Improved Documentation of Electronic Cigarette Use in an Electronic Health Record.

Thulasee Jose,David O Warner,J Taylor Hays

doi:10.3390/ijerph17165908

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.

Highlights

Cigarette smoking is the leading cause of preventable disease and death in the United States [1].Despite the overall progress made to curb combustible cigarette smoking in the U.S, between 2014 and 2018, the prevalence of electronic cigarette (e-cigarette) use increased from 5.1% to 7.6% in U.S adults aged 19–24 years [2]
A separate electronic health records (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

Summary

Introduction

Despite the overall progress made to curb combustible cigarette smoking in the U.S (the prevalence of smoking was 13.7% in 2018), between 2014 and 2018, the prevalence of electronic cigarette (e-cigarette) use increased from 5.1% to 7.6% in U.S adults aged 19–24 years [2]. E-cigarettes are battery-powered devices that deliver an aerosol by heating solutions that usually contain nicotine, propylene glycol, and a variety of other solvents and flavoring agents [3]. According to the World Health Organization (WHO), many countries lack tobacco surveillance and monitoring systems to effectively assess the prevalence of current e-cigarette use [5]. A recent report suggested that in mid-2018, at least 40 million adults across the globe used e-cigarettes [6]

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