TY - JOUR
T1 - Do you vape? Leveraging electronic health records to assess clinician documentation of electronic nicotine delivery system use among adolescents and adults
AU - Young-Wolff, Kelly C.
AU - Klebaner, Daniella
AU - Folck, Bruce
AU - Carter-Harris, Lisa
AU - Salloum, Ramzi G.
AU - Prochaska, Judith J.
AU - Fogelberg, Renee
AU - Tan, Andy S.L.
N1 - Publisher Copyright: © 2017 Elsevier Inc.
PY - 2017/12
Y1 - 2017/12
N2 - Use of electronic nicotine delivery systems (ENDS) has increased substantially over the past decade. However, unlike smoking, which is systematically captured by clinicians through routine screening and discrete documentation fields in the electronic health record (EHR), unknown is the extent to which clinicians are documenting patients' use of ENDS. Data were gathered from medical visits with patients aged 12 and older (N = 9,119; 55% male) treated in a large, integrated healthcare system. We used natural language processing to assess the incidence rates of clinician documentation of patients' ENDS use in unstructured tobacco comments in the EHR, and the words most frequently documented in relation to ENDS, from 2006–2015. ENDS documentation in the EHR increased dramatically over time (from 0.01 to 9.5 per 10,000 patients, p < 0.0001), particularly among adults aged 18–24 and 25–44. Most prevalent were “e-cig,” “electronic cigarettes”, and “vape,” with much variation in spelling and phrasing of these words. Records of adolescent and young adult patients were more likely to contain the word “vape”, and less likely to have “e-cig” and “electronic cigarette” than records of adults (ps < 0.0001). The relatively low observed number of patients with ENDS terms in the EHR suggested vast under documentation. While healthcare providers are increasingly documenting patients' use of ENDS in the EHR, overall documentation rates remain low. Discrete EHR fields for standard screening and documentation of ENDS that reflect the language used by patients would provide more complete longitudinal population-level surveillance of ENDS use and its association with short- and long-term health outcomes.
AB - Use of electronic nicotine delivery systems (ENDS) has increased substantially over the past decade. However, unlike smoking, which is systematically captured by clinicians through routine screening and discrete documentation fields in the electronic health record (EHR), unknown is the extent to which clinicians are documenting patients' use of ENDS. Data were gathered from medical visits with patients aged 12 and older (N = 9,119; 55% male) treated in a large, integrated healthcare system. We used natural language processing to assess the incidence rates of clinician documentation of patients' ENDS use in unstructured tobacco comments in the EHR, and the words most frequently documented in relation to ENDS, from 2006–2015. ENDS documentation in the EHR increased dramatically over time (from 0.01 to 9.5 per 10,000 patients, p < 0.0001), particularly among adults aged 18–24 and 25–44. Most prevalent were “e-cig,” “electronic cigarettes”, and “vape,” with much variation in spelling and phrasing of these words. Records of adolescent and young adult patients were more likely to contain the word “vape”, and less likely to have “e-cig” and “electronic cigarette” than records of adults (ps < 0.0001). The relatively low observed number of patients with ENDS terms in the EHR suggested vast under documentation. While healthcare providers are increasingly documenting patients' use of ENDS in the EHR, overall documentation rates remain low. Discrete EHR fields for standard screening and documentation of ENDS that reflect the language used by patients would provide more complete longitudinal population-level surveillance of ENDS use and its association with short- and long-term health outcomes.
KW - Adolescents
KW - Clinicians
KW - E-cigarettes
KW - Electronic health record
KW - Electronic nicotine delivery systems
KW - Integrated healthcare
KW - Natural language processing
KW - Semantics
KW - Vaping
UR - http://www.scopus.com/inward/record.url?scp=85028953066&partnerID=8YFLogxK
U2 - 10.1016/j.ypmed.2017.08.009
DO - 10.1016/j.ypmed.2017.08.009
M3 - Article
C2 - 28823688
SN - 0091-7435
VL - 105
SP - 32
EP - 36
JO - Preventive Medicine
JF - Preventive Medicine
ER -
