Translational Behavioral Medicine

, Volume 3, Issue 3, pp 244–252 | Cite as

Electronic health records as a tool for recruitment of participants' clinical effectiveness research: lessons learned from tobacco cessation

  • David FraserEmail author
  • Bruce A Christiansen
  • Robert Adsit
  • Timothy B Baker
  • Michael C Fiore
Original Research


Translating tobacco dependence treatments that are effective in research settings into real-world clinical settings remains challenging. Electronic health record (EHR) technology can facilitate this process. This paper describes the accomplishments and lessons learned from a translational team science (clinic/research) approach to the development of an EHR tool for participant recruitment and clinic engagement in tobacco cessation research. All team stakeholders—research, clinical, and IT—were engaged in the design and planning of the project. Results over the first 17 months of the study showed that over one half of all smokers, coming in for any type of clinic appointment, were offered participation in the study, a very high level of adherent use of the EHR. Study recruitment over this period was 1,071 individuals, over 12 % of smokers in the participating clinics.


Electronic health records Recruitment Tobacco cessation 



This research was supported by the National Cancer Institute (5P50CA143188-13 and 5K05CA139871-04) and the Wisconsin Partnership Program. The clinical trials are registered as NCT01122238, NCT01116986, and NCT01120704.


  1. 1.
    Davis D, Evans M, Jada A, et al. The case for knowledge translation: shortening the journey from evidence to effect. BMJ. 2003;327:33-35.PubMedCrossRefGoogle Scholar
  2. 2.
    Zapka J, Goins KV, Pbert L, Ockene JK. Translating efficacy research to effectiveness studies in practice: lessons from research to promote smoking cessation in community health centers. Health Promot Pract. 2004;5:245-255.PubMedCrossRefGoogle Scholar
  3. 3.
    Burnam MA. Measuring outcomes of care for substance use and mental disorders. New Dir Ment Health Serv. 1996;71:3-17.PubMedCrossRefGoogle Scholar
  4. 4.
    Goldblatt EM, Lee WH. From bench to bedside: the growing use of translational research in cancer medicine. Am J Transl Res. 2010;2:1-18.PubMedGoogle Scholar
  5. 5.
    Lenfant C. Shattuck lecture—clinical research to clinical practice—lost in translation? The NEMJ. 2003;349:868-874.Google Scholar
  6. 6.
    Thorndike AN, Rigotti NA, Stafford RS, Singer DE. National patterns in the treatment of smokers by physicians. JAMA. 1998;279:604-608.PubMedCrossRefGoogle Scholar
  7. 7.
    Whitlock EP, Orleans CT, Pender N, Allan J. Evaluating primary care behavioral counseling interventions: an evidence-based approach. Am J Prev Med. 2002;22:267-284.PubMedCrossRefGoogle Scholar
  8. 8.
    Aveyard P, Brown K, Saunders C, et al. Weekly versus basic smoking cessation support in primary care: a randomised controlled trial. Thorax. 2007;62:898-903.PubMedCrossRefGoogle Scholar
  9. 9.
    Yano EM, Rubenstein LV, Farmer MM, et al. Targeting primary care referrals to smoking cessation clinics does not improve quit rates: implementing evidence-based interventions into practice. Health Serv Res. 2008;43:1637-1661.PubMedCrossRefGoogle Scholar
  10. 10.
    Baker TB, Mermelstein R, Collins LM, et al. New methods for tobacco dependence treatment research. Ann Behav Med. 2011;41:192-207.PubMedCrossRefGoogle Scholar
  11. 11.
    Blumenthal DS. Barriers to the provision of smoking cessation services reported by clinicians in underserved communities. J Am Board Fam Med. 2007;20:272-279.PubMedCrossRefGoogle Scholar
  12. 12.
