1. NEXTGEN TOBACCO STATUS DEMONSTRATION This demonstration reviews documentation of tobacco status in NextGen. This has been prepared for EHR 5.7 and KBM 8.1. Subsequent updates may display cosmetic and functional changes. Use the keyboard or mouse to pause, review, and resume as necessary.

2. Tobacco vs Smoking History Documentation of tobacco status in NextGen is a bit redundant & confusing. This is largely due to the fact that the verbiage in the Meaningful Use rules specifies the recording of smoking status, whereas good medical practice documents the abuse of any form of tobacco. Hopefully this lesson with help you navigate this a little easier.

3. At the bottom of the Histories Tab, under the Social History section, select the Substances pilltab, then click Add.

4. The Social History popup appears. Note that there are several headings on the left, & we’re on the Tobacco/Alcohol/Caffeine heading. Also note that, since no Smoking Status is recorded, there is a red Required for MU (Meaningful Use) notice. To document this, click either that red notice or Tobacco Usage.

5. The Tobacco Use popup appears. Note there are 2 sections at the top. The 1 st is Tobacco Use. The 2 nd is Smoker Status (Meaningful Use). You need to complete both of these sections. Smoker Status is what appeases the Meaningful Use overlords. But Tobacco Use is more detailed, & lets you record a history of tobacco use over time, since people can stop & stop various forms of tobacco over time.

6. If the patient has never used any form of tobacco, it’s simple. Click Never in each section. Click Add to add this Tobacco Use documentation to the Tobacco Use-History grid.

7. For someone who currently uses tobacco, click current under Tobacco Use; fill in other details as known/pertinent. Also click one of the Current options under Smoker Status, then Add.

8. This status is added to the Tobacco Use Grids.

9. If you make a mistake recording tobacco status, click on that line of the Tobacco Use – Current grid, & you’ll see that an Update button appears. Correct your Tobacco Use entries, then click Update. Make sure you also change the Smoker Status if necessary. When done click Save & Close.

10. You’re returned to the Social History popup, with the tobacco & smoking statuses recorded. Your clinic may have a policy that nurses rooming patients always advise tobacco users to quit. If so, the nurse can click the Tobacco cessation discussed checkbox. A sample dialog might go as follows: “Do you still smoke? Of course, we recommend that everyone quit smoking. [Check the Tobacco cessation discussed checkbox.] Would you like to talk to the doctor today about help quitting?” If the answer is YES, add Smoking Cessation to today’s Reasons For Visit.

11. You may notice this Tobacco Cessation link. This leads to a detailed template on which you could more thoroughly document tobacco counseling. But unless the entire visit is for this purpose, you probably don’t want to use this. You can document other components of the Social History here, moving through the headings on the left as appropriate. When done, click Save & Close.

12. You’re returned to the Histories Tab, with the information you recorded displaying.

13. Remember that Meaningful Use requires that smoking status be documented for everyone after the 13 th birthday. And it is particularly important to ask these questions at every visit during adolescence, since that is when smoking status is most likely to change, and when preventive counseling is most pertinent.

14. This concludes the NextGen Tobacco Documentation demonstration. What happens if you get scared half to death twice? R. Lamar Duffy, M.D. Associate Professor University of South Alabama College of Medicine Department of Family Medicine

15. This concludes the NextGen Tobacco Documentation demonstration. What happens if you get scared half to death twice? R. Lamar Duffy, M.D. Associate Professor University of South Alabama College of Medicine Department of Family Medicine