Background: Screening high risk patients for lung cancer with Low Dose Computed Tomography (LDCT) reduces lung cancer-specific mortality, however its adoption in routine clinical care has been limited. We designed an Electronic Medical Record (EMR) based application to identify patients for screening in the primary care setting. Methods: A two-step screening application was created to identify patients meeting CMS criteria for LDCT screening in a visit to a primary care provider (PCP). First, the application directs medical assistants to complete a patient’s smoking history. If the patient meets eligibility for LDCT screening, step-by-step direction for PCPs to complete the screening process, including reviewing smoking history, shared decision making and ordering the LDCT scan, is initiated. We compared the number of referrals for screening LDCT in the 12-month periods before and after implementation of the screening application. Results: During the 12-month period prior to implementation of the screening application in a 18-person PCP group, there were a total of 198 referrals for LDCT screening. Of these, 162 (81.8%) were negative (CAT 1 and 2), 20 (10.1%) required follow up CT (CAT 3), 16 (8.1%) were positive (CAT 4), 3 (1.5%) required an invasive diagnostic procedure (bronchoscopy with biopsy, endobronchial ultrasound, CT guided biopsy, thoracic surgery). Cancer was diagnosed in 2 patients (1.0%), both of whom received cancer treatment. In the 12 months after implementation, referrals increased by 40% to 278. Of these, 241 (86.7%) were negative, 19 (6.8%) required follow up CT, 18 (6.5%) were positive, 4 (1.4%) required an invasive diagnostic procedure, and 3 (1.1%) were diagnosed with cancer and are receiving treatment. Major challenges include variable user compliance in completing accurate smoking history and providers ignoring alerts to initiate lung cancer screening. Conclusions: To our knowledge this is the first report on the use of an EMR based application to identify patients at risk for lung cancer. Implementation of the EMR based application correlated with an increase in referrals for LDCT screening and led to the identification of high risk lung lesions including lung cancer.