In order to determine whether providers follow smoking cessation practice guidelines, it is important to find an accurate way to measure providers' counseling activity. This study compares information on tobacco counseling practices from three sources: the electronic medical record, a patient survey, and a provider survey. The study examined providers' use of the United States Public Health Service five-step protocol - the "5A's" - which includes asking patients about tobacco use, advising them to quit, assessing their interest in quitting, assisting with treatment, and arranging for follow-up. Researchers received surveys from 766 patients seen in the Boston area in a three-month time frame. They received 110 surveys from providers serving those patients. Agreement between the patient surveys and the electronic medical record was poor for all five counseling behaviors. Little agreement was found between provider surveys and either patient surveys or electronic medical records. Providers reported that they completed the counseling behaviors more frequently than did patient surveys or the electronic medical record. The authors conclude that implementing an electronic medical record does not, on its own, improve documentation of tobacco interventions. They suggest that the electronic medical record might be a more valuable tool if it were adapted to include standardized language on tobacco counseling.