Documentation of Electronic Nicotine Delivery System, Nicotine Pouch and Combustible Tobacco Product Use in Electronic Health Record Clinical Notes

<ns3:p>Background Due to the lack of standardized codes, documentation of electronic nicotine delivery system (ENDS) use is non-existent in healthcare claims data and severely limited in structured electronic health record (EHR) data. We conducted a comprehensive assessment on the documentation of terms related to ENDS, nicotine pouch, and combustible tobacco use in unstructured EHR clinical notes. Methods Utilizing retrospective data from Optum’s EHR and Clinical Notes Databases (2007–2023), 13.6 million patients had ≥1 diagnosis code for combustible tobacco use history, and 5.2 million also had ≥1 clinical note. Searches were conducted for terms for ENDS, nicotine pouches, or combustible tobacco in the clinical notes. Results There were 4.4 million patients with ≥1 clinical note containing a term for ENDS, nicotine pouches, or combustible tobacco, with 66.1 million notes. Seventy-seven ENDS-related terms were identified, in addition to 27 ENDS brand terms, with the terms used evolved over time. There were 8 terms and 10 brand names for nicotine pouches, and 118 terms for combustible tobacco. Conclusions Extensive ENDS use data are available in unstructured EHR clinical notes that can be extracted for research. When combined with additional data sources (structured EHR, claims, and survey linkage), these data may enable robust studies on the health impacts associated with the use of ENDS. Standardization and consistent documentation practices will further enhance the utility of these data for research.</ns3:p>