Clearing the smoke around Pack Years…

Recently, another consultant mentioned her frustration with “an old bug” in the Enterprise EHR. She went on to tell me the numerous times she had seen clients throw up their hands in frustration when they attempted to enter smoking information under a patients Social History. She went on to state that there is a “Known Issue” and she wondered if and when it would ever be resolved. She was talking about the Social History statement of “Smoking Cigarettes For ____ Pack-years 305.1”. She went on to explain how the system wouldn’t accept the “words” they were trying to enter. Immediately, I knew the issue…and it wasn’t the system. The intended data for this field is numeric, not text. I went on to explain to her that this is a field where we can document a measurement of lifetime tobacco use. For example: If a patient smoked 1 pack a day for 4 years, they would have a 4 pack-year history. If they smoked 2 packs a day for 4 years, they would have an 8 pack-year history. I had her try plugging “8” in and, as I expected, it worked! Yes, we did the math, but putting the right information in the EEHR made it work correctly. So, it wasn’t broken after all!!

Documenting pack years alerts the provider that they need to be watching for certain cancers and a myriad of other diseases. In women, as some studies have suggested, they need to start looking at lower smoking levels than men. Of course, no matter the gender, the higher the pack-years, the higher the risk. I could go on about the risks of smoking, but I’ll leave that for another time and place.

One might wonder why we document it that way instead of just saying they smoked 2 packs a day for 4 years. It’s more concise (we know how important being concise is to a busy provider!) and standardized so that all cigarette smoking is viewed in the same terms of “a pack a day” for “x” number of years. Think about how some people change their smoking habits from time to time. They might smoke 1 pack for 3 years, half a pack for 2 year, and 2 packs for 1.5 years. That’s cumbersome. “7 pack-years” is so much easier to read and gives a clearer picture of the cancer risk—which is the reason we’re documenting it in the first place.

The consultant was so relieved to know what to do. I hope this was helpful to you as well!

There is a wiki on Pack-Years.

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