Are Quitlines Ready for the E-World? Massachusetts Tobacco Cessation and Prevention Program (MTCP) Donna Warner, MBA, MA, Consultant Tom Land, PhD, Director.

Are Quitlines Ready for the E-World?

Massachusetts Tobacco Cessation and Prevention Program (MTCP)Donna Warner, MBA, MA, ConsultantTom Land, PhD, Director of Surveillance and Evaluation, MTCPAnna Landau, MPH, Quitline Contract Manager, Cessation Program DirectorMichael Stelmach, [Insert Degrees], Consultant to John Snow Inc. and MTCP

MTCP – QuitWorks Partnerships, Planning, and Evaluation Tim Gorin, MPH, Database AnalystLois Keithly, PhD, MTCP DirectorThomas Land, PhD, Director of Surveillance and Evaluation Anna Landau, MPH, Quitline Contract Manager and Cessation Program Manager Donna Warner, MBA, QuitWorks Founder/Director, Consultant

UMass Medical School – QuitWorks Detailing and Training Elena List, MSW, LICSW, Project DirectorDenise Jolicoeur, MPH, CHES, Special Projects Director

JSI Research and Training Institute, Inc.- QuitWorks/Quitline Operations Ann Marie Rakovic, MSW, Director, MA Smokers’ HelplineKristen Risley, MSW Operations Manager, MA Smokers‘ HelplineMichael Stelmach, MBA, IT Consultant for E-Referrals; Privacy/Security and Consent

Atrius/Harvard Vanguard Medical Associates – QuitWorks Electronic ReferralsThad Schilling, MD, Clinical Champion for Smoking CessationElizabeth Hardy, Project Manager

The QuitWorks E-Referral Team

Agenda What do we mean by the e-world? Why integrate quitlines into healthcare and

EMRs? Can we agree on a common terminology? How does it work? Electronic options, privacy

and security Are quitlines ready: what capabilities do you

need? What does the future hold? Next steps….

Question 1

Are quitlines ready for the e-world? Yes NoNot sureDon’t know

What do we mean by the e-world?

DRAFT: DO NOT CIRCULATE

EMR Adopters by State

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The Trend Line for Meaningful Use

2009 2011 2013 2015

Source: Meaningful Use Workgroup Presentation, July 16, 2009

Integrating quitlines into healthcare: Why do it? Benefits to providers, patients, quitline and public

health Increase reach and impact of quitlines Alternative to costly media campaigns for programs

with limited media budgets Availability of fax or e-referral program may

improve upstream interventions in healthcare

Integrating Quitlines into Healthcare: Multiple Benefits

Self-Referred Callers and QuitWorks ReferralsJuly 2009 through December 2010

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Integrating Quitlines into Healthcare: Multiple Benefits

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Moving to e-referral options: Why do it? Make changes in program to keep pace with

changes in the healthcare delivery system Opportunity NOW with EMRs and meaningful

use

The problem with paper…Can’t file a paper feedback report in an EMR

Home > Beacon Communities > An Innovative, Community-based Approach to Smoking Cessation

An Innovative, Community-based Approach to Smoking Cessation

March 10, 2011, 5:27 pm / Jason Kunzman and Aaron McKethan / Beacon Communities Project Officer and Beacon Communities Program Director

One of the criteria set forth in Stage One Meaningful Use guidelines pertains to capturing information at the point of care ab out patients’ smoking status, and as relevant, offering counseling to help patients quit smoking. While attending the Rhode Island Statewide Patient Centered Medical Home Learning Collaborative on February 5, we learned about the kinds of innovations that this aspect of meaningful use may inspire and make more widespread in the future.

Terri Mrozak of Quality Partners of Rhode Island introduced us to a comprehensive smoking cessation strategy that makes the best available use of health information technology (health IT) to support patients seeking to quit smoking across three states. She explained that quitting smoking is often the single most important thing one can do to improve their health, and that it takes most smokers as many as eight quit attempts before they are able to quit permanently.1

Terri then told us about QuitWorks – RI , a free stop-smoking service sponsored by the Rhode Island Department of Health and based on a program created by the Massachusetts Tobacco Control Program in 2002. Since its inception, providers in three states (Massachusetts, New Hampshire, and Rhode Island) have referred more than 30,000 patients to QuitWorks, and nearly one in every five patients contacted has quit smoking within six months after enrolling in the program. 2 More than a telephonic quit line, which are widely available across the country, QuitWorks combines traditional telephonic care management with a heal th IT-enabled referral management system.

According to Donna Warner, QuitWorks founder in Massachusetts, patients interested in smoking cessation resources can be electronically referred to the QuitWorks program through their physicians’ electronic health records (EHRs) with the patient’s medical ID attached. This automatically triggers a follow-up telephonic referral to a trained quitline counselor who will reach out to the patients and offer targeted education and coaching. Importantly, status reports can be provided back to physicians directly into their EHR system, which allows physicians to follow up with patients and monitor their progress as they seek to quit. As part of the program, Quality Partners of Rhode Island also helps physician practices develop the workflow changes needed in their office to support approaches to tobacco-dependence treatment. While QuitWorks itself pre-dates the meaningful use rule, the combination of well-established tobacco counseling approaches with health IT linking patients’ data back into referring physicians’ EHRs represents the kind of innovation that meaningful use may support more broadly.

1 Massachusetts Office of Health and Human Services

2 Dr. Thomas Land, Massachusetts Tobacco Control Program, Director of Surveillance and Evaluation

RI and MA QuitWorksE-Referrals Featured on Health IT.gov

While QuitWorks itself pre-dates the meaningful use rule, the combination of well-established tobacco counseling approaches with health IT linking patients’ data back into referring physicians’ EHRs represents the kind of innovation that meaningful use may support more broadly.

