CONTEXT: The expanded use of electronic medical records (EMRs) may provide an opportunity to increase the use and impact of clinical guidelines to promote tobacco-cessation treatment in primary care settings. The objective of this systematic review is to evaluate the evidence for such an effect. EVIDENCE ACQUISITION: After a systematic search of the English-language literature regarding an EMR effect on either smoking cessation or clinician behavior, relevant articles were abstracted and findings summarized from both observational studies and RCTs. EVIDENCE SYNTHESIS: Of ten identified studies of EMRs and tobacco, only two RCTs were found. Adding tobacco status as a vital sign resulted in an increase in some clinical guideline recommended actions, particularly documentation of smoking status. There was insufficient evidence to quantify the effect of an EMR on changes in patient smoking behaviors. CONCLUSIONS: While the use of EMRs to prompt or provide feedback on the clinical treatment of tobacco dependence demonstrates some promising results, substantial additional research is needed to understand the effects of EMRs on provider and patient behavior.