University of Wisconsin–Madison

Scientific Advisors Meet in Madison to Discuss Progress on Innovative EHR Projects

Dr. Michael Fiore presents research strategies for projects resulting from the R35 grant. Scientific advisers observe. Photo by Shelin Xu
Dr. Michael Fiore presents research strategies for projects resulting from the R35 grant. Scientific advisers observe. Photo by Shelin Xu

A group of experts from around the country met at Monona Terrace in Madison, Wisconsin in August to discuss progress on partnerships between UW-CTRI, Epic, Smokefree.gov, and three Wisconsin health-care systems to leverage electronic health records (EHR) technology to help patients quit smoking.

UW-CTRI Research Director Dr. Tim Baker discusses R35 projects. Photo by Shelin Xu

UW-CTRI Director Dr. Michael Fiore presented on several projects made possible by the seven-year, $6.4 million R35 Outstanding Investigator Award (OIA) from the National Cancer Institute (NCI), which supports investigators with outstanding records of productivity in cancer research.

UW-CTRI Director Dr. Michael Fiore presents the rates at which two clinics referred patients to the Wisconsin Tobacco Quit Line via eReferral or fax. Photo by Shelin Xu
UW-CTRI Director Dr. Michael Fiore presents the rates at which two clinics referred patients to the Wisconsin Tobacco Quit Line via eReferral or fax. Photo by Shelin Xu

Fiore noted that the R35 projects leverage both technology and a population-based approach to help patients quit smoking. While they highlight the central role of primary care clinicians, they also identify resources and staff to off-load time-intensive interventions. Fiore spoke about several projects, including:

  1. Quit Line Referral Method Study. This project included 25 clinics, including 13 from Wheaton Franciscan Healthcare and 12 from Gundersen Health System. In each system, about half the clinics tested closed-loop, HIPAA-compliant electronic referral (eReferral) to the Quit Line via EHR, while others operated the Fax to Quit program. Fiore reported that, in this study, health-care providers referred a higher percentage of patients to the Quit Line via eReferral than Fax to Quit.
  2. SmokefreeTXT Pilot Study. This project integrates NCI’s SmokefreeTXT program that sends text messages to participants’ phone to inspire and support an attempt to quit smoking. At two participating Gundersen Health System clinics, if a patient was ready to quit smoking, the “best practice alert” in the EHR prompted clinicians to refer to SmokefreeTXT via an eReferral order. Data from this small pilot study indicated feasibility of the approach, and present questions on which members of a care team may be best suited to intervene with this approach.
  3. Comprehensive Chronic Care Smoking Treatment System. Given that only about half of smokers in America are advised to quit during clinic visits, UW-CTRI has teamed with Epic and GHC in a program designed to reach out to all GHC patients who smoke. GHC Tobacco Cessation Outreach Specialists Katherine Coates and Hannah Wallenkamp are ensuring their patients have the tools they need to quit smoking for good. (For more on that, see the story below in this newsletter.) So far, four clinics are on board with another two to be added this fall. The Wisconsin State Journal featured this project in a news story.
UW-CTRI Associate Director of Research Dr. Danielle McCarthy is leading data analysis for R35 projects. Here, she makes notes during the meeting with scientific advisers. Photo by Shelin Xu

At the meeting, experts discussed challenges, such as modest reach to smokers and fatigue among providers facing multiple EHR alerts. Some astute questions from the group centered on cost, but answers are largely to be determined.

UW-CTRI Researcher Mark Zehner and Outreach Director Rob Adsit, who work with Epic on several projects involving EHR tools, have been integral to establishing the partnership, and UW-CTRI Research Director Tim Baker joined Dr. Fiore in writing the original grant application. UW-CTRI Associate Director of Research Danielle McCarthy has been leading the data analysis and UW-CTRI Specialist Marika Rosenblum has assisted with R35 project coordination. UW-CTRI Students Alex Doyle and Shelin Yu helped with logistics for the meeting with scientific advisors.

“This was a tremendous opportunity to share our progress with our highly respected panel of experts,” said Fiore. “These colleagues provided insight on how we can strategically move forward to maximize the number of patients who can quit smoking in the most efficient ways.”

Participants in the R35 Scientific Advisers Meeting included, from left: Dr. Elisa Tong (UC-Davis), Dr. Michael Fiore (UW-CTRI), Dr. Marlon Mundt (UW-CTRI), Amy Conlon (UW-CTRI), Mark Zehner (UW-CTRI), Dr. Christian Kastman (GHC-SCW), Dr. Michael Whitcomb (Essentia Health), Dr. Jessica Bartell (UW Health), Dr. Tim Baker (UW-CTRI), Dr. Danielle McCarthy (UW-CTRI), Dr. Linda Sarna (UCLA), Dr. David Ahern (Harvard), Rob Adsit (UW-CTRI), Dr. Hilary Tindle (Vanderbilt), Dr. Paul Reber (AboutHealth), Dr. Steve Bernstein (Yale), Marika Rosenblum (UW-CTRI). Photo by Shelin Xu