The Manual Process

Tobacco user fills in their information

Specifies language preference

Gives signed consent to be called

Provider fills in their information or it is pre-filled

2. Fax to 1-866-560-9113

1. Complete Referral Form 3. Give Patient A Brochure

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Defining Terms What do we mean by e-referrals?

Five stages in a quitline referral with feedback

Manual or electronic? Paper or electronic? Multiple electronic modes

What do we mean by electronic?

Initiating the Referral• Manual: Form filled out on paper• Hybrid: Form downloaded, some fields pre-populated• Fully Electronic: Form in EMR, completion automatic

Transmitting the Referral

• Manual: Paper forms are transmitted by FAX• Hybrid: Referral by FAX, email or internet• Fully Electronic: One click referral to Quitline

Interfacing with Database• Manual: Paper based, manual data entry into database• Hybrid: Manual data entry into database• Fully Electronic: Automatic entry into Quitline database

Transmitting the Feedback

• Manual: Paper forms are transmitted by FAX• Hybrid: Transmission by FAX or email • Fully Electronic: Daily or real- time transmission

Interfacing with EMR• Manual: File paper feedback reports• Hybrid: File/scan paper feedback reports or manual data entry• Fully Electronic: EMR record automatically updated

Step 1 Step 2

Step 3

Step 4Step 5

Arriving At the Quitline

In the Provider’s Office In Hyperspace

Back In Hyperspace

Leaving the QuitlineIn the Provider’s Office

And In the Medical Record

Health-e-link SupportsQuitline eReferrals

EPIC

eClinical Works

AllScripts

NextGen

GE Centricity

Other EMRs

Health-e-link-Secure transmission

-HIPAA compliant-Standardizes data

-Path to full integration

MassachusettsDatabase

State 1Database

State 2Database

State 3Database

State 4Database

Other States

Information Exchange Network

Public Domain-e-link-Secure transmission

-HIPAA compliant-Standardizes data

-Path to full integration

Quitline Feedback

Data

Quitline Referral

Data Items

Quitline Referral

Data Items

Quitline Feedback

Data

How It Works: Referral Options Paper-based Referrals

Providers fax referrals to QuitLine and receive paper-based updates via fax.

eForms-based Referrals Providers securely email electronic forms (pdf, word

documents) and receive electronic updates (Health-e-link). eReferrals

Referrals are made directly from EMRs. Updates are returned directly to patient charts in EMRs (Health-e-link).

How It Works: Privacy & Security Paper-based Referrals

HIPAA allows providers to fax patient information for treatment purposes.

eForms Referrals More secure and accountable. Documents are exchanged over a

secure network with restricted access. eReferrals

Most secure and accountable system-to-system data exchange. Removes majority of manual intervention.

Regardless of approach, HIPAA must be addressed.

Atrius / HVMA Case Study 5 medical groups with 800 physicians in 30+ sites use a shared

EPIC/EMR platform. Atrius used hybrid e-referral model (form in EMR / FAX

transmission) for 5 years. EMR supports eReferrals from the point-of-care. Health-e-link accepts eReferrals, translates data and routes to

TobaccoWeb. Benefits include increased referrals and reduced burden. Planned next steps include Referral Updates directly into EMR

patient charts.

Quitline Referrals Before and After e-Referral Launch(21 Atrius Health Sites -- 2009 vs 2010)

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Capabilities NeededAre you ready? Operations performance standards Real-time access to referral data Flexible feedback reporting capability Knowledge of:

EMR products Meaningful Use tobacco measures Joint Commission proposed measures Knowledge of privacy, security, and consent

Detailing and training with clinical workflow and EMR fields

Question 2

Does your quitline referral program have the capacity to generate feedback reports to providers on every patient referred?YesNoDon’t Know

Does your fax referral program offer on-site detailing service for institutional users (e.g. hospitals, CHCs, larger provider practices)YesNoDon’t know

Question 3

Question 4

Does your quitline have performance standards that are monitored at least monthly (e.g. time from referral receipt to first contact attempt, contact rates, time within which feedback reports must be sent) Yes No Don’t Know

Question 5

Does your quitline have the capability to transmit referral data from an EMR to quitline and back to an EMR electronically?YesNoUnder developmentDon’t Know

What Does the Future Hold? Meaningful use will continue to incent providers

to adopt “certified” EMR systems which support electronic data exchange.

States will continue to develop health information exchanges (HIEs).

State and federal agencies will seek to leverage the above efforts to improve public health program management and healthcare oversight.

Next Steps Understand the overall eReferral process and how

it may benefit your program and participating practices.

Consider a phased approach for implementation (paper-based, eForms, eReferrals).

Understand the broader “meaningful use” context. Stage 1, 2, 3 Clinical Quality Measures

Next Steps - continued Understand the capabilities of your systems.

EMR, HIE, QuitLine Consider long term implications of IT choices.

(3rd party, open source, custom, hosted solutions) Engage local resources that can help.

Regional extension centersHealth information exchangesEMR vendorsPublic health program leaders

Notes of Caution eReferrals must fit into clinical workflow. “Certified” EMRs offer different levels of support for

public health programs (understand how EMR vendors interpret and support meaningful use).

HIEs don’t automatically resolve all data exchange issues. Understand your local HIE priorities and capabilities.

Thank you!

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[email protected]

[email protected] [email protected][email protected]@state.ma.us

Join the MultiState Collaborative on upcoming webinars: 1) Meaningful Use 4/26/2011, 12:30pm-2:00pm

2) Drill-down on technical e-Referral questions and answers (May-TBA)