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Potential Social, Environmental, and Regulatory Threats to Electronic Health Record Strategies for Improving Tobacco Treatment in Healthcare

Published online by Cambridge University Press:  20 September 2013

Frank T. Leone ,
Sarah Evers-Casey ,
Michael J. Halenar ,
Keiren O'Connell  and
for the Southeastern Pennsylvania Tobacco Control Project
Frank T. Leone*
Affiliation:
Associate Professor of Medicine, Division of Pulmonary and Critical Care Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA Director, Comprehensive Smoking Treatment Program, University of Pennsylvania, Philadelphia, PA
Sarah Evers-Casey
Affiliation:
Associate Director, Comprehensive Smoking Treatment Program, University of Pennsylvania, Philadelphia, PA
Michael J. Halenar
Affiliation:
Tobacco Cessation Specialist, Health Promotion Council, Philadelphia, PA
Keiren O'Connell
Affiliation:
Regional Director, Tobacco Prevention and Control, Health Promotion Council, Philadelphia, PA
*
Address for correspondence: Email: [email protected]
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Abstract

Introduction – The potential impact of electronic health records (EHR) in driving tobacco treatment behaviours within healthcare settings has been established. However, little is known about the administrative variables that may undermine effectiveness in real world settings.

Aims – Assist healthcare planners interested in implementing tobacco-EHR systems by identifying an EHR framework that is consistent with published treatment guidelines, and the important organisational variables that can undermine the effectiveness of tobacco-EHR.

Methods – This paper considers the established literature on EHR implementation and physician behaviour change, and integrates this understanding with the observations of an expert workgroup tasked with facilitating tobacco-EHR implementation in Southeastern Pennsylvania.

Results/ Findings – System change in this topic area will continue to be problematic unless attention is paid to several important lessons regarding: 1) the evolving healthcare regulatory environment, 2) the integration of tobacco use treatment into primary care, and 3) the existing social and organisational barriers to uptake of evidence-based recommendations.

Conclusion – Healthcare organisations seeking to reduce the impact of tobacco use on their patients are well served by tobacco-EHR systems that improve care. Managers can avoid sub-optimal implementation by considering several threats to effectiveness before proceeding to systems change.

Type
Articles
Information
Journal of Smoking Cessation , Volume 8 , Issue 2 , December 2013 , pp. 106 - 114
Copyright
Copyright © The Author(s), published by Cambridge University Press on behalf of Australian Academic Press Pty Ltd 2013 

