An In-Depth Look at Smoking and Meaningful Use

The configuration and workflows relating to the Core Meaningful Use objective Record Smoking Status can get confusing; and recent information was released indicating a change in some of the setup for this measure.  Record Smoking Status requires that providers report that more than 50% of all unique patients 13 years-old or older seen by the eligible professional (EP) have “smoking status” recorded as structured data.  CMS has altered its reporting requirements for this measure so that now reports should only include the CDC smoking statuses.  Those smoking statuses include:

  • Current Every Day Smoker
  • Current Some Day Smoker
  • Former Smoker
  • Never Smoker
  • Smoker, Current Status Unknown
  • Unknown if Ever Smoked

You may be asking yourself, what do I do because providers at my practices have been entering terms other than the ones above as the patient’s smoking status?  Allscripts has developed a script that links previous smoking terms to the terms required to meet the measure in order for the provider to get credit on all smoking terms documented.  One thing to keep in mind when running the script is that it does not always match the terms on the patient’s chart to the most accurate CDC term.  For instance, a denial of smoking documented on the patients chart could fall under two separate CDC terms, “Former Smoker” and “Never Smoker”, but since the script can only link to one term, it chooses “Unknown if Ever Smoked”.  “Unknown if Ever Smoked” is not the most accurate, but the provider does get credit for the Meaningful Use measure. 

Because the script does not give the most accurate information for reporting, it is recommended that providers discontinue using the “denied” option when documenting smoking statuses and add the CDC smoking diagnoses to their quick list for easy reference for physicians.  Providers should attempt to use the CDC smoking terms to identify a patient’s smoking status as often as possible.

The CDC smoking diagnoses can be added to provider’s quick lists using SSMT.  The Content Categories of Favorites: Patient Hx – Active Problem or Favorites: Patient Hx – Social History can be utilized to identify the quick list items.  The steps are as follows:

  1. Manually add all of the CDC smoking diagnoses to a user’s social or active problems list. (depending in which problem section the providers will be documenting the smoking status)
  2. Extract for that user the Favorites: Patient Hx – Active Problem or Favorites: Patient Hx – Social History content categories from SSMT.
  3. Open an Excel spreadsheet.
  4. Highlight the whole spreadsheet, right click, and choose Format Cells.
  5. Choose the Category of Text and click OK.
  6. In SSMT, use CTRL+A to highlight all the text and CTRL+C to copy the text.
  7. Paste the text in the Excel spreadsheet.
  8. Copy columns B through J and paste on a new Excel spreadsheet. With the same formatted cell settings.
  9. In column A, type the username of the provider you want to add the favorites to.
  10. Make sure a Y is in the column labeled TopFavoriteFlag and in the column labeled Create.
  11. Repeat steps 8 through 10for all providers that need the smoking statuses added to their Quicklist.
  12. Copy all fields and paste them into SSMT.
  13. Click the Import button.
  14. Confirm the import worked for a few users.
  15. Repeat these steps if setting the quick list in both Active and Social History problems.

It is important to note that the CDC smoking terms were delivered in Q3 and Q4 2010 Medcin releases.  It is required that these releases be installed in Enterprise EHR in order to meet the Record Smoking Status Meaningful Use objective.  In Allscripts Enterprise EHRTM version 11.2 HF 9, the Record Smoking MU Alert will be linked to the CDC smoking terms and the provider will be able to reconcile this alert by selecting the appropriate term from the list of smoking terms.

An additional recommendation for configuration includes setting the TWAdmin preference Smoking Status for Patients 13 and Older is Not Documented to “Show in My Alerts”.

The configuration and workflows for the Core Clinical Quality Measure Preventative Care and Screening Measure Pair: Tobacco Use Assessment and Tobacco Cessation Intervention is often confused with the configuration and workflows for the Meaningful Use measure Record Smoking Status.  Although the terms used for recording the smoking status are applicable for recording tobacco use, additional workflow is required to meet the Quality Measure.  The Quality Measures can be reviewed in more detail in the Quality Measures PDF on the Allscripts Client Connect website.

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