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Appl Clin Inform 2022; 13(02): 504-515
DOI: 10.1055/s-0042-1748148
Research Article

Electronic Health Record-Embedded, Behavioral Science-Informed System for Smoking Cessation for the Parents of Pediatric Patients

Brian P. Jenssen
1   Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
2   Center for Pediatric Clinical Effectiveness, PolicyLab, and The Possibilities Project, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
3   Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
,
Dean J. Karavite
3   Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
,
Shannon Kelleher
2   Center for Pediatric Clinical Effectiveness, PolicyLab, and The Possibilities Project, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
,
Ekaterina Nekrasova
2   Center for Pediatric Clinical Effectiveness, PolicyLab, and The Possibilities Project, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
,
Jeritt G. Thayer
3   Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
,
Raj Ratwani
4   MedStar Health National Center for Human Factors in Healthcare, Washington, Dist. of Columbia, United States
,
Judy Shea
5   Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Emara Nabi-Burza
6   Division of General Academic Pediatrics and Tobacco Research and Treatment Center, Massachusetts General Hospital for Children, Boston, Massachusetts, United States
,
Jeremy E. Drehmer
6   Division of General Academic Pediatrics and Tobacco Research and Treatment Center, Massachusetts General Hospital for Children, Boston, Massachusetts, United States
,
Jonathan P. Winickoff
6   Division of General Academic Pediatrics and Tobacco Research and Treatment Center, Massachusetts General Hospital for Children, Boston, Massachusetts, United States
,
Robert W. Grundmeier
1   Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
3   Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
,
Robert A. Schnoll
7   Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Alexander G. Fiks
1   Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
2   Center for Pediatric Clinical Effectiveness, PolicyLab, and The Possibilities Project, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
3   Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
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Abstract

Background Helping parents quit smoking is a public health priority. However, parents are rarely, if ever, offered tobacco use treatment through pediatric settings. Clinical decision support (CDS) systems developed for the workflows of pediatric primary care may support consistent screening, treatment, and referral.

Objectives This study aimed to develop a CDS system by using human-centered design (HCD) that identifies parents who smoke, provides motivational messages to quit smoking (informed by behavioral science), and supports delivery of evidence-based tobacco treatment.

Methods Our multidisciplinary team applied a rigorous HCD process involving analysis of the work environment, user involvement in formative design, iterative improvements, and evaluation of the system's use in context with the following three cohorts: (1) parents who smoke, (2) pediatric clinicians, and (3) clinic staff. Participants from each cohort were presented with scenario-based, high-fidelity mockups of system components and then provided input related to their role in using the CDS system.

Results We engaged 70 representative participants including 30 parents, 30 clinicians, and 10 clinic staff. A key theme of the design review sessions across all cohorts was the need to automate functions of the system. Parents emphasized a system that presented information in a simple way, highlighted benefits of quitting smoking, and allowed direct connection to treatment. Pediatric clinicians emphasized automating tobacco treatment. Clinical staff emphasized screening for parent smoking via several modalities prior to the patient's visit. Once the system was developed, most parents (80%) reported that it was easy to use, and the majority of pediatricians reported that they would use the system (97%) and were satisfied with it (97%).

Conclusion A CDS system to support parental tobacco cessation in pediatric primary care, developed through an HCD process, proved easy to use and acceptable to parents, clinicians, and office staff. This preliminary work justifies evaluating the impact of the system on helping parents quit smoking.

Keywords

tobacco use treatment - clinical decision support - human-centered design

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was reviewed by the Children's Hospital of Philadelphia Institutional Review Board.




Publication History

Received: 20 December 2021

Accepted: 15 March 2022

Article published online:
18 May 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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