Integrating a Systematic, Comprehensive E-Cigarette and Vaping Assessment Tool into the Electronic Health Record

Abstract

Background: Recently, the use of electronic cigarettes increased sharply, leading to increased e-cigarette, or Vaping Product Use-Associated Lung Injury (EVALI), and other acute pulmonary conditions. There is an urgent need for clinical information about e-cigarette users to identify factors that contribute to EVALI. We developed an e-cigarette/vaping assessment tool (EVAT) that was integrated into the Electronic Health Record (EHR) of a large state-wide medical system and initiated a system-wide dissemination and education to support its use.Methods: EVAT documented current vaping status, history, and e-cigarette content (nicotine, cannabinoids, and/or flavoring). Educational materials and presentations were developed via a comprehensive literature review. EVAT utilization in the EHR was assessed quarterly. Patients' demographic data and clinical site name were also collected.Results: The EVAT was built, validated, and integrated with the EHR in July 2020. Live and virtual seminars were conducted for prescribing providers and clinical staff. Asynchronous training was offered using podcasts, e-mails, and Epic tip sheets. Participants were informed about vaping harm and EVALI and instructed on the use of EVAT. As of December 31, 2022, EVAT was used 988,181 times, with 376,559 unique patients evaluated. Overall, 1,063 hospital units and affiliated ambulatory clinics used EVAT, including 64 Primary Care, 95 Pediatrics, and 874 Specialty sites.Conclusions: EVAT was successfully implemented. Continued outreach efforts are needed to further increase its usage. Education materials should be enhanced to help providers to reach youth and vulnerable populations and connect patients to the tobacco treatment resources.

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“…Tobacco and e-cigarette users reported using e-cigarettes as an aid to quit smoking (52.6%), to avoid secondhand tobacco smoking (16.1%), and also as a harm reduction tool (8%). 3 Khanna et al, 6 report that about 18.1% of 18-24-year-olds use e-cigarettes and those men vape more often than women (7.3% and 5.5%, respectively). Cigarette and e-cigarette smoke, which is rich in harmful toxins, is known to be a significant cause of diseases with fatal health impacts, such as coronary disease, stroke, increased risk of cancer and susceptibility to bacterial and viral infections, in addition to having negative impacts during pregnancy.…”