JMIR Publications

ABSTRACT

Background:

Smoking has severe health consequences and secondhand smoke (SHS) exposure among children increases the risk of sudden infant death syndrome, chronic respiratory diseases, such as asthma, and lung cancer in adulthood. For many parents, pediatricians are the primary source of interaction with the healthcare system. Nevertheless, in pediatric settings, appropriate tobacco treatments are rarely, if ever, provided to parents who smoke. To best address tobacco use among parents, it is ideal to develop scalable solutions that are coordinated across health systems, community partners, and national services within pediatric settings.

Objective:

Develop a parent-focused smoking cessation clinical decision support (CDS) system in a pediatric institution that leverages multiple international standards to support shareability.

Methods:

We mapped the needs of a hybrid clinician- and patient-facing CDS system to existing interoperability standards. To reduce dissemination barriers of the CDS to other organizations, we prioritized available technology standards and limited to those that were well supported by our commercial electronic health record (EHR) vendor.

Results:

The smoking cessation system incorporates three international standards: SMART, Fast Healthcare Interoperability Resources (FHIR), and CDS Hooks. FHIR is used across all components. SMART is limited to the clinician-facing tool and CDS Hooks is used in the patient-facing portion. Use of healthcare interoperability standards supported a significant portion of the overall system, but non-standard technologies were also required. The CDS was used in 194,946 visits, identified 7,847 parents who smoke, and connected 2,954 parents to 6,320 treatment services.

Conclusions:

Our work demonstrates that building CDS systems using international standards, such as SMART, FHIR, and CDS Hooks, is possible, but challenges remain. Limits in the CDS Hooks standard to support common workflows and lack of communication standards used by 3rd parties outside the healthcare system represent areas for future work. To support these requirements, additional EHR-specific records and communication mechanisms were required.