Impact of clinical practice EMR capabilities on the pharmacotherapy and behavioral intervention activities in patient smoking cessation

Smoking is the number one preventable cause of premature death in the United States. The majority of smokers (70%) see a healthcare provider at least once, annually, resulting in the encounter being the ideal time in which to address cessation. The Electronic Medical Record (EMR) may offer an effective intervention in which to improve smoking cessation at the point of care. This study investigates the relationship between Electronic Medical Record (EMR) capabilities and smoking cessation activities. The primary outcome, smoking cessation activities, was measured utilizing a Likert scale format. The study survey also solicited feedback from these clinics on their practice technology. For analyses, the clinics were separated into three groups based on EMR capabilities: Full EMR Group with decision support and drug reference database; Partial EMR Group with some of the capabilities to achieve the definition of meaningful use; and the No EMR Group or clinic without electronic capabilities. Kendall's Tau-b statistic was used to assess the ordinal differences in the variables based on EMR type allowing us to see a trend in relation to EMR capability. 174 Internal and Family Medicine practices participated in this study. Most of the clinics initiated smoking cessation counseling, but the majority of practices did not establish follow-up cessation visits for their patients who smoke. Rate of follow-up appointments varied by the EMR capability of the clinic, with those practices reporting “No EMR capabilities” being significantly (p=0.028) more likely to schedule follow-up appointments than their “partial or full” EMR counterparts. Conversely, nicotine replacement therapy was significantly more likely to be prescribed by clinics with “partial or full” EMR capabilities than those practices that did not have an EMR. (p=0.016). EMR capabilities were positively associated with NRT and negatively related to arranging follow up visits for smoking cessation.