Background: The adoption of Electronic Health Records (EHRs) in healthcare settings is an opportunity for promoting smoking cessation. EHR functionality related to smoking cessation has potential to shape clinician behavior and standardize best practices. Previous studies have not systematically examined the characteristics of EHRs related to smoking cessation.
Objectives: The purpose of this study is to review the published literature that describes EHR modifications aimed at supporting cessation and to document the prevalence of EHR functionality using a 5 A’s framework (Ask, Advise, Assess, Assist, Arrange). Methods: A literature review was conducted and 18 published studies covering 14 unique EHRs were identified. A content analysis for EHR functionality related to tobacco treatment was conducted by two independent coders.
Results: For functionality related to Ask, 100% of EHRs allowed for the documentation of smoking status, in some cases, prompted by an alert (42.8%). Others allowed for the documentation of cigarettes smoked per day (28.6%), tobacco type (35.7%), and previous quit attempts (21.4%). For Advise, 35.7% of EHRs provided functionality helping a clinician provide advice to quit. For Assess, more than half of EHRs included a feature to document a patient’s willingness to quit. For Assist, EHRs provided several features, sometimes grouped together in an order set and/or with the presence of an alert. The vast majority provided medication prescribing functionality (78.6%). About half included a feature to refer a patient to the quitline (50.0%), to a tobacco treatment specialist (42.8%), or to educational materials (57.1%). Finally, for Arrange, EHRs helped by scheduling follow-up visits (35.7%) or by linking specialists back to primary care providers (28.6%).
Conclusions: Studies that have attempted to modify EHRs for tobacco treatment purposes have included modifications across the steps in the 5 A’s model, with most supporting documentation of smoking status (Ask) and assisting with medication prescribing (Assist). Future studies need to examine the relationship between the presence of specific EHR functionality and smoking cessation outcomes