Although the dangers of smoking are well known, tobacco still remains the No. 1 cause of preventable death in the United States. The U.S. Public Health Service recommends that physicians ask all patients about their tobacco use and connect them to cessation services, but there are still many patients who are never asked about their smoking habits.

Researchers at Brigham and Women’s Hospital (BWH) have found that by enhancing the electronic health record, physicians were more likely to document a patient’s smoking habit, and access to cessation counseling was improved. This research was published in yesterday’s edition of the Archives of Internal Medicine.

“As the use of the electronic health record expands, so does the opportunity to use it to improve patient care and delivery. In our study, we found that an enhancement in the electronic health record is a successful tool to remind clinicians to ask patients about smoking status and refer smokers for cessation counseling,” said Jeffrey Linder, a physician and researcher at BWH and lead author of the study. Linder is an assistant professor of medicine at Harvard Medical School.

Linder and colleagues developed an electronic health record enhancement to increase documentation of smoking status, the prescription of tobacco treatment medications, and referral of patients to tobacco treatment counseling. This study was performed in 26 primary care practices that were randomized to be intervention practices, and have the enhancement implemented in their electronic health record system, or be a control practice without the enhanced electronic medical record. Over a period of nine months, more than 315,000 patient visits were made to the participating practices.

Researchers found that documentation of a patient’s smoking status in the health record was improved in all participating practices, but intervention practices had a higher increase, a 17 percent increase compared with 11 percent in control practices. They also found that in practices with the intervention, patients who were documented smokers at the start of the study were more likely to be non-smokers at the end of the study (a 3.4 percent increase in documented non-smokers) when compared with practices without the enhancement in the medical record. Researchers note that this finding may be due to improved overall documentation. They also found the enhancement did not change the number of patients who were prescribed cessation medication, but did find that documented smokers at the intervention practices were over 10 times more likely to make contact with a smoking-cessation counselor. Making contact with cessation counseling roughly doubles a smoker’s odds of successfully quitting.

“Tobacco use is the leading preventable cause of death in the United States, and more research is needed to maximize the utilization of health information technology to streamline tobacco treatment efforts by clinicians,” said Linder.

This research was funded by a grant from the National Cancer Institute and the Agency for Healthcare Research and Quality.