Table 2 Summary of key modifications and adaptations to eReferral strategies before, during, and after eReferral implementation in two healthcare systems
Summary of proactive, planned modifications (adaptations) | Modification goal |
|---|---|
Align eReferral initiative with other high-priority health system objectives: •Configure eReferral so it can demonstrate meaningful use of EHR •Align interoperability approach to system HIT resources and infrastructure | Increase adoption and sustainment system-wide, align with sociopolitical-level mandates |
Engage health system stakeholders (clinicians, HIT developers and trainers, quality improvement leaders, smoking cessation champions, clinic managers) to tweak and refine eReferral user displays and training in their use: •Make EHR eReferral alert format highly salient •Remove “hard-stop” and reduce frequent alert firing that burdens clinicians •Prompt clinicians to offer assistance in quitting smoking before assessing patient readiness to quit •Prepopulate as many fields as possible to reduce data entry burden •Remove system defaults that increase burden without adding needed functionality •Add deferral option for clinicians who routinely pre-chart | Enhance adoption, fidelity, acceptability, and sustainability among clinicians (and downstream reach among patients) system-wide |
Engage health system stakeholders (clinicians, HIT developers and trainers, quality improvement leaders, smoking cessation champions, clinic managers) to tweak and refine eReferral workflows and associated training: •Prompt eReferral in all face-to-face encounters with all primary care clinicians (including physicians and advanced practice providers) •Train medical assistants who conduct rooming activities in the importance of logging out of encounters (vs. securing login session) to facilitate clinician eReferral workflow •Automate incorporation of quitline information in after-visit summaries for all patients for whom the EHR alert fired (whether eReferred during the visit or not) so this happens consistently and without additional clinician data entry | Enhance adoption, fidelity, acceptability, and sustainability among clinicians’ reach among patients system-wide |
Maintain and enhance interoperability and clinician feedback functions: •Monitor and maintain interoperability functioning, especially after system updates •Modify returned eReferral results so they cover all possible outcomes and are clear to clinicians making eReferrals •Adapt QuitLine standards to increase yield from eReferrals | Increase adoption, acceptability, sustainability, and/or reach |