Electronic referrals speed care for patients wanting to quit tobacco

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An interoperable electronic health records-based electronic referral system can produce higher rates of patient referrals to a state tobacco Quit Line than does fax-based referral.

According to a study published in the Journal of the American Medical Informatics Association, the University of Wisconsin Center for Tobacco Research and Intervention is developing a new smoking referral information system, supported with electronic health records to more efficiency and effectively refer patients who smoke to the Wisconsin Tobacco Quit Line. A total of 23 primary care clinics from two health systems in Wisconsin participated in the research.

Results of the study find that clinics using electronic referrals sent more adult smokers to the Quit Line, with a clinic referral rate of 17.9 percent vs. 3.8 percent for other clinics.

During every patient visit, the EHR will prompt the clinic’s medical assistant who transports a patient from the waiting area to the examination room to collect information such as current medications, vital signs and allergies before clinicians see them, and the assistant again will be prompted to inquire about tobacco use and offer tobacco quitting services.

If the patient indicates interest in quitting, an electronic referral order is automatically populated with the patient’s name and contact information, as well as optimal times for the quit line to call the patient. The electronic referral is then sent to Optum, the vendor operating the quit line, in real time when the physician places the order.

The exchange of patient information in both directions between the healthcare system and the state’s quit line is done via Health Level 7 standard messaging. After the quit line receives the electronic referral, it attempts to contact the patient and provide cessation services, in the same way that occurs if a physician is using a paper fax referral.

If the patient cannot be reached, the quit line sends patient data back to the EHR, and the data is automatically saved in the electronic health record as a “referral outcome note,” while provision of over-the-counter nicotine replacement medication including medication start and end dates are documented in the patient’s medication list.

To help physicians more easily contact patients, an electronic texting tool, called SmokefreeTXT, can be offered to a patient. The workflow for SmokefreeTXT will mimic that of an electronic referral to the Quit Line almost exactly, with medical assistants recording the use of SmokefreeTXT in the electronic health record.

Because SmokefreeTXT does not provide medications to patients, it is not necessary to update the patient’s medication list.

Additional information on the study is available here.

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