Tobacco-related disease remains the leading cause of death in the United States and a major cause of medical expenditures and productivity losses. Fortunately, there is strong evidence that advice and assistance from primary care physicians can significantly increase cessation rates among patients who smoke. To combat tobacco use, the US Department of Health and Human Services PHS produced an evidencebased clinical-practice guideline, which recommends that clinicians provide smokers with the "5-A's" cessation services. Population-based studies on the implementation of the 5-As guidelines has been hampered by the lack of an efficient and accurate measure of service delivery.

To meet this need, HMOs Investigating Tobacco 2 (HIT2) has developed innovative approach for collecting tobacco treatment data from structured and free text fields from electronic medical records. In the first phase of the study, a team of tobacco cessation experts developed a concept map for defining coding rules consistent with the established national guidelines for tobacco cessation treatment (the 5-A's). These concepts were then used in the development of a natural language coding program called MediClass using examples of medical records from each of the four HIT 2 sites.

While this developmental work was underway, each of the four HIT 2 sites (KP Hawaii, KP Colorado, KP Northwest, and Harvard Pilgrim) had to develop local procedures for extracting

As many of you may remember, during the first four years of the CRN, Ed Wagner and Sarah Greene visited different CRN sites in an effort to learn more about the individual sites. The site visits were originally prompted by qualitative data from the CRN Evaluation which conveyed a desire for greater connectivity between the sites and the PI's office. These in-person meetings have proven to be extremely helpful for better understanding the unique scientific strengths and operational complexities of each site, and have served as one important vehicle to help us navigate the challenges of multisite research.

Sarah Greene, in her relatively new role as Scientific Research Associate, and Chelsea Jenter, the relatively new CRN Project Director, conducted their first site visit together at Kaiser Permanente Hawaii in late March. The site visit included meetings covering everything from SDRC topics to administrative issues. The site visit also afforded the opportunity to meet KPH's newest coinvestigator, Melissa Finucane, PhD, whose primary area of research interest is risk assessment and decision making.

One of the highlights was a scientific brainstorming session that KPH organized, with collaborators from Cancer Research Center of Hawaii (Carolyn Gotay PhD, and Loic LeMarchand, MD, PhD) and the University of Hawaii Medical School (Jimmy Thomas Efird, PhD).

Given the amount of CRN business transacted by conference calls, we've found it invaluable to meet with colleagues in person. Seeing the research environment, and simply knowing what our colleagues look like, are two of the many intangibles that contribute to better overall functioning as a Network. The CRN road show has now visited six sites in five states, and will be back on tour again soon. Maybe we should budget for an RV in the next renewal.

-Sarah Greene and Chelsea Jenter, GHC