Knowing patients’ smoking history helps guide who may benefit from preventive services
such as lung cancer screening. The accuracy of smoking history electronic health records
This was a secondary analysis of data collected from a portal-based lung cancer screening
decision aid. Participants of an academically affiliated health system, aged 55–76
years, completed an online survey that collected a detailed smoking history including
years of smoking, years since quitting, and smoking intensity. Eligibility for lung
cancer screening was defined using the Centers for Medicare and Medicaid Services
criteria. Data analysis was performed May–December 2018, and data collection occurred
between November 2016 and February 2017.
A total of 336 participants completed the survey and were included in the analysis.
Of 175 participants with self-reported smoking intensity, 72% had packs per day and
62% had pack-years recorded in the electronic health record. When present, smoking
history in the electronic health records correlated well with self-reported years
of smoking (r =0.78, p≤0.0001) and years since quitting (r =0.94, p≤0.0001). Self-reported smoking intensity, including pack-years (r =0.62, p<0.0001) and packs per day (r =0.65, p≤0.0001), was less correlated. Of those participants eligible for lung cancer screening
by self-report, only 35% met criteria for screening by electronic health records data
alone. Others were either incorrectly classified as ineligible (23%) or had incomplete
The electronic health records frequently misses critical elements of a smoking history,
and when present, it often underestimates smoking intensity, which may impact who
receives lung cancer screening.