title: Implementation of an Inpatient Electronic Referral System (Opt-to-Quit) From the Electronic Health Record to the New York State Smokers' Quitline: First Steps.
abstract: (1) To implement a new policy-driven referral program, Opt-to-Quit, using electronic data transfer from the electronic health record (EHR) to the New York State Smokers' Quitline (NYSSQL) and (2) to improve referrals to the NYSSQL for smoking caregivers of children admitted to a children's hospital.
  
  
  
  Smoking caregivers of pediatric patients were referred to the NYSSQL through a standardized template built into the EHR, during the child's hospitalization or emergency department encounter. Direct data exchange was based on a point-to-point protocol, without dependence on any external centralized processing service. Input and oversight were provided by a multidisciplinary task force, which included physician and nursing leadership, information technology specialists, Health Insurance Portability and Accountability Act compliance personnel and legal counsel, and NYSSQL staff. The process was refined through several iterative plan-do-study-act cycles, using a single-armed, prospective cohort study design, including surveys of nursing staff and continued input of information technology experts on both hospital and Quitline sides.
  
  
  
  In 2013, 193 smokers were identified in 2 pilot units; 62% (n= 119) accepted referral to the NYSSQL. In 2014, after expansion to all inpatient units and the emergency department, 745 smokers were identified, and 36% (n = 266) accepted referral. Over the 2 years, overall increase in referrals was 124%; as of the first quarter of 2015, referral rate was sustained at 34%.
  
  
  
  Hospital-wide implementation of the Opt-to-Quit program through our EHR was feasible and sustainable and has significantly improved referrals to the NYSSQL.
authors.affiliation: Stony Brook Children's Hospital, Stony Brook, New York; and rachel.boykan@stonybrookmedicine.edu.
authors.forename: Rachel
authors.initials: R
authors.lastname: Boykan
authors.affiliation: Stony Brook Children's Hospital, Stony Brook, New York; and.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Milana
authors.affiliation: Stony Brook Children's Hospital, Stony Brook, New York; and.
authors.forename: Grace
authors.initials: G
authors.lastname: Propper
authors.affiliation: Roswell Park Cessation Services, Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Patricia
authors.initials: P
authors.lastname: Bax
authors.affiliation: Roswell Park Cessation Services, Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Paula
authors.initials: P
authors.lastname: Celestino
mesh_terms: D017028:Caregivers; D015331:Cohort Studies; D057286:Electronic Health Records; D006776:Hospitals, Pediatric; D006801:Humans; D009518:New York; D015397:Program Evaluation; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D016540:Smoking Cessation