Many health care providers and health care organizations lack a consistent protocol to conduct brief interventions and offer effective treatment or referrals. Further, many EMR/HIT systems do not include data fields for tobacco use intervention. Often, providers who do conduct interventions do not record their interaction. Without sufficient requirements from organizations such as JCAHO and NCQA, little motivation exists for compliance with sustained performance improvement related to tobacco interventions. Given this situation, the Organization-Level Health Systems Change task group concluded that addressing the promotion of systems changes within health care organizations is a high priority. It identified five objectives for future action.

Recommended Actions:

• Explore how tobacco use interventions could be effectively integrated into existing health care delivery frameworks, such as the Chronic Care Model, a comprehensive organizational approach to caring for patients in primary care settings [1, 2].
• Identify and disseminate protocols for implementing the PHS Guideline, including models for how clinical practice teams can use various team members to intervene with the tobacco user.
• Explore institutionalization of standards for coding for tobacco dependence interventions.
• Develop and promote standards related to tobacco use for EMR systems.
• Encourage the provision of performance incentives for provider brief interventions or enrollments in treatment programs.