E-referrals for stop smoking initiative in Massachusetts

An innovative stop-smoking campaign of the Massachusetts Department of Public Health (DPH)—QuitWorks—works hand in glove with doctors and other healthcare providers. If patients want help to stop smoking, their doctors refer them to QuitWorks for follow-up counseling.

Launched in 2002 by the DPH, QuitWorks was the first program that standardized approaches between healthcare providers to link patients and counselors in a coordinated anti-smoking campaign.

Referrals are key to the widely recognized success of the program, in which JSI Research & Training Institute, Inc. takes part in collaboration with the DPH. Once a referral is made, JSI screens patients for need and eligibility and, if necessary, offers counseling and nicotine patches.

Until recently, healthcare providers referring a patient to QuitWorks had only one way to do it. They had to fill out a paper form and send it by fax to QuitLine, the helpline of the counseling program. To confirm that QuitWorks had actually received the fax, a doctor or an assistant had to call and ask.

Then, once the counseling had run its course, a return fax would go from QuitWorks to the patient's doctor, reporting the outcome of the follow-up. "There was a lot of frustration with paper faxes going back and forth," says Michael Stelmach, a JSI information systems consultant. "We proposed an e-referrals solution to address the problem."

The QuitWorks version of the e-referrals system, which uses the Health-e-link data exchange application, enables a doctor to refer a patient instantly with the click of a button in a patient's file. In addition, the system provides security features to meet federal HIPAA (Health Insurance Portability and Accountability Act) requirements.

In September 2009, Harvard Vanguard Medical Associates, which operates 16 healthcare centers in Massachusetts, became the first healthcare organization to adopt Health-e-link, which is interactive and Web-based. Harvard Vanguard has eliminated paper QuitWorks referrals entirely.

At the heart of the Health-e-link system is a secure network for sharing patient information and allowing users direct access by standard e-mail. Stelmach, who developed the software for JSI, says it has broad application for health data collection and management. "The architecture is well suited to health data referrals, making them less cumbersome and more reliable, as we've been able to demonstrate at QuitWorks," Stelmach says.

Massachusetts is one of 23 states that are collaborating to improve the fax-referral function of their QuitLine programs. "All the states in the collaborative are likely candidates to implement the Health-e-link technology," says Ann Marie Rakovic, a JSI manager of QuitLine in Massachusetts. "This solution supports the crucial trend toward paperless recordkeeping in the nation's healthcare system."

JSI worked with public health officials in Rhode Island and New Hampshire, as well as Massachusetts, to develop the QuitWorks concept and implement it in the three states. It is a multi-pronged program of health-system restructuring to help smokers break their habit.

"QuitWorks has become a national model for health systems change," Rakovic says. "It has proven its effectiveness time and again. More than 400 healthcare institutions and thousands of providers have referred their patients to the program."

Besides the Health-e-link technology, JSI developed the initial concept for a Web-based interactive system that allows the DPH to streamline the enrollment tracking and other kinds of data management for QuitWorks. The technology provides JSI staff and the DPH with virtual data base interaction and management via the Internet.