Author ORCID Identifier


Date Available


Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Elizabeth Tovar

Clinical Mentor

Jessica Sass

Committee Member

Dr. Angela Grubbs

Committee Member

Dr. Julianne Ossege


BACKGROUND: Tobacco cessation counseling and documentation of the counseling is insufficient in many primary care settings across the United States. This can lead to care gaps such as missed opportunities for interventions appropriate to the level of readiness for change with regard to tobacco cessation. In addition, there is a potential for loss of revenue due to missed opportunities to provide a service and/or not capturing the service when provided. The Medicare Access and CHIP Reauthorization Act (MACRA) in 2015 started a new payment approach known as the merit-based incentive payment system (MIPS) which identified tobacco screening and cessation intervention as a Quality Payment Program (QPP) measure.

One family medicine clinic in central Kentucky noted low rates of documentation of smoking cessation counseling and chose this as one of six quality measures to improve. Previous work revealed a root cause of the problem was providers not knowing how and where to document smoking cessation counseling. Initial efforts to address this knowledge deficit occurred until the healthcare enterprise changed the EHR systems which altered the process of smoking cessation documentation. The clinic leadership team requested the principal investigator of this study lead the evaluation of changes in tobacco cessation counseling documentation after implementation of the new EHR.

PURPOSE: The purpose of this project was to evaluate the effect of an EHR change from Allscripts to Epic on tobacco cessation counseling documentation among primary care providers at a central KY family medicine clinic.

METHODS: This project was a single-center quality improvement project conducted from October 2020 to October 2021. The project was guided by the FOCUS-PDSA model for improvement. The focus of this paper is on PDSA cycle three, conducted from May 2021 until October 2021. Four randomly selected providers from the previous PDSA cycles were evaluated via chart review on frequencies of tobacco screening and counseling, and billing information using one of four approved documentation methods needed to meet the quality metric for tobacco screening and counseling.

RESULTS:PDSA cycle three had a significant increase in tobacco screening and cessation counseling documentation across all PDSA time periods from October 2020 to October 2021 (F=37.7, p

CONCLUSIONS: An EHR change to Epic improved tobacco cessation counseling documentation performance rates among all providers in the central KY clinic. Future investigation should include a more robust evaluation of performance rates over a longer period of time, and include evaluation of billable counseling rates and smart phrases usage specifically in primary care provider notes.