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Step 5: Achieve Meaningful Use Stage 1

Record Smoking Status


Record smoking status for patients 13 years old or older.


More than 50 percent of all unique patients 13 years old or older seen by the eligible professional have smoking status recorded as structured data.

Clinical Importance

Tobacco use and tobacco-related illness represents the single greatest health risk to patients in the United States. With clear and compelling evidence that provider interest in a patient's tobacco use can be an important first step in durable cessation, the simple act of asking and recording a patient's use of tobacco can have a profound benefit.

CMS Resources

The following resources are available to help you meet the Record Smoking Status meaningful use core measure:

Related CMS EHR Incentive Program Frequently Asked Questions

Lessons from the Field

 "Our organization found it beneficial for a patient's smoking status to be recorded during the patient workup and flagged within the EHR for further review by the physician, who could discuss the issue with the patient as needed."

Sarah Chouinard,MD, EHR Advisor and Chief Medical Officer, West Virginia Regional Health Information Technology Extension Center (WVRHITEC) 

Implementers in the field identified an efficient process for recording smoking status while ensuring provider to patient discussions were pursued when necessary. During the patient workup, a nurse documents the patient's vitals and chief complaint as well as their tobacco status and body mass index (BMI). All tobacco and BMI data is then flagged in the EHR by applying blue font. The diagnosis of "Tobacco Use Disorder" or "Overweight" is also added to the problem list in blue font if that tobacco status is positive or if BMI is elevated. The blue font highlights these issues for the physician, alerting them to review the data and pursue tobacco or obesity counseling conversations during the patient appointment if necessary.

 "We found that practices that have been collecting the smoking status of patients for years may still fall short of meeting meaningful use simply because of the smoking status entries available within their EHR. We encourage practices take advantage of the option of adding more smoking status choices to their EHR if that is what the practice prefers, but to also ensure all of the smoking status options required by meaningful use are included and utilized within their EHR."

Angela Strain, Organizational Advancement Director, The Center for the Advancement of Health IT 

Ensuring that the smoking status data is entered appropriately into an EHR is a key component to successfully meeting this meaningful use measure. Each practice must work with their vendor to guarantee that all six (6) of the required smoking status options (as outlined in the ONC Final Rule Certification Criteria 170.302(g) [PDF - 10MB]) are available for physicians to select. However, they should also confirm that there are no duplicative options that might cause inconsistent data entry or limited use of the required status options. Properly utilizing these six (6) required options allows for physicians to compare their care to others across their community, their state, and the nation as these options are also utilized with the Center for Disease Control's Behavioral Risk Factor Surveillance System.

National Learning Consortium Resources

The NLC resources are examples of tools that are used in the field today, and that are recommended by “boots-on-the-ground” professionals. The NLC, in partnership with HealthIT.gov, shares this collective EHR implementation knowledge and resources throughout this site.

National Learning Consortium Resources
Resource NameDescriptionSource

Electronic Preventative Services Selector (ePSS)


Tool designed to help primary care clinicians identify the screening, counseling, and preventive medication services that are appropriate for their patients.

Agency for Healthcare Research and Quality (AHRQ)

Integrating Tobacco Cessation Into Electronic Health Records


[PDF - 172 k] 

Quick reference guide for integrating tobacco cessation into EHR systems.

American Academy of Family Physicians (AAFP)

The material in these guides and tools represents the collective EHR implementation experiences and knowledge gained directly from the field of ONC’s outreach programs (REC, Beacon, State HIE) and through the Health Information Technology Research Center (HITRC) Communities of Practice (CoPs) in their performance of technical support and EHR implementation assistance to primary care providers. The information contained in these resources is not intended to serve as legal advice nor should it substitute for legal counsel. The resource list is not exhaustive, and readers are encouraged to seek additional detailed technical guidance to supplement the information contained herein.

Reference in this web site to any specific resources, tools, products, process, service, manufacturer, or company does not constitute its endorsement or recommendation by the U.S. Government or the U.S. Department of Health and Human Services.

Related CMS EHR Incentive Program Frequently Asked Questions

For additional questions around meaningful use, visit the CMS EHR Incentive Program Frequently Asked Questions (FAQs).


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