TITLE:
Enhanced physician prompts in prenatal electronic medical records impact documentation on smoking cessation
AUTHORS:
Lisa D. Levine, Jitsen Chang, Irwin R. Merkatz, Peter S. Bernstein
KEYWORDS:
Prenatal EMR; Physician Prompts; Smoking Cessation
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.3 No.10,
December
13,
2013
ABSTRACT:
Objective: Smoking cessation during pregnancy is a modifiable intervention that can
improve maternal and neonatal outcomes. Encouraging smoking cessation is an
assessed measure of the Meaningful Use incentives to ensure best practices with
the increased use of the electronic medical record (EMR). Physician EMR prompts
have been used shown to be successful with preventive care but there is a
paucity of data evaluating prompts within obstetrics. The objective of this
study is to determine the effectiveness of enhanced smoking cessation prompts
in a prenatal EMR. Methods: A retrospective cohort study of an enhanced smoking
cessation prompting system within our prenatal EMR was performed. Pregnant
women who reported tobacco use at first prenatal visit were included. The
number of times a smoking cessation method was offered and documented, the
number of documented attempts at smoking cessation, and the final number of
cigarettes smoked were compared pre and post the enhancement of the smoking
cessation prompting system. Results: 95 patients were included (48 pre-enhancement;
47 post-enhancement). Post-enhancement, the documentation of smoking cessation
method offered increased (0 vs. 1, p = 0.03) and documentation of smoking
cessation attempts increased (1 vs. 2, p = 0.006). There was no change in the
final number of cigarettes smoked (p = 0.9). Conclusions: Enhanced prompting
systems increase documentation related to smoking cessation with no change in
number of cigarettes smoked. In the era of Meaningful Use guidelines which
focus on documentation in the EMR, continued research must be done to assure
that software enhancements and improved documentation truly result in improved
patient care.