Workflow analysis for design of an electronic health record-based tobacco cessation intervention in community health centers 

February 17, 2021

Published: February 11, 2021
Bryan Gibson, Heidi Kramer, Charlene Weir, Guilherme Fiol, Damian Borbolla, Chelsey R Schlechter, Cho Lam, Marci Nelson, Claudia Bohner, Sandra Schulthies, Tracey Sieperas, Alan Pruhs, Inbal Nahum-Shani, Maria E Fernandez, David W Wetter

LAY SUMMARY - Tobacco use is the leading cause of preventable illness and death in the United States. Quitlines provide telephone-based tobacco cessation services but are underused. The goal of this project was to describe current clinical workflows for Quitline referral, and design an optimal workflow for Ask-Advice-Connect (AAC), an intervention to increase Quitline referrals.

Ten Community Health Center systems (CHC), participated in this study. We conducted: 9 group discussions with CHC leaders; 33 observations/interviews of clinical teams' workflow; surveys with 57 clinical staff; and assessment of the Electronic Health Record capabilities in each CHC. Data across these methods were coded and used to notate the current and optimal workflows. We compared the requirements of the optimal workflow with Electronic Health Record capabilities.

Current workflows are inefficient in data collection, variable in enactment, 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 clinics; however, deviations from the optimal workflow were necessary. We propose an optimal workflow and discuss improvements in EHR capabilities that would improve the implementation of AAC.

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