System level intervention to increase tobacco cessation services through EHR's

Purpose: Systemic change within healthcare settings is imperative to creating sustainable action in the field of tobacco cessation and control. Specifically, healthcare systems with electronic health records (EHRs) lie at the core of emerging health information technology. The University of Texas at Austin implemented a tobacco cessation protocol focusing on ambulatory clinics within large healthcare settings. The protocol includes information on integrating Meaningful Use (MU) Guidelines and the US Public Health Guidelines for tobacco cessation through an EHR. A pilot study tested whether the protocol helped increase Quitline (a state-funded public telephone-based tobacco cessation service) referrals.

Methods: Six ambulatory clinics (three urban and three rural) served as pilot testing sites for the protocol. Three ambulatory clinics used the paper-based protocol (as a comparison point) and three ambulatory clinics used the electronic-based EHR template. The research team trained hospital personnel on the protocol operations, and clearly defined relevant expectations. Following pilot testing, the research team conducted focus groups to discuss the protocol effectiveness and ease of use. Findings were positive and the process has stimulated continued use of the protocol and adoption by the Texas Department of State Health Services.

Results: Both the electronic and paper-based template led to increased Quitline referrals.

Conclusions: Ambulatory clinics’ use of the tobacco protocol appeared to be an effective method to increase Quitline referrals. Tobacco cessation protocols need to be streamlined in all Texas healthcare systems, and more training is needed to assist healthcare professionals in using the protocol.