26 quitlines had not yet embarked on the process of implementing eReferral.

Additional information on these activities is available here. 

 

Workgroup Resources

The Barriers and Challenges of Scaling-up eReferral (2017)

In 2017 members of the eReferral workgroup engaged in a conversation to discuss the core barriers, costs challenges and potential solutions associated with scaling-up eReferral. The Barriers and Challenges of Scaling-up eReferral document outlines the outcomes of these discussions with Workgroup members. The tables are segmented by topic area and include specific examples of the challenges faced within that area along with potential solutions that, with the help of NAQC and CDC, could help advance state efforts. If you have questions or want more information contact naqc@naquitline.org.

Table Displaying eReferral Implementation in US (2018 Update)

In June 2018, NAQC reached out to service providers to update the status of  eReferral capacity among the states they work. The resulting table contains information shared by the 11 services providers that operate the 53 quitlines across the states and territories. NAQC will continue to assess the status of eReferral capacity and update the table to reflect progress made.

Guide for Implementing eReferral Using Certified EHRs! (2015)

An updated version of the guide is was posted on February 29, 2016.
This guide is a resource for quitlines and other cessation services that would like to establish referral systems with healthcare electronic health record (EHR) systems. It provides recommended standards for implementing eReferral in a straightforward and efficient way.

• For non-technical program staff, the guide’s introduction, purpose and summary of recommendations will provide useful background on eReferral (see first 5 pages).
• For technical staff at quitlines, other cessation services and healthcare institutions, the guide’s recommended set of standards provides a roadmap for creating bi-directional eReferrals (read full guide and appendices).

Quality Improvement Initiative Issue Paper: Quitline Referral Systems (2012)

This issue paper aims to explore the current landscape of quitline referral systems with healthcare and other providers and to examine in detail the critical operational and outcome-related components of these referral systems. While the primary focus of the paper is on the U.S. experience, the authors have incorporated critical aspects of the Canadian systems where appropriate. In addition to providing a review of the evidence, authors address the fundamental processes that underlie all referral systems, regardless of the referral method (e.g., phone, fax or electronic) and make recommendations for quality referral systems practices.
view issue paper (PDF 1,487KB)

State Pilot Projects for Developing eReferral Capacity

Members of NAQC’s eReferral workgroup have been engaged in pilot projects to implement eReferral programs between state quitlines and a variety of health care institutions. Below are descriptions of some state pilot projects:

California
- Success Story – California Smokers’ Helpline Declared a Specialized Registry
- UC Medical Centers (UC-Davis, LA, SF, SD and Irvine), Epic, Allscripts and California Smokers Helpline (URL disabled)

Oklahoma
- Mercy Health System, Epic and Alere Wellbeing
- Chickasaw Nation Medical Center, RPMS and Alere Wellbeing

New York
- RPCS/NYSSQL Opt-to-Quit for RPCI Just Breathe Program
- RPCS/NYSSQL Opt-to-Quit for Richmond UniversityMedical Center Program
- RPCS Opt-to-Quit for Stony Brook ChildrensHospital Program

Pennsylvania
- University of Pittsburgh Medical Center, Cerner (EHR), Medicity (HIE) and National Jewish Health

Texas
- Baylor Scott and White, Epic, Alere Wellbeing and University of Texas at Austin (URL disabled)
- GE Centricity, Alere Wellbeing and University of Texas at Austin
- Holon Solutions, Alere Wellbeing and University of Texas at Austin (URL disabled)
- Lonestar Circle of Care, NextGen, Alere Wellbeing and University of Texas at Austin
- NextGen, Alere Wellbeing and University of Texas at Austin

Wisconsin
- Dean Health, Epic and Alere Wellbeing

Other Resources

Background on Meaningful Use The government’s website on meaningful use provides useful background information and updates on progress that is being made.

February 2014 (webinar)
Referrals, Reach and Retention: Are Our Efforts Paying Off?

September 2013 (webinar)
Role of Health Information Exchanges in eReferral: What Action Can States Take Now?

January 2013 (comments)
NAQC’s comments to the Office of the National Coordinator (ONC) for Health Information Technology on the Stage 3 definition of meaningful use of electronic health records. The request for comment is comprised of three sections:1) meaningful use objectives and measures; 2) quality measures; and 3) privacy and security.

November 2012 (webinar)
Electronic Quitline Referrals: How Far Have We Come and What Are the Next Steps?

August 2012 (conference)
Electronic Quitline Referrals: How Far Have We Come and What Are the Next Steps?

April 2011 (webinar)
Are quitline referral systems ready for the world of electronic health records?