Challenges with Collecting Smoking Status in Electronic Health Records

Smoking is the leading cause of preventable death in the United States. Obtaining patients' smoking status is the first step in delivering smoking cessation counseling. In this study, we assessed the quality of smoking status captured in an electronic health record from a large academic medical center. We analyzed data from structured notes, finding that smoking status was documented in 98% of 64,451 hospital encounters in 2016. 32% hospital encounters had discrepant documentation, and 54.5% of patients had implausible changes (e.g., changes from "current smoker" to "never smoker"). Overall, only 2.9% of patients were documented as active smokers, but 36.4% were documented as "unknown" or had discrepancies in their smoking status. These results suggest that patients that smoke are not appropriately identified. Centralized documentation with clinically actionable smoking status categories and implementation of patient-facing tools that allow patients to directly record their information could improve data quality of smoking status.