    Helgason AR, Lund KE. General practitioners' perceived barriers to smoking cessation—results from four Nordic countries. Scan J Public Health. 2002;30:141-147.Google Scholar
  13. 13.
    Zwar NA, Richmond RL. Role of the general practitioner in smoking cessation. Drug Alcohol Rev. 2006;25:21-26.PubMedCrossRefGoogle Scholar
  14. 14.
    Bodenheimer T, Young DM, MacGregor K, Holtrop JS. Practice-based research in primary care: facilitator of, or barrier to, practice improvement? Ann Fam Med. 2005;3(Suppl 2):S28-32.PubMedCrossRefGoogle Scholar
  15. 15.
    Stoves J, Connolly J, Cheung CK, et al. Electronic consultation as an alternative to hospital referral for patients with chronic kidney disease: a novel application for networked electronic health records to improve the accessibility and efficiency of healthcare. Qual Saf Health Care. 2010;19:e54.PubMedGoogle Scholar
  16. 16.
    Garrido T, Jamieson L, Zhou Y, Wiesenthal A, Liang L. Effect of electronic health records in ambulatory care: retrospective, serial, cross sectional study. BMJ. 2005;330:581.PubMedCrossRefGoogle Scholar
  17. 17.
    Nemeth LS, Wessell AM. Improving medication safety in primary care using electronic health records. J Patient Saf. 2010;6:238-243.PubMedCrossRefGoogle Scholar
  18. 18.
    Harris SB, Glazier RH, Tompkins JW, et al. Investigating concordance in diabetes diagnosis between primary care charts (electronic medical records) and health administrative data: a retrospective cohort study. BMC Health Serv Res. 2010;10:347.PubMedCrossRefGoogle Scholar
  19. 19.
    Linder JA, Kaleba EO, Kmetik KS. Using electronic health records to measure physician performance for acute conditions in primary care: empirical evaluation of the community-acquired pneumonia clinical quality measure set. Med Care. 2009;47:208-216.PubMedCrossRefGoogle Scholar
  20. 20.
    Lindholm C, Adsit R, Bain P, et al. A demonstration project for using the electronic health record to identify and treat tobacco users. Wis Med J. 2010;109:335-340.Google Scholar
  21. 21.
    Boyle R, Solberg L, Fiore M. Use of electronic health records to support smoking cessation. Cochrane Database Syst Rev. 2011.Google Scholar
  22. 22.
    Hsiao C-J, Hing E, Socey TC, Cai B. Electronic medical record/electronic health record systems of office-based physicians: United States, 2009 and preliminary 2010 estimates. Accessed 15 March 2012.Google Scholar
  23. 23.
    Embi PJ, Jain A, Clark J, Bizjack S, Hornung R, Harris CM. Effect of a clinical trial alert system on physician participation in trial recruitment. Arch Intern Med. 2005;165:2272-2277.PubMedCrossRefGoogle Scholar
  24. 24.
    Miller JL, The EHR. solution to clinical trial recruitment in physician groups. Health Manag Technol. 2006;27:22-25.PubMedGoogle Scholar
  25. 25.
    Wilke RA, Berg RL, Peissig P, et al. Use of an electronic medical record for the identification of research subjects with diabetes mellitus. Clin Med Res. 2007;5:1-7.PubMedCrossRefGoogle Scholar
  26. 26.
    Wilcox A, Natarajan K, Weng C. Using personal health records for automated clinical trials recruitment: the ePaIRing Model. Summit on Translational Bioinformatics 2009, 136-140. Accessed 15 March 2012.Google Scholar
  27. 27.
    Peterson KA, Fontaine P, Speedie S. The Electronic Primary Care Research Network (ePCRN): a new era in practice-based research. J Am Board Fam Med. 2006;19:93-97.PubMedCrossRefGoogle Scholar
  28. 28.
    Collins LM, Baker TB, Mermelstein RJ, Piper ME, Jorenby DE, Smith SS, et al. The Multiphase optimization strategy for engineering effective tobacco use interventions. Ann Behav Med. 2011;41(2):208-226.PubMedCrossRefGoogle Scholar
  29. 29.
