Research In Practice Blog

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Take Down Tobacco National Day of Action: Celebrating CHOP’s Tobacco Treatment Platform in Primary Care
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By Atyia Collins, Lindsey Klinger-O'Donnell and Misato Shimizu, Communications Intern

Exposure to tobacco smoke poses a significant public health issue for children, as tobacco use is the leading preventable cause of disease and death in the United States, with most users starting in childhood or adolescence. Assisting parents and caregivers in quitting smoking has numerous benefits for children, including a reduced risk of respiratory illnesses, fewer long-term developmental problems, and decreased likelihood of the children becoming future tobacco users. However, the effectiveness of smoking cessation resources and interventions depends on medical providers' timely adherence to evidence-based guidelines.

Take Down Tobacco National Day of Action is set for April 1, 2025. On this day, schools, organizations, and advocates will raise awareness, promote prevention, and stand against the harmful influence of tobacco products. This event serves as a reminder that every effort counts in protecting health and saving lives.

CHOP Primary Care Network Receives Health Promotion Council’s STAR Accreditation

In anticipation of Take Down Tobacco National Day of Action, on March 31, 2025, at the Roberts Center for Pediatric Research at Children's Hospital of Philadelphia (CHOP), a team of CHOP researchers were awarded a Smoking Treatment Accreditation Recognition (STAR) for their work on integrating a Clinical Decision Support (CDS) tool called eCEASE, which connects families to tobacco cessation services within CHOP’s Primary Care Network. STAR is awarded by the Health Promotion Council (HPC), a nonprofit organization established in 1981 to promote community-based hypertension education and control programs. The interdisciplinary research team included Clinical Futures' core faculty members Brian Jenssen, MD, MSHP, Alex Fiks, MD, MSCE, Jeritt Thayer, PhD, Robert Grundmeier, MD, and Lisa Biggs, MD as well as Research Study Lead Jan Ramachandran, MS, MPH, and Possibilities Project Manager Maura Powell, MPH.

CHOP researchers with STAR award plaques

From left to right (Jeritt Thayer, Alex Fiks, Brian Jenssen and Jan Ramachandran)

Health Promotion Council’s Smoking Treatment Accreditation & Recognition (STAR) is a tobacco dependence treatment accreditation program funded by a grant from the Pennsylvania Department of Health. It is managed by HPC in partnership with the University of Pennsylvania. The mission of STAR is to facilitate the integration of tobacco dependence treatment into existing healthcare workflows. Each year, HPC uses the STAR Accreditation to recognize the various tobacco-related activities carried out by healthcare organizations. Achieving this accreditation is a visible indicator of the organization’s professionalism and commitment to providing the highest standard of community-based, comprehensive care.

The event featured presentations from key stakeholders, an overview of the STAR Accreditation initiative, and a Q&A session with the interdisciplinary team responsible for this achievement. The team discussed the implementation of a Clinical Decision Support (CDS) tool called eCEASE, which connects families to tobacco cessation services within CHOP’s Primary Care Network.  

"We are uniquely positioned as healthcare providers not only to support our patients but also to make a positive impact on their families as a whole. Our goal is to ensure that healthcare providers utilize evidence-based practices and innovative tools during a critical time in their patients' lives when lifelong habits begin to form," said Dr. Brian Jenssen. "We are grateful to HPC for recognizing CHOP’s Tobacco Treatment Platform with STAR Accreditation. We are excited about the growth of the Tobacco Treatment Platform within the CHOP Primary Care Network and beyond. Our aim is to provide accessible support and treatment to as many parents, families, and patients as possible."  

Dr. Jenssen presenting at STAR event


Creating More Wholistic Family-Centered Care and Treatment Options

CHOP leads the charge in addressing nicotine addiction through the community and family lens—providing equitable access to treatment and ensuring sustainable intervention strategies. CHOP’s STAR Accreditation proves that the cross-system sharing of eCEASE serves as an emerging model for disseminating complex CDS tools.

This tool is administered through a questionnaire provided in-person during appointments or prior to them. It streamlines the process of identifying household members who smoke, provides motivational messaging to encourage quitting, and increases the initiation of evidence-based treatments by automating the delivery of tobacco cessation medications and counseling programs to parents, guardians, and other family members who choose to opt-in.  

Such resources include:  

  • Nicotine Replacement Therapy (NRTs), which includes patches, gums, and lozenges, as well as Varenicline
  • Quitline, counseling by phone
  • SmokefreeTXT, motivational text messages

“The feedback we have received from patients and families has been outstanding and highly encouraging. Families consistently find the tool and process to be both easy and effective,” stated Jan Ramachandran, Clinical Research Study Lead for the Tobacco Treatment Program.

With its successes at CHOP, this CDS tool was implemented at The MetroHealth System (MetroHealth), a large tertiary care health system in Northeast Ohio serving both adults and children that uses the same commercial EHR.

Even considering the different community and policy environments between CHOP and MetroHealth as well as differences in clinical workflow, the CDS tool was successful in enrolling many parents and caregivers to tobacco cessation resources. This allowed researchers to successfully identify data architecture, source code repositories, and EHR build records necessary for its implementation.  

By promoting evidence-based programs such as the Tobacco Treatment Program, pediatricians, pediatric researchers, and individuals committed to children's health have taken significant steps to combat tobacco use. These efforts aim to help children, adolescents, and their families live free from tobacco. Continued support and implementation of this program can prevent new addictions, end the tobacco epidemic, and foster a tobacco-free future.

Research in Practice Implications:

Actionable Insights:  

  • Clinical: “The cross-system sharing of eCEASE serves as an early model for distributing complex CDS tools and reveals opportunities for improvement.”  
  • eCEASE can serve as a model for dissemination complex clinical decision support tools  
  • Research: “Future work should focus on creating validated dissemination frameworks and improving use of standards for EHR integration”
  • Advocacy/Policy:  Smoking cessation tools for parents from the pediatric sites

Information & Resources:

Sharing a Hybrid EHR + FHIR CDS Tool Across Health Systems: Automating Smoking Cessation for Pediatric Caregivers 

Clinical Futures author(s): Jeritt Thayer, Alexander Fiks, Brian Jenssen, Robert Grundmeier

Additional study author(s) from Children’s Hospital of Philadelphia: Sameh Nagui Saleh, Eric Kim, Emara Nabi, Dean Karavite, Jonathan Winickoff , Nicholas Riley  

Citation:  

Saleh SN, Kim E, Thayer JG, Nabi E, Karavite D, Winickoff J, Fiks A, Jenssen BP, Riley N, Grundmeier RW. Sharing a Hybrid EHR + FHIR CDS Tool Across Health Systems: Automating Smoking Cessation for Pediatric Caregivers. Appl Clin Inform. 2025 Feb 11. doi: 10.1055/a-2535-5823. Epub ahead of print. PMID: 39933722.