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References

An, L. (2004). Treatment of tobacco use as a chronic medical condition: primary care physicians’ self-reported practice patterns. Preventive Medicine, 38 (5): 574–585.Google Scholar
Andrade, A. D., Ruiz, J. G., Mintzer, M. J., Cifuentes, P., Anam, R., Diem, J., . . . Roos, B. A. (2012). Medical students’ attitudes toward obese patient avatars of different skin color. Studies in Health Technology and Informatics, 173: 23–29.Google Scholar
Ashenden, R., Silagy, C., & Weller, D. (1997). A systematic review of the effectiveness of promoting lifestyle change in general practice. Family Practice, 14 (2): 160–176.Google Scholar
Bate, L., Hutchinson, A., Underhill, J., & Maskrey, N. (2012). How clinical decisions are made. British Journal of Clinical Pharmacology, 74 (4): 614–620.CrossRefGoogle Scholar
Bates, D. W., Kuperman, G. J., Wang, S., Gandhi, T., Kittler, A., Volk, L., . . . Middleton, B. (2003). Ten commandments for effective clinical decision support: making the practice of evidence-based medicine a reality. Journal of the American Medical Informatics Association: JAMIA, 10 (6): 523–530.Google Scholar
Ben-Haim, Y. (2012). Doing our best: optimization and the management of risk. Risk Analysis, 32 (8):1326–1332.CrossRefGoogle ScholarPubMed
Boyle, R. G., Solberg, L. I., & Fiore, M. C. (2010). Electronic medical records to increase the clinical treatment of tobacco dependence: a systematic review. American Journal of Preventive Medicine, 39 (6 Suppl 1), S77–82.Google Scholar
Boyle, R., Solberg, L., & Fiore, M. (2011). Use of electronic health records to support smoking cessation. Cochrane Database of Systematic Reviews (Online), Dec 7; (12), CD008743.Google Scholar
Brener, L., Von Hippel, W., & Kippax, S. (2007). Prejudice among health care workers toward injecting drug users with hepatitis C: does greater contact lead to less prejudice? The International Journal on Drug Oolicy, 18 (5): 381–387.Google ScholarPubMed
Buck, J. A. (2011). The looming expansion and transformation of public substance abuse treatment under the Affordable Care Act. Health Affairs (Project Hope), 30 (8): 1402–1410.Google Scholar
Cigarette smoking among adults–United States, 2006 (2007). MMWR. Morbidity and Mortality Weekly Report, 56 (44): 1157–1161.Google Scholar
Dexheimer, J. W., Talbot, T. R., Sanders, D. L., Rosenbloom, S. T., & Aronsky, D. (2008). Prompting clinicians about preventive care measures: a systematic review of randomized controlled trials. Journal of the American Medical Informatics Association: JAMIA, 15 (3): 311–320.Google Scholar
Dovidio, J. F., & Fiske, S. T. (2012). Under the radar: how unexamined biases in decision-making processes in clinical interactions can contribute to health care disparities. American Journal of Public Health, 102 (5): 945–952.Google Scholar
Edelstein, S., Silva, N., & Mancini, L. (2009). Obesity bias among dietitians by using the Fat People-Thin People Implicit Association Test. Topics in Clinical Nutrition, 24 (1): 67–72.Google Scholar
Erhardt, L. (2009). Cigarette smoking: An undertreated risk factor for cardiovascular disease. Atherosclerosis, 205 (1): 23–32.Google Scholar
Evers-Casey, S. (2004, February). Tobacco-related Knowledge and Attitudes Do Not Relate to Provider Self-efficacy. Presented at the Society for Research on Nicotine and Tobacco, Scottsdale, AZ.Google Scholar
Fiore, M., Jaén, C., Baker, T., et al. (2008). Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service.Google Scholar
Graf, P., & Schacter, D. L. (1985). Implicit and explicit memory for new associations in normal and amnesic subjects. Journal of Experimental Psychology. Learning, Memory, and Cognition, 11 (3): 501–518.Google Scholar
Greenwald, A. & Krieger, L. (2006). Implicit bias: Scientific foundations. California Law Review, 94: 945–967.Google Scholar
Greenwald, A. (1990). What cognitive representations underlie social attitudes? Bulletin of the Psychonomic Society, 28 (3): 254–260.Google Scholar
Jacoby, L., & Witherspoon, D. (1982). Remembering without awareness. Canadian Journal of Psychology, 36: 300–324.CrossRefGoogle Scholar
Jaén, C. R., Cummings, K. M., Shah, D., & Aungst, W. (1997). Patterns of use of a free nicotine patch program for Medicaid and uninsured patients. Journal of the National Medical Association, 89 (5): 325–328.Google Scholar
Kottke, T. E., Battista, R. N., DeFriese, G. H., & Brekke, M. L. (1988). Attributes of successful smoking cessation interventions in medical practice. A meta-analysis of 39 controlled trials. JAMA: the journal of the American Medical Association, 259 (19): 2883–2889.Google Scholar
Macdonald, J., Bath, P. A., & Booth, A. (2008). Healthcare managers’ decision making: findings of a small scale exploratory study. Health Informatics Journal, 14 (4): 247–258.CrossRefGoogle ScholarPubMed
Mawar, N., Saha, S., Pandit, A., & Mahajan, U. (2005). The third phase of HIV pandemic: social consequences of HIV/AIDS stigma & discrimination & future needs. The Indian Journal of Medical Research, 122 (6): 471–484.Google Scholar
McEwen, A., Akotia, N., & West, R. (2001). General Practitioners’ views on the English national smoking cessation guidelines. Addiction (Abingdon, England), 96 (7): 997–1000.Google Scholar
McEwen, A., West, R., & Owen, L. (2001). General Practitioners’ views on the provision of nicotine replacement therapy and bupropion. BMC Family Practice, 2: 6.Google Scholar
McGreevey, J. D. 3rd. (2013). Order sets in electronic health records: principles of good practice. Chest, 143 (1): 228–235.Google Scholar
