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 64451 hospital encounters in 2016 32 hospital encounters had discrepant documentation and 545 of patients had implausible changes eg changes from current smoker to never smoker overall only 29 of patients were documented as active smokers but 364 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 patientfacing tools that allow patients to directly record their information could improve data quality of smoking status