The Accuracy and Trends of Smoking History Documentation in Electronic Medical Records in a Large Managed Care Organization

Abstract

The accuracy of smoking history documentation in the electronic medical records was examined at a large managed care organization among 36,494 male members who self-reported smoking history in mailed surveys. The sensitivity of electronic smoking history documentation for ever-smoking status was 0.19 in years 2003-2005 (using ICD-9/CPT code only), 0.80 in 2006-2008 and 0.84 in 2009-2010 (combination of ICD-9/CPT codes and risk factor module used after 2006). The positive predictive value was 0.96, 0.90, and 0.95 in these periods, respectively. Among self-reported ever-smokers, increased healthcare utilization and smoking intensity/duration were associated with higher likelihood of having electronic smoking history documentation, while Asian race and Spanish language preference were associated with lower likelihood. These data suggest that enhanced efforts may be needed to screen for and document smoking among racial/ethnic minorities.

Can Electronic Health Records Be Used for Population Health Surveillance? Validating Population Health Metrics Against Established Survey Data

“…However, our results are consistent with findings from British40,41 and U.S 32. studies comparing EHR data with survey estimates, and with evidence of improvement in smoking history documentation over time 42. The improvement in smoking history documentation in the U.S. was likely attributable to federal incentive payments to providers who met specific Meaningful Use criteria for EHRs, including structured documentation of smoking status in the EHR for at least 50 percent of their patients 43…”

Hidradenitis suppurativa is a systemic disease with substantial comorbidity burden: A chart-verified case-control analysis

“…The surprisingly low prevalence of smoking in the control population may be a reflection of inadequate coding and documentation of smoking and tobacco use reported previously. 18 Similar trends in undercoding of obesity have also been observed, which may serve to explain such low rates of obesity in our control population (\1%). 19 The association between obesity and HS remains high with 17.3-fold higher odds of being obese when also afflicted with HS.…”

Validation of Veterans Affairs Electronic Medical Record Smoking Data Among Iraq- and Afghanistan-Era Veterans

“…Other aspects of EMR data quality (e.g., completeness, plausibility, currency) should also be considered before reuse for research. 38 Results from this study contribute to the growing literature documenting the potential utility of leveraging EMR systems to algorithmically assess risk for smoking, 36 prompt providers to collect smoking status, and provide recommendations for empirically supported treatments for smoking cessation. 39 In summary, VA EMR Health Factors smoking data can be used to accurately determine smoking status for Iraq/Afghanistan era veterans.…”

“…EMR data indicate that ICD-9 codes and medical procedure codes considerably underestimate smoking status. 36,37 Current findings indicate that the use of screening data is a feasible and valid approach to determine smoking status. While the VA mandated universal population-based screening, it allowed local variation in how clinical reminders were implemented (resulting in more than 900 different Health Factor text entries) negatively impacting data quality.…”