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A content analysis of electronic health record (EHR) functionality to support tobacco treatment

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Translational Behavioral Medicine

Abstract

Government regulations have created new incentives for health systems to implement changes in electronic health records (EHRs) to reduce tobacco use among patients. The purpose of this study is to conduct a content analysis of EHR modifications aimed at supporting tobacco cessation and to document these modifications using a 5 A’s framework (i.e., Ask, Advise, Assess, Assist, Arrange). Fourteen trials were identified that met inclusion criteria. A content analysis of EHR functionality in these trials was conducted by two independent reviewers between February and June 2015. For “Ask,” all trials provided for the documentation of smoking status in the EHR. For “Advise,” 35.7 % of EHRs provided functionality related to helping a clinician provide advice to quit. For “Assess,” more than half (57.1 %) of EHRs included a feature to document a patient’s willingness to quit. For “Assist,” EHRs offered features for medication prescribing (78.6 %), providing educational materials to patients (57.1 %), referring a patient to the quitline (50.0 %), referring a patient to a tobacco treatment specialist (42.9 %), and documenting the provision of counseling (35.7 %). Finally, for “Arrange,” EHRs supported the following up of patients (35.7 %) and allowed tobacco treatment specialists to “pass back” patient notes to primary care providers (28.6 %). Studies that have modified EHRs for tobacco treatment have done so across the steps in the 5 As model, with most modifications occurring to support documenting smoking status (Ask) and assisting with medication prescribing (Assist). As health systems attempt to comply with Meaningful Use regulations, an understanding of the range of EHR modifications to support tobacco treatment is warranted.

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Acknowledgment

This research was supported by R18HL108788 at Yale University and internal funding at the George Washington University.

Author information

Authors and Affiliations

  1. Department of Prevention and Community Health, The George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue, 3rd Floor, Washington, DC, NW, 20052, USA

    Jennifer M. Schindler-Ruwisch MPH, Lorien C. Abroms ScD & Christina L. Heminger DrPH

  2. Yale University School of Medicine, 464 Congress Ave., Suite 260, New Haven, CT, 06519-1315, USA

    Steven L. Bernstein MD

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  1. Jennifer M. Schindler-Ruwisch MPH
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  2. Lorien C. Abroms ScD
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  3. Steven L. Bernstein MD
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Corresponding author

Correspondence to Lorien C. Abroms ScD.

Ethics declarations

This research was conducted in concordance with Helsinki standards. This analysis did not involve human subjects as it is a secondary analysis of previously published papers. The authors therefore did not seek IRB approval and the research did not require informed consent. There were no human rights issues to resolve.

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The authors have no relevant conflicts of interest to disclose.

Additional information

Lorien C. Abroms is the corresponding author. Please direct correspondence to lorien@gwu.edu

Jennifer M. Schindler-Ruwisch and Lorien C. Abroms share co-first authorship

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Table 3 5As by trial
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Schindler-Ruwisch, J.M., Abroms, L.C., Bernstein, S.L. et al. A content analysis of electronic health record (EHR) functionality to support tobacco treatment. Behav. Med. Pract. Policy Res. 7, 148–156 (2017). https://doi.org/10.1007/s13142-016-0446-0

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