Investigating the Documentation of Electronic Cigarette Use in the
            Veteran Affairs Electronic Health Record: A Pilot Study

Mowery, Danielle L.; South, Brett R.; Patterson, Olga V.; Zhu, Shu‐Hong; Conway, Mike

doi:10.18653/v1/w17-2335

Cited by 4 publications

(7 citation statements)

References 14 publications

(6 reference statements)

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“…Similarly, Steinberg et al 15 made use of an e-mailed link to a Web-based survey to enroll 150 physician specialists and ask about physician-patient communication regarding ENDS. Slightly more than one-third (36%) of the physicians endorsed a harm-reduction approach when justifying ENDS use, and consistent with previous results, 17 30% of the physicians recommended ENDS in lieu of combustible cigarettes.…”

Section: Introductionsupporting

confidence: 78%

“…Still, approximately one-third of our physicians do not hold strong objections to ENDS use, a result consistent with previous studies. 17 , 19 Many of our physicians did, however, express concerns regarding patients who do not readily disclose ENDS use or initiate ENDS use without medical approval.…”

Section: Discussionmentioning

confidence: 99%

“…Several different types of studies exist to explore the question of how patients are currently advised on this topic. These studies have involved e-mail and online surveys with patients and quit line staff 15 ; an analysis of free-text tobacco use comments in electronic health record (EHR) documentation 16 , 17 ; and qualitative and survey-based research focusing on physicians’ views of ENDS products. 18 , 19 …”

Section: Introductionmentioning

confidence: 99%

“…Mowery et al 17 analyzed Veterans Administration (VA) patient record data (2008-2014) to examine the frequency of ENDS use documentation in the VA EHR. A cohort of 2000 patients who were recorded as smokers in the VA EHR were identified using keyword searches for ENDS-related terms—eg, vape, ecig, e-cig —that matched actual instances of ENDS use notation, discovering that ENDS-related keywords were present in 4% of patient records.…”

Section: Introductionmentioning

confidence: 99%

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Exploring Physician Attitudes Regarding Electronic Documentation of E-cigarette Use: A Qualitative Study

Hurst

Conway

2018

Tob Use Insights

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Background:In this article, we present qualitative work designed to explore physicians’ attitudes toward and knowledge of electronic cigarettes (or Electronic Nicotine Delivery Systems—ENDS), particularly focusing on personal attitudes held by physicians regarding ENDS use, physician beliefs regarding the relative safety of ENDS, attitudes regarding the efficacy of ENDS as a smoking cessation tool, and how physicians’ document ENDS use in the electronic health record (EHR).Methods:We completed a total of 17 semistructured qualitative interviews with physicians in 4 different outpatient clinic locations. Clinics were selected with the goal of reaching patient panels across a diversity of socioeconomic and local geographic locations.Results:The findings from our qualitative analysis suggest that physicians feel uninformed about the long-term health risks of ENDS and believe that they lack the critical medical knowledge required for discussing ENDS with their patients who smoke. Although physician responses did not endorse the view that ENDS use is a safer alternative to combustible tobacco use, approximately one-third of our physician sample did not hold strong objections to ENDS usage. Physicians placed varying degrees of importance on the issue of ENDS documentation practices.Discussion:Three overarching themes were revealed from our analysis. These themes included (1) physicians’ attitudes regarding the use of ENDS for smoking cessation, (2) physicians’ guidance and advisement to patients in the use of ENDS for smoking cessation, and (3) current practices of clinical documentation of ENDS use in an EHR. Our qualitative results indicate that physicians in our study rarely screen patients for ENDS use, even for those patients who are both documented smokers and recipients of physician-led tobacco cessation counseling. However, most physicians agreed that the prospect of creating a structured data field specifically for the documentation of ENDS use within the EHR would result in the likelihood of increased screening and documentation of ENDS use patterns.

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Section: Introductionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Exploring Physician Attitudes Regarding Electronic Documentation of E-cigarette Use: A Qualitative Study

Hurst

Conway

2018

Tob Use Insights

Self Cite

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“…The evidence suggests that many clinicians record e-cigarette information within the "tobacco use" section of the EHR, along with multiple combustible tobacco products (cigarettes, cigars, pipes, etc. ), or as free-text entries as a part of their clinical notes [11,12]. These documentation efforts are not consistent across clinical practices, nor systematically tracked by the health system.…”

Section: Introductionmentioning

confidence: 99%

Improved Documentation of Electronic Cigarette Use in an Electronic Health Record

Jose

Hays

Warner

2020

IJERPH

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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.

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An NLP approach to identify SDoH-related circumstance and suicide crisis from death investigation narratives

Wang

Dang

Sun

et al. 2023

Journal of the American Medical Informatics Association

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Objectives Suicide presents a major public health challenge worldwide, affecting people across the lifespan. While previous studies revealed strong associations between Social Determinants of Health (SDoH) and suicide deaths, existing evidence is limited by the reliance on structured data. To resolve this, we aim to adapt a suicide-specific SDoH ontology (Suicide-SDoHO) and use natural language processing (NLP) to effectively identify individual-level SDoH-related social risks from death investigation narratives. Materials and Methods We used the latest National Violent Death Report System (NVDRS), which contains 267 804 victim suicide data from 2003 to 2019. After adapting the Suicide-SDoHO, we developed a transformer-based model to identify SDoH-related circumstances and crises in death investigation narratives. We applied our model retrospectively to annotate narratives whose crisis variables were not coded in NVDRS. The crisis rates were calculated as the percentage of the group’s total suicide population with the crisis present. Results The Suicide-SDoHO contains 57 fine-grained circumstances in a hierarchical structure. Our classifier achieves AUCs of 0.966 and 0.942 for classifying circumstances and crises, respectively. Through the crisis trend analysis, we observed that not everyone is equally affected by SDoH-related social risks. For the economic stability crisis, our result showed a significant increase in crisis rate in 2007–2009, parallel with the Great Recession. Conclusions This is the first study curating a Suicide-SDoHO using death investigation narratives. We showcased that our model can effectively classify SDoH-related social risks through NLP approaches. We hope our study will facilitate the understanding of suicide crises and inform effective prevention strategies.

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Investigating the Documentation of Electronic Cigarette Use in the Veteran Affairs Electronic Health Record: A Pilot Study

Cited by 4 publications

References 14 publications

Exploring Physician Attitudes Regarding Electronic Documentation of E-cigarette Use: A Qualitative Study

Exploring Physician Attitudes Regarding Electronic Documentation of E-cigarette Use: A Qualitative Study

Improved Documentation of Electronic Cigarette Use in an Electronic Health Record

An NLP approach to identify SDoH-related circumstance and suicide crisis from death investigation narratives

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