@Article{信息:doi 10.2196 / / jmir。1721年，作者=“Sadasivam, Rajani S和delaughm, Kathryn和Crenshaw, Katie和Sobko, Heather J和Williams, Jessica H和Coley, Heather L和Ray, Midge N和Ford, Daniel E和Allison, Jeroan J和Houston, Thomas K”，标题=“开发一种交互式的，网络传输系统，以增加提供者——患者参与戒烟”，期刊=“J医学互联网研究”，年=“2011”，月=“10”，日=“18”，卷=“13”，数=“4”，页=“e87”，关键词=“戒烟;一般实践;家庭实践;公共卫生信息学;用户界面;随机对照试验;卫生服务研究;背景:患者自我管理干预戒烟是有效的，但未得到充分利用。卫生保健提供者通常不会建议吸烟者接受这些干预措施。 Objective: The objective of our study was to uncover barriers and facilitators to the use of an e-referral system that will be evaluated in a community-based randomized trial. The e-referral system will allow providers to refer smokers to an online smoking intervention during routine clinical care. Methods: We devised a four-step development and pilot testing process: (1) system conceptualization using Delphi to identify key functionalities that would overcome barriers in provider referrals for smoking cessation, (2) Web system programming using agile software development and best programming practices with usability refinement using think-aloud testing, (3) implementation planning using the nominal group technique for the effective integration of the system into the workflow of practices, and (4) pilot testing to identify practice recruitment and system-use barriers in real-world settings. Results: Our Delphi process (step 1) conceptualized three key e-referral functions: (1) Refer Your Smokers, allowing providers to e-refer patients at the point of care by entering their emails directly into the system, (2) practice reports, providing feedback regarding referrals and impact of smoking-cessation counseling, and (3) secure messaging, facilitating provider--patient communication. Usability testing (step 2) suggested the system was easy to use, but implementation planning (step 3) suggested several important approaches to encourage use (eg, proactive email cues to encourage practices to participate). Pilot testing (step 4) in 5 practices had limited success, with only 2 patients referred; we uncovered important recruitment and system-use barriers (eg, lack of study champion, training, and motivation, registration difficulties, and forgetting to refer). Conclusions: Implementing a system to be used in a clinical setting is complex, as several issues can affect system use. In our ongoing large randomized trial, preliminary analysis with the first 50 practices using the system for 3 months demonstrated that our rigorous preimplementation evaluation helped us successfully identify and overcome these barriers before the main trial. Trial: Clinicaltrials.gov NCT00797628; http://clinicaltrials.gov/ct2/show/NCT00797628 (Archived by WebCite at http://www.webcitation.org/61feCfjCy) ", issn="1438-8871", doi="10.2196/jmir.1721", url="//www.mybigtv.com/2011/4/e87/", url="https://doi.org/10.2196/jmir.1721", url="http://www.ncbi.nlm.nih.gov/pubmed/22011394" }