Thank you, Monique.
Good afternoon all. Today I am going to present or share my experience with using EHR for tobacco cessation. Most of the material in today's session relates to Patagonia Health EHR, but the tips and tricks I share can be applied to other EHRs as well. You can build the same functionality in any system.
Background on Patagonia Health
Patagonia Health is an easy-to-use, web-based electronic health record system focused on public health departments, mental health or behavioral health agencies, and FQHCs. We have worked with several organizations on tobacco cessation services, and what I am presenting today comes from findings with those organizations.
As we all know, tobacco use and smoking are among the leading causes of avoidable death in the United States. Tobacco use puts individuals at higher risk of other comorbidities. About 15 percent of adults in the country are smokers and are at risk of these issues. This costs the United States billions of dollars.
Seventy percent of smokers want to quit, but they need help. Many are successful when clinicians assist them, and clinicians also need tools. That is where EHRs come in.
Since EHRs are so prevalent, they can help you meet your tobacco cessation goals.
What You Should Look for in an EHR
The EHR should:
- Be easy to use
- Be an asset, not a burden
- Assist clinicians without getting in the way
- Move quickly and streamline workflow
Clinicians should not have to click through multiple screens to finish their work. Templates should be designed so that captured data can be reported on and used for follow up.
For example, documenting smoking status should be within the client’s workflow. Clinicians should not have to leave their clinical template just to enter smoking status. That becomes a hindrance.
Smoking status should be captured in the same screen as social history while discussing alcohol use, exercise, caffeine, and so on. This keeps workflow smooth.
Smoking cessation can occur in many visit types:
- Prenatal care
- Family planning
- Behavioral or mental health programs
One popular tool is the Five A’s counseling method. To encourage documentation, the Five A’s template should be within the workflow, not on a separate screen. Otherwise clinicians may perform the counseling but not document it, which means you lose data for reporting.
I will show a few examples of how templates can be set up.
Using Reportable Templates
Templates should store information in reportable fields. For example, in a Five A’s template, cigarettes per day should be a dropdown rather than a free text field. If you use a free text field, some will type “2,” some “2.0,” others “two,” which makes reporting inconsistent.
Dropdowns, checkboxes, and radio buttons make data reportable and usable.
Integrating Smoking Status Into the Workflow
Users have asked us to put the smoking question within the social history area. This increases the likelihood that clinicians capture smoking status even if they are not providing cessation counseling that day.
Capturing smoking status also helps you:
- Meet meaningful use requirements
- Generate reports
- Identify whether your population needs cessation programs
Tracking Goals and Progress
If a clinician sets a goal such as reducing smoking to two packs per day, they can update the status at each visit. Over time, this creates a graph that shows progress, plateaus, or regression.
This makes it easier to see how effective your cessation services are.
Referrals to Quitlines
Many clinicians refer clients to Quitlines. Traditionally, this is done by fax, paper, or phone, which breaks workflow.
With technology, referrals can be sent electronically using HL7. A CCD with client information can be sent directly to the Quitline with one click.
Some Quitlines are bidirectional, meaning they send progress updates back into the EHR.
We are currently working with a couple of organizations to build these electronic HL7 referrals.
Following Up Using Reports and Messaging
After counseling, clinicians may set quit dates and goals. To follow up:
- Run a report of all clients who received Five A’s counseling.
- Sort by quit date.
- Identify who needs follow up.
You can then:
- Call clients, or
- Automate follow up using text messages or emails directly from the EHR
Clinicians can send personalized messages or bulk messages. Some organizations send helpful videos or educational materials.
GIS Mapping for Community Planning
At an organizational level, you may want to know where your smokers are coming from. Using integrated GIS tools, you can map clients by ZIP code and visually identify areas with high smoking prevalence.
This helps you plan community outreach programs.
You can also analyze which services smokers are using:
- Family planning
- Pregnancy care
- Diabetes nutrition clinics
- Other medical programs
This helps you decide where to introduce cessation interventions and how to train staff.
You can also analyze comorbidities such as asthma, obesity, or diabetes to plan more comprehensive services.
Insurance Reimbursement for Smoking Cessation
There is reimbursement available for cessation counseling. The EHR should help you:
- Check insurance eligibility
- Work with clearinghouses connected to thousands of payers
- Avoid retyping information into external portals
Common service codes and reimbursement rates vary by state. You may want to provide clinicians with a cheat sheet or set up decision support rules so that relevant codes auto-populate when counseling is provided.
The Future of EHR and Tobacco Cessation
Some emerging technologies include:
- QuitBit: A lighter with a sensor that sends data to the EHR each time the client lights a cigarette
- Environmental monitors: Research tools that track whether a client smokes, sending that data to the EHR
- Predictive modeling: Using big data to profile smoker types and guide the most effective treatment
These tools connect the EHR directly to patient behavior in daily life.
If you would like additional resources, the links on the slide point to information from the Lung Association and the CDC.
Thank you for the opportunity to present today. We enjoyed putting this presentation together and sharing what technology can do. If you have any questions, please contact us via email or phone.
Q & A
If you have any questions, please put them in the questions box. We will hang out for a few more minutes.
Okay, I do not see any questions coming in. This webinar has been recorded and will be uploaded to the GoToWebinar site. If you would like to see the recording or share it with someone in your organization, you can register again at the link and receive the recording.
Thank you everyone for attending and we hope to see you next time.
