Use of electronic health records to support smoking cessation

Abstract

Health information systems such as electronic health records (EHR), computerized decision support systems, and electronic prescribing are potentially valuable components to improve the quality and efficiency of clinical interventions for tobacco use. To assess the effectiveness of electronic health record-facilitated interventions on smoking cessation support actions by clinicians and on patient smoking cessation outcomes. We searched the Cochrane Tobacco Addiction Group Specialised Register, CENTRAL, MEDLINE, EMBASE, PsycINFO, CINAHL, and reference lists and bibliographies of included studies. We searched for studies published between January 1990 and May 2011. We included both randomized studies and non-randomized studies that reported interventions targeting tobacco use through an EHR in health care settings. The intervention could include any use of an EHR to improve smoking status documentation or cessation assistance for patients who use tobacco, either by direct action or by feedback of clinical performance measures. Characteristics and content of the interventions, participants, outcomes and methods of the included studies were extracted by one author and checked by a second. Because few randomized studies existed, we did not conduct a meta-analysis. We included three randomized and eight non-randomized observational studies of fair to good quality that tested the use of an existing EHR to improve documentation and/or treatment of tobacco use. None of the studies included a direct assessment of patient quit rates. Overall, these studies found only modest improvements in some of the recommended clinician actions steps on tobacco use. At least in the short term, documentation of tobacco status and increased referral to cessation counseling do appear to increase following the introduction of an expectation to use the EHR to record and treat patient tobacco use at medical visits. There is a need for additional research to further understand the effect of EHRs on smoking treatment in healthcare settings.