The documentation gap between cannabis use prevalence and EHR documentation is 7:1. It is an institutional design problem rooted in how care systems are built, and it has specific, documentable patient safety consequences.
Lapham et al. (2022) published the verified primary source for the documentation gap: 35.1% of primary care patients reported implicit medical cannabis use; EHR documented rate was 4.8% — from the same patient population, measured simultaneously. Tavabi et al. (2023) found the gap tracks racial and socioeconomic lines independent of use prevalence: the populations most burdened by the gap are already facing the greatest healthcare equity challenges. Beiler et al. (2024) confirmed that documentation completeness depends on whether structured EHR fields exist, independent of patient willingness. The governance response focuses on institutional infrastructure and how systems are designed to document care.
35.1% vs. 4.8%. Verified 7:1 gap from the same patient population, measured simultaneously.
370,087 patients. Documentation <2%. Racial and socioeconomic disparities independent of use prevalence.
Structured EHR fields produce 93.6% completion vs. 30.8% without. Documentation is infrastructure-dependent.
The prototype organizes reflection across six proposed governance dimensions. It does not produce a validated institutional score, audit, accreditation, or certification.
Validated cannabis screening at every patient contact (≥85% completion); all clinical providers trained in CYP450 interactions within 2 years; structured cannabis EHR fields (≥85% completion); written disclosure safety policy communicated in writing at intake; documented legal guidance updated within 3 years; cannabis documentation rate as quarterly QI metric.
The full tier operationalization — PIONEERING through EARLY STAGE, with specific observable criteria for all six dimensions — is documented in the Framework Foundation.
Primary care practices · Hospitals and health systems · FQHCs · Community health organizations · Native Hawaiian and Pacific Islander health programs · Any institution where the service population includes cannabis users
And any patient whose cannabis use goes undocumented, and the clinician who needs to see it before prescribing.
Review the module scope and proposed dimensions. The assessment remains an educational prototype; no email report or institutional finding is active.