The Electronic Medical Record's Role in Support of Smoking Cessation Activities

Electronic medical records (EMRs) have been touted as a tool for improving physicians' performance in the effort to reduce smoking harm. The purpose of this research is to assess EMR sophistication and functionality in relationship to smoking status documentation, cessation counseling, and medication use in ambulatory care settings.

Regression analyses of the 2007-2010 National Ambulatory Medical Care Survey were conducted to measure the association between EMR sophistication and smoking status recorded, smoking cessation counseling, and medication prescribing during visits. In general, EMR sophistication is measured by the presence of interactive EMR capabilities where "advanced" systems include functionalities for clinical decision support and management of orders and tests compared to "basic" systems.

Physicians using advanced EMR systems were significantly more likely to record smoking status, counsel patients on smoking cessation, and document prescribing medications to support cessation efforts than doctors using less sophisticated technologies.

Generally, the use of more sophisticated EMRs were associated with improved smoking cessation support by physicians in the ambulatory environment. Physicians purchasing or upgrading an EMR system should include the smoking cessation support features as part of their requirements. Future stages in the federal government's EMR Meaningful Use incentives and rewards program should include explicit metrics related to smoking cessation activities.

The findings of this article contribute to current literature on EMR and smoking cessation by providing empirical evidence that advanced EMR systems with features like clinical reminders serve to influence the structure of the clinical encounter such that clinicians are significantly more likely to document smoking, engage in counseling, and prescribe medications. Physicians purchasing or upgrading an EMR system should include the smoking cessation support features as part of their requirements. Future stages in the federal government's EMR Meaningful Use incentives and rewards program should include explicit metrics related to smoking cessation activities.