Are Quitlines Ready for the E-World?

1. Are Quitlines Ready for the E-World? Massachusetts Tobacco Cessation and Prevention Program (MTCP) Donna Warner, MBA, MA, Consultant Tom Land, PhD, Director of Surveillance and Evaluation, MTCP Anna Landau, MPH, Quitline Contract Manager, Cessation Program Director Michael Stelmach, [Insert Degrees], Consultant to John Snow Inc. and MTCP

2. The QuitWorks E-Referral Team • MTCP – QuitWorks Partnerships, Planning, and Evaluation Tim Gorin, MPH, Database Analyst Lois Keithly, PhD, MTCP Director Thomas 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 Director Denise Jolicoeur, MPH, CHES, Special Projects Director • JSI Research and Training Institute, Inc.- QuitWorks/Quitline Operations Ann Marie Rakovic, MSW, Director, MA Smokers’ Helpline Kristen Risley, MSW Operations Manager, MA Smokers‘ Helpline Michael Stelmach, MBA, IT Consultant for E-Referrals; Privacy/Security and Consent • Atrius/Harvard Vanguard Medical Associates – QuitWorks Electronic Referrals Thad Schilling, MD, Clinical Champion for Smoking Cessation Elizabeth Hardy, Project Manager

3. 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….

4. Question 1 • Are quitlines ready for the e-world? • Yes • No • Not sure • Don’t know

5. What do we mean by the e-world?

6. Electronic Health Record Use by Office-Based Physicians DRAFT: DO NOT CIRCULATE EMR Adopters by State Source: http://www.cdc.gov/nchs/data/hestat/emr_ehr_09/emr_ehr_09.pdf

7. The Trend Line for Meaningful Use 2009 2011 2013 2015 Source: Meaningful Use Workgroup Presentation, July 16, 2009 7

8. 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

9. Integrating Quitlines into Healthcare: Multiple Benefits

10. Integrating Quitlines into Healthcare: Multiple Benefits

11. 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

12. RI and MA QuitWorks E-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.

13. The Manual Process 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 Tobacco user fills in their information Specifies language preference Gives signed consent to be called 13

14. 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

15. What do we mean by electronic? In the Provider’s Office In Hyperspace Step 1 Step 2 • 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 Arriving At the Quitline Step 3 • Interfacing with Database • Manual: Paper based, manual • data entry into database • Hybrid: Manual data entry • into database • Fully Electronic: Automatic • entry into Quitline database Step 5 Step 4 • Interfacing with EMR • Manual: File paper feedback • reports • Hybrid: File/scan paper feedback • reports or manual data entry • Fully Electronic: EMR record • automatically updated • Transmitting the Feedback • Manual: Paper forms are • transmitted by FAX • Hybrid: Transmission by FAX • or email • Fully Electronic: Daily or real- • time transmission Leaving the Quitline In the Provider’s Office And In the Medical Record Back In Hyperspace

16. Health-e-link SupportsQuitline eReferrals Information Exchange Network EPIC Massachusetts Database Quitline Referral Data Items eClinical Works Quitline Referral Data Items State 1 Database • Health-e-link • Secure transmission • HIPAA compliant • Standardizes data • Path to full integration • Public Domain-e-link • Secure transmission • HIPAA compliant • Standardizes data • Path to full integration AllScripts State 2 Database NextGen State 3 Database Quitline Feedback Data Quitline Feedback Data GE Centricity State 4 Database Other EMRs Other States

17. 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).

18. 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.

19. 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.

20. Atrius System Referrals 2009 vs. 2010

21. 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

22. Question 2 • Does your quitline referral program have the capacity to generate feedback reports to providers on every patient referred? • Yes • No • Don’t Know

23. Question 3 • Does your fax referral program offer on-site detailing service for institutional users (e.g. hospitals, CHCs, larger provider practices) • Yes • No • Don’t know

24. 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

25. Question 5 • Does your quitline have the capability to transmit referral data from an EMR to quitline and back to an EMR electronically? • Yes • No • Under development • Don’t Know

26. 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.

27. 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

28. 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 centers • Health information exchanges • EMR vendors • Public health program leaders

29. 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.

30. Thank you! www.quitworks.org info@quitworks.org thomas.land@state.ma.us anna.landau@state.ma.us michael_stelmach@jsi.com donna.warner@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) 30