Representing Patient Tobacco Use (Smoking Status)

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Type Standard / Implementation Specification Standards Process Maturity Implementation Maturity Adoption Level Federally required Cost Test Tool Availability
Standard for observations
Final
Production
Rating 5
No
Free
N/A
Standard for observation values
Final
Production
Rating 5
Yes
Free
N/A
Limitations, Dependencies, and Preconditions for Consