Enhanced physician prompts in prenatal electronic medical records impact documentation on smoking cessation


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.

Share and Cite:

Levine, L. , Chang, J. , Merkatz, I. and Bernstein, P. (2013) Enhanced physician prompts in prenatal electronic medical records impact documentation on smoking cessation. Open Journal of Obstetrics and Gynecology, 3, 717-721. doi: 10.4236/ojog.2013.310132.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Centers for Disease Control and Prevention. (2006) The health consequences of involuntary exposure to tobacco smoke: A report of the surgeon general. Atlanta, GA.
[2] Castles, A., Adams, E.K., Melvin, C.L., Kelsch, C., Boulton, M.L. (1999). Effects of smoking during pregnancy: Five metaanalyses. American Journal of Preventive Medicine, 16, 208-215.
[3] Centers for Disease Control and Prevention. (2012) Reproductive Health: Tobacco use and pregnancy. http://www.cdc.gov/reproductivehealth/tobaccousepregnancy
[4] Centers for Medicare & Medicaid Services. (2011) EHR-Meaningful Use Overview.
[5] Department of Health and Human Services. (2008) Treating tobacco use and dependence: Clinical Practice Guideline. Rockville, MD: United States Public Health Service.
[6] Lumley, J., Chamberlain, C., Dowswell, T., Oliver, S., Oakley, L. and Watson, L. (2009) Interventions for promoting smoking cessation during pregnancy. Cochrane Database of Systematic Reviews, 8, pp. 1-134. http://dx.doi.org/10.1002/14651858.CD001055.pub3
[7] Rigotti, N.A., Park, E.R., Chang, Y. and Regan, S. (2008) Smoking cessation medication use among pregnant and postpartum smokers. Obstetrics & Gynecology, 111, 348-355. http://dx.doi.org/10. 1097/01.AOG.0000297305.54455.2e
[8] Dexheimer, J.W., Sanders, D.L., Rosenbloom, S.T. and Aronsky, D. (2005) Prompting clinicians: A systematic review of preventive care reminders. AMIA Annual Symposium Proceedings Archive, 938.
[9] Tang, P.C., LaRosa, M.P., Newcomb, C. and Gorden, S.M. (1999) Measuring the effects of reminders for outpatient influenza immunizations at the point of clinical opportunity. Journal of the American Medical Informatics Association, 6, 115-121. http://dx.doi.org/10.1136/jamia.1999.0060115
[10] Balas, E.A., Weingarten, S., Garb, C.T., Blumenthal, D., Boren, S.A. and Brown, G.D. (2000) Improving preventive care by prompting physicians. JAMA Internal Medicine, 160, 301-308. http://dx.doi.org/ 10.1001/archinte.160.3.301
[11] Dexheimer, J.W., Talbot, T.R., Sanders, D.L., Rosenbloom, S.T. and Aronsky, D. (2008) Prompting clinicians about preventive care measures: A systematic review of randomized controlled trials. Journal of the American Medical Informatics Association, 15, 311-320. http://dx.doi.org/10. 1197/jamia.M2555
[12] Klatt, T.E. and Hopp, E. (2012) Effect of a best-practice Alert on the rate of influenza vaccination of pregnant women. Obstetrics & Gynecology, 119, 301-305. http://dx.doi.org/10.1097/AOG.0b013 e318242032a

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.