UW-CTRI has partnered to use electronic health records (EHRs) to refer patients who smoke or chew tobacco to the Wisconsin Tobacco Quit Line, and the improvement over traditional referral systems has been significant. In fact, the new eReferral system helped clinicians refer 14% of adult tobacco users, compared to the traditional Fax to Quit system that resulted in the referral of only 0.3% of patients. The journal Translational Behavioral Medicine will publish the results.

Across the nation, few smokers receive evidence-based tobacco treatment during health-care visits. EHR presents an opportunity to efficiently identify and refer smokers to state tobacco quitlines. UW-CTRI partnered with several organizations to create a closed-loop EHR referral system linking patients visiting health-care clinics with the Wisconsin Tobacco Quit Line. They included:

  • Epic, one of the largest EHR vendors.
  • Dean Health System. 
  • Alere Wellbeing, the vendor of services for the Wisconsin Tobacco Quit Line.

The Quit Line referral rate increased by a factor of about 46 when the eReferral system replaced the paper fax referral system known as Fax to Quit. The EHR enhancements met the three feasibility goals established at the start of the pilot project:

  • The eReferral system appeared to mesh well with existing clinic workflow and responsibilities. “Tobacco use identification is part of the vital signs at Dean Clinics,” said UW-CTRI Outreach Director Rob Adsit, the lead author of the paper. In that system, “tobacco use must be verified/updated before they can leave the vital signs portion of the patient visit.” Rob said the required auto-prompt was crucial to the success of the project.
  • eReferrals were effectively transmitted from the clinic sites to the quitline vendor in a way that complied with requirements for patient privacy, known as The Health Insurance Portability and Accountability Act (HIPAA).
  • Quit Line services provided as a result of the quitline referral were electronically transmitted back to the individual patient’s EHR in compliance with HIPAA.

One goal of this eReferral system is to make it ubiquitous among all health systems. “The good news for other Epic customers is that this eReferral mechanism wil be part of Epic 2014,” Rob said. “So, for any system purchasing or upgrading to Epic 2014, it will be built in. 
 
“We are currently working on the next generation eReferral. It will be more robust, modern and efficient with real-time, secure transmission of data. It’ll be a standards-based solution that could be implemented by other EHR vendors.”

Rob hopes that one day they’ll have a tool that UW-CTRI outreach specialists can take to health systems and say, “we can work with you to implement eReferrals to the Wisconsin Tobacco Quit Line.”

Adsit RT, Fox BM, Tsiolis T, Ogland C, Simerson M, Vind LM, Bell SM, Skora AD, Baker TB, Fiore MC. Using the Electronic Health Record to Connect Primary Care Patients to Evidence-Based Telephonic Tobacco Quitline Services: A Closed-Loop Demonstration Project. Translational Behavioral Medicine.