title: Are We Asking Patients if They Smoke?: Missing Information on Tobacco Use in Canadian Electronic Medical Records.
abstract: BACKGROUND
  All adolescent and adult patients should be asked if they smoke. Data entered in electronic medical records offer new opportunities to study tobacco-related clinical activities. The purpose of this study is to examine the recording of tobacco use in Canadian electronic medical records.
  
  
  METHODS
  Data were collected on September 30, 2013, and analyzed in 2014. Data on 249,223 patients that were aged ≥16 years as of September 30, 2013 and had at least one primary care encounter in the previous 2 years were included. The proportion of patients with information on tobacco use entered in a summative health profile was calculated. Associations between data gaps and patient or physician factors were examined.
  
  
  RESULTS
  Information on tobacco use was available for 64.4% of patients. Physicians using an electronic medical record for ≥4 years were more likely to have data (AOR=4.57, 95% CI=1.84, 7.29, p<0.0001). Patients aged ≥30 years were more likely to have tobacco information present (AOR=2.92, 95% CI=2.82, 3.02, p<0.0001, for patients aged 30-59 compared to those aged <30 years), as were patients with any comorbidities (AOR=1.41, 95% CI=1.36, 1.45, p<0.0001, for patients with one or two comorbidities compared with none) or more visits.
  
  
  CONCLUSIONS
  A third of Canadians in this sample lacked data on tobacco in their electronic medical record. Younger, healthier people were less likely to have information about their smoking status. Efforts to improve the recording of tobacco-related information in electronic medical records, especially for younger patients, are needed.
authors.affiliation: Department of Family and Community Medicine, University of Toronto; North York General Hospital, Toronto. Electronic address: mgreiver@rogers.com.
authors.forename: Michelle
authors.initials: M
authors.lastname: Greiver
authors.affiliation: Department of Family and Community Medicine, University of Toronto; North York General Hospital, Toronto.
authors.forename: Babak
authors.initials: B
authors.lastname: Aliarzadeh
authors.affiliation: Department of Family and Community Medicine, University of Toronto.
authors.forename: Christopher
authors.initials: C
authors.lastname: Meaney
authors.affiliation: Department of Family and Community Medicine, University of Toronto.
authors.forename: Rahim
authors.initials: R
authors.lastname: Moineddin
authors.affiliation: Department of Family and Community Medicine, University of Toronto; North York General Hospital, Toronto.
authors.forename: Chris A
authors.initials: CA
authors.lastname: Southgate
authors.affiliation: Department of Family Medicine, Queen's University, Kingston, Ontario.
authors.forename: David T S
authors.initials: DT
authors.lastname: Barber
authors.affiliation: Department of Family and Community Medicine, University of Toronto; North York General Hospital, Toronto.
authors.forename: David G
authors.initials: DG
authors.lastname: White
authors.affiliation: Department of Family Medicine, Queen's University, Kingston, Ontario.
authors.forename: Ken B
authors.initials: KB
authors.lastname: Martin
authors.affiliation: Department of Family and Community Medicine, University of Toronto.
authors.forename: Tabassum
authors.initials: T
authors.lastname: Ikhtiar
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Tyler
authors.initials: T
authors.lastname: Williamson
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002170:Canada; D003625:Data Collection; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D012907:Smoking / Q000453:epidemiology*; D064424:Tobacco Use / Q000453:epidemiology*; D055815:Young Adult