Capturing tobacco status using an automated billing system: steps toward a tobacco registry

In 1999, Group Health Cooperative (GHC), a health system with 575,000 enrollees, launched a quality improvement initiative to systematically record patient tobacco-use status and provider intervention using an automated billing system. Performance feedback and senior-level incentives were added to foster compliance with the automated recording. Prior to this period, tobacco-use status was recorded primarily via a paper-based chart system, with billing-system recording averaging only 7.5% of primary care visits. In 2000, tobacco-use status was recorded using the billing system in an average of 82% of visits (p