McIlvain, H. E., Backer, E. L., Crabtree, B. F., & Lacy, N. (2002). Physician attitudes and the use of office-based activities for tobacco control. Family Medicine, 34 (2): 114–119.Google Scholar
McLellan, A. T., & Meyers, K. (2004). Contemporary addiction treatment: a review of systems problems for adults and adolescents. Biological Psychiatry, 56 (10): 764–770.CrossRefGoogle ScholarPubMed
Moskowitz, G. B., Stone, J., & Childs, A. (2012). Implicit stereotyping and medical decisions: unconscious stereotype activation in practitioners’ thoughts about African Americans. American Journal of Public Health, 102 (5): 996–1001.Google Scholar
Mowat, D. L., Mecredy, D., Lee, F., Hajela, R., & Wilson, R. (1996). Family physicians and smoking cessation. Survey of practices, opinions, and barriers. Canadian Family Physician Médecin de Famille Canadien, 42: 1946–1951.Google Scholar
Park, E., Eaton, C. A., Goldstein, M. G., DePue, J., Niaura, R., Guadagnoli, E., . . . Dube, C. (2001). The development of a decisional balance measure of physician smoking cessation interventions. Preventive Medicine, 33 (4): 261–267.Google Scholar
Physician and other health-care professional counseling of smokers to quit–United States, 1991 (1993). MMWR. Morbidity and Mortality Weekly Report, 42 (44): 854–857.Google Scholar
Preventive Services Covered Under the Affordable Care Act. (n.d.). Retrieved November 19, 2012, from http://www.healthcare.gov/news/factsheets/2010/07/preventive-services-list.htmlGoogle Scholar
Roddy, S., Stewart, I., & Barnes-Holmes, D. (2010). Anti-fat, pro-slim, or both? Using two reaction-time based measures to assess implicit attitudes to the slim and overweight. Journal of Health Psychology, 15 (3): 416–425.Google Scholar
Russell, M. A., Wilson, C., Taylor, C., & Baker, C. D. (1979). Effect of general practitioners’ advice against smoking. British Medical Journal, 2 (6184): 231–235.Google Scholar
Sabin, J. A., Rivara, F. P., & Greenwald, A. G. (2008). Physician implicit attitudes and stereotypes about race and quality of medical care. Medical Care, 46 (7): 678–685.Google Scholar
Sabin, J., Nosek, B. A., Greenwald, A., & Rivara, F. P. (2009). Physicians’ implicit and explicit attitudes about race by MD race, ethnicity, and gender. Journal of Health Care for the Poor and Underserved, 20 (3): 896–913.CrossRefGoogle ScholarPubMed
Sachs, D., Leone, F., Farber, H., Bars, M., Prezant, D., Schane, R., . . . Lewis, S. (n.d.). ACCP Tobacco Dependence Treatment Toolkit. American College of Chest Physicians Tobacco-Dependence Treatment Tool Kit, 3rd Edition. Retrieved November 8, 2010, from http://tobaccodependence.chestnet.orgGoogle Scholar
Salsberg, E.et al. (2007). Physician Behavior and Practice Patterns Related to Smoking Cessation. Washington, DC. Retrieved March 2, 2012, from http://www.legacyforhealth.org/4233.aspxGoogle Scholar
Schenarts, P. J., Goettler, C. E., White, M. A., & Waibel, B. H. (2012). An objective study of the impact of the electronic medical record on outcomes in trauma patients. The American Surgeon, 78 (11): 1249–1254.Google Scholar
Schwartz, M. B., Chambliss, H. O., Brownell, K. D., Blair, S. N., & Billington, C. (2003). Weight bias among health professionals specializing in obesity. Obesity, 11 (9): 1033–1039.Google Scholar
Silagy, C., Muir, J., Coulter, A., Thorogood, M., Yudkin, P., & Roe, L. (1992). Lifestyle advice in general practice: rates recalled by patients. BMJ: British Medical Journal, 305 (6858): 871–874.Google Scholar
Specifications Manual for National Hospital Inpatient Quality Measures | Joint Commission. (n.d.). Retrieved July 18, 2012, from http://www.jointcommission.org/specifications_manual_for_national_hospital_inpatient_quality_measures.aspxGoogle Scholar
Thorndike, A. N., Rigotti, N. A., Stafford, R. S., & Singer, D. E. (1998). National patterns in the treatment of smokers by physicians. JAMA: The Journal of the American Medical Association, 279 (8): 604–608.CrossRefGoogle ScholarPubMed
Thorndike, A. N., Stafford, R. S., & Rigotti, N. A. (2001). US physicians’ treatment of smoking in outpatients with psychiatric diagnoses. Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco, 3 (1): 85–91.CrossRefGoogle ScholarPubMed
Thorndike, A. N., Regan, S., & Rigotti, N. A. (2007). The treatment of smoking by US physicians during ambulatory visits: 1994 2003. American Journal of Public Health, 97 (10): 1878–1883.Google Scholar
Tundia, N. L., Kelton, C. M. L., Cavanaugh, T. M., Guo, J. J., Hanseman, D. J., & Heaton, P. C. (2013). The effect of electronic medical record system sophistication on preventive healthcare for women. Journal of the American Medical Informatics Association: JAMIA, 20 (2): 268–276.Google Scholar
Vogt, F., Hall, S., & Marteau, T. M. (2005). General practitioners’ and family physicians’ negative beliefs and attitudes towards discussing smoking cessation with patients: a systematic review. Addiction, 100 (10): 1423–1431.Google Scholar
Von Hippel, W., Brener, L., & Von Hippel, C. (2008). Implicit prejudice toward injecting drug users predicts intentions to change jobs among drug and alcohol nurses. Psychological Science, 19 (1): 7–11.Google Scholar
Weaver, K. E., Danhauer, S. C., Tooze, J. A., Blackstock, A. W., Spangler, J., Thomas, L., & Sutfin, E. L. (2012). Smoking Cessation Counseling Beliefs and Behaviors of Outpatient Oncology Providers. The Oncologist. February 2012.Google Scholar
Wechsler, H., Levine, S., Idelson, R. K., Schor, E. L., & Coakley, E. (1996). The physician's role in health promotion revisited – a survey of primary care practitioners. The New England Journal of Medicine, 334 (15): 996–998.Google Scholar