    Fiore MC. The new vital sign. Assessing and documenting smoking status. JAMA. 1991;266:3183-3184.PubMedCrossRefGoogle Scholar
  30. 30.
    McCullough A, Fisher M, Goldstein AO, Kramer KD, Ripley-Moffitt C. Smoking as a vital sign: prompts to ask and assess increase cessation counseling. J Am Board Fam Med. 2009;22:625-632.PubMedCrossRefGoogle Scholar
  31. 31.
    Luck MB, McIntire M, Blades N, Robinson W. Characteristics of women with gynecologic cancer who enter clinical trials. J Reprod Med. 2005;50:481-485.PubMedGoogle Scholar
  32. 32.
    Bentz CJ, Bailey BK, Bonin KE, et al. Provider feedback to improve 5A's tobacco cessation in primary care: a cluster randomized clinical trial. Nicotine Tob Res. 2007;9:341-349.PubMedCrossRefGoogle Scholar
  33. 33.
    Zhou YY, Unitan R, Wang JJ, et al. Improving population care with an integrated electronic panel support tool. Popu Health Manag. 2011;14:3-9.CrossRefGoogle Scholar
  34. 34.
    Goss CH, Rubenfeld GD, Ramsey BW, Aitken ML. Clinical trial participants compared with nonparticipants in cystic fibrosis. Am J Respir Crit Care Med. 2006;173:98-104.PubMedCrossRefGoogle Scholar
  35. 35.
    Stone VE, Mauch MY, Steger K, Janas SF, Craven DE. Race, gender, drug use, and participation in AIDS clinical trials. Lessons from a municipal hospital cohort. J Gen Intern Med. 1997;123:150-157.Google Scholar
  36. 36.
    Hutchins LF, Unger JM, Crowley JJ, Coltman CA Jr, Albain KS. Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med. 1999;341:2061-2067.PubMedCrossRefGoogle Scholar
  37. 37.
    Sharpe N. Clinical trials and the real world: selection bias and generalisability of trial results. Cardiovasc Drugs Ther. 2002;16:75-77.PubMedCrossRefGoogle Scholar
  38. 38.
    Berger VW, Exner DV. Detecting selection bias in randomized clinical trials. Control Clin Trials. 1999;20:319-327.PubMedCrossRefGoogle Scholar
  39. 39.
    Verheggen FW, Nieman F, Jonkers R. Determinants of patient participation in clinical studies requiring informed consent: why patients enter a clinical trial. Patient Educ Couns. 1998;35:111-125.PubMedCrossRefGoogle Scholar
  40. 40.
    Moore S. A need to try everything: patient participation in phase I trials. J Adv Nurs. 2001;33:738-747.PubMedCrossRefGoogle Scholar
  41. 41.
    Buckley B, Murphy AW, Byrne M, Glynn L. Selection bias resulting from the requirement for prior consent in observational research: a community cohort of people with ischaemic heart disease. Heart. 2007;93:1116-1120.PubMedCrossRefGoogle Scholar
  42. 42.
    Ives DG, Traven ND, Kuller LH, Schulz R. Selection bias and nonresponse to health promotion in older adults. Epidemiology. 1994;5:456-461.PubMedCrossRefGoogle Scholar
  43. 43.
    Sinha G. Electronic health records help recruit trial participants and track drug safety. J Natl Cancer Inst. 2008;100:384-385.PubMedCrossRefGoogle Scholar
  44. 44.
    Rollman BL, Fischer GS, Zhu F, Belnap BH. Comparison of electronic physician prompts versus waitroom case-finding on clinical trial enrollment. J Gen Intern Med. 2008;23:447-450.PubMedCrossRefGoogle Scholar
  45. 45.
    Fiore MC, Jaen CR, Baker TB, et al. Treating tobacco use and dependence: 2008 update, U.S. Department of Health and Human Services, U.S. Public Health Service, Rockville, MD. 2008.Google Scholar

Copyright information

© Society of Behavioral Medicine 2012

Authors and Affiliations

  • David Fraser
    • 1
    Email author
  • Bruce A Christiansen
    • 1
  • Robert Adsit
    • 1
  • Timothy B Baker
    • 1
  • Michael C Fiore
    • 1
  1. 1.Center for Tobacco Research and Intervention, School of Medicine and Public HealthUniversity of WisconsinMadisonUSA

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