Improved Documentation of Electronic Cigarette Use in an Electronic Health Record

Abstract

The use of electronic cigarettes (e-cigarettes) can affect patient health and clinical care. However, the current documentation of e-cigarette use in the electronic health records (EHR) is inconsistent. This report outlines how the ambulatory clinical practices of a large U.S. hospital system optimized its electronic health records (EHR) framework to better record e-cigarettes used by patients. The new EHR section for e-cigarette information was implemented for outpatient appointments. During a 30-week evaluation period post-implementation, 638,804 patients (12 yrs and older) completed ambulatory appointments within the health system; of these, the new section contained e-cigarette use information for 37,906 (6%) patients. Among these patients, 1005 (2.7%) were identified as current e-cigarette users (current every day or current some day e-cigarette use), 941 (2.5%) were reported as former e-cigarette users, and 35,960 (94%) had never used e-cigarettes. A separate EHR section to document e-cigarette use is feasible within existing clinical practice models. Utilization of the new section was modest in routine clinical practice, indicating the need for more intensive implementation strategies that emphasize the health effects of e-cigarette use, and how consistent ascertainment could improve clinical practice.

Electronic Cigarette Use Is Not Associated with COVID-19 Diagnosis

“…10 Compared with these previous investigations, our study analyzed a clinical cohort (ie, patient seeking medical care) and used self -reported e-cigarette use data that were confirmed and documented in an EHR by a clinician. 6 Also, COVID-19 diagnosis in our study was confirmed using a diagnostic PCR test. 7 This analysis is subject to the limitations common to observational cohort studies, for example, inclusion of some, but likely not all, confounding variables (ie, related both to COVID-19 risk and e-cigarette use).…”

“…Screening utilized a novel electronic health record documentation as previously described. 6 As part of routine clinical care during ambulatory appointments, clinicians ascertain e-cigarette use history from patients and document the information as structured data in the electronic health record (EHR). This documentation framework was implemented in EHR as a quality improvement initiative for our health system since September 2019.…”

Impact of vaping on respiratory health

“…189 190 In part augmented by EMR frameworks that prompt collection of data on vaping history, more recent estimates indicate that a vaping history is being collected in up to 6% of patients. 191 Compared with the widespread use of vaping, particularly among adolescent and young adult populations, this number remains low. Considering generational trends in nicotine use, vaping will likely eventually overcome cigarettes as the most common mode of nicotine use, raising the importance of collecting a vaping related history.…”

“…Retrospective analysis of outpatient visits showed that a vaping history was collected in less than 0.1% of patients in 2015,188 although this number has been increasing 189190. In part augmented by EMR frameworks that prompt collection of data on vaping history, more recent estimates indicate that a vaping history is being collected in up to 6% of patients 191. Compared with the widespread use of vaping, particularly among adolescent and young adult populations, this number remains low.…”

Implementation Science to Improve Tobacco Cessation Services in Oncology Care

“…As of April 2021, 681 (18%) of those referred had completed $1 NDC appointment, of which 173 (27%) were relisted as former smokers in the EHR. C3I support also catalyzed the implementation of changes to infrastructure at the health system level by including structured documentation in the EHR to record e-cigarette use, 14 the establishment of a tobacco and e-cigarette registry, an EHR alert for scheduling staff to update tobacco use history, a patient engagement video delivered via an appointment portal, and use of the NCI's Cancer Patient Tobacco Use Questionnaire. Changing the health system infrastructure as an implementation strategy using an "opt-out" referral workflow that does not require clinician involvement demonstrated effectiveness and sustainability in oncology practices.…”