This planning grant was a pilot study that tested the feasibility of designing and implementing a CPT-like “tracking code” system to measure and report tobacco cessation activities in a clinic utilizing a paper medical record. A parallel effort was initiated in a clinic utilizing an electronic medical record. The outcomes were the documentation of the reliability of information gathered in both the paper and electronic systems pre and post intervention, and identifying factors that affected the successful implementation of the systems changes.

The paper-based clinic implemented a separate form to document the tracking code that was stapled to the fee ticket. Data from the tracking code form (asking and advising) was entered into the clinic billing system and health plan claims database and was fed back to providers. The electronic medical record clinic added fields to its EMR database to track rates of asking and advising) and also fed back to providers.

The paper-based clinic saw a fairly stable documentation of smoking status (42% pre-intervention, 45% post-intervention). In the electronic medical record clinic, rates of documentation increased from 79% to 88% of patient visits. Tracking codes appear to be a feasible strategy for paper-based clinics; however, substantial infrastructure support is required. Multiple insurers or health plans would need to adopt this system consistently to foster broad implementation.