Gibson Bryan, Kramer Heidi, Weir Charlene, Fiol Guilherme, Borbolla Damian, Schlechter Chelsey R, Lam Cho, Nelson Marci, Bohner Claudia, Schulthies Sandra, Sieperas Tracey, Pruhs Alan, Nahum-Shani Inbal, Fernandez Maria E, Wetter David W
Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.
Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, Salt Lake City, Utah, USA.
JAMIA Open. 2021 Feb 11;4(3):ooaa070. doi: 10.1093/jamiaopen/ooaa070. eCollection 2021 Jul.
Tobacco use is the leading cause of preventable morbidity and mortality in the United States. Quitlines are effective telephone-based tobacco cessation services but are underutilized. The goal of this project was to describe current clinical workflows for Quitline referral and design an optimal electronic health record (EHR)-based workflow for Ask-Advice-Connect (AAC), an evidence-based intervention to increase Quitline referrals.
Ten Community Health Center systems (CHC), which use three different EHRs, participated in this study. Methods included: 9 group discussions with CHC leaders; 33 observations/interviews of clinical teams' workflow; surveys with 57 clinical staff; and assessment of the EHR ecosystem in each CHC. Data across these methods were integrated and coded according to the Fit between Individual, Task, Technology and Environment (FITTE) framework. The current and optimal workflow were notated using Business Process Modelling Notation. We compared the requirements of the optimal workflow with EHR capabilities.
Current workflows are inefficient in data collection, variable in who, how, and when tobacco cessation advice and referral are enacted, and lack communication between referring clinics and the Quitline. In the optimal workflow, medical assistants deliver a standardized AAC intervention during the visit intake. Referrals are submitted electronically, and there is bidirectional communication between the clinic and Quitline. We implemented AAC within all three EHRs; however, deviations from the optimal workflow were necessary.
Current workflows for Quitline referral are inefficient and ineffective. We propose an optimal workflow and discuss improvements in EHR capabilities that would improve the implementation of AAC.
在美国，吸烟是可预防的发病和死亡的主要原因。戒烟热线是有效的基于电话的戒烟服务，但未得到充分利用。本项目的目标是描述当前戒烟热线转诊的临床工作流程，并为“询问-建议-连接”（AAC）设计一种基于电子健康记录（EHR）的最佳工作流程，AAC是一种基于证据的干预措施，旨在增加戒烟热线转诊。
十个使用三种不同电子健康记录的社区卫生中心系统（CHC）参与了本研究。方法包括：与CHC负责人进行9次小组讨论；对临床团队工作流程进行33次观察/访谈；对57名临床工作人员进行调查；以及评估每个CHC的电子健康记录生态系统。根据个人、任务、技术和环境之间的适配（FITTE）框架，对这些方法获得的数据进行整合和编码。使用业务流程建模符号记录当前和最佳工作流程。我们将最佳工作流程的要求与电子健康记录功能进行了比较。
当前工作流程在数据收集方面效率低下，在提供戒烟建议和转诊的人员、方式和时间方面存在差异，并且转诊诊所与戒烟热线之间缺乏沟通。在最佳工作流程中，医疗助理在就诊登记时提供标准化的AAC干预。转诊通过电子方式提交，诊所和戒烟热线之间存在双向沟通。我们在所有三种电子健康记录中实施了AAC；然而，有必要偏离最佳工作流程。
当前戒烟热线转诊的工作流程效率低下且效果不佳。我们提出了一种最佳工作流程，并讨论了电子健康记录功能的改进，这将改善AAC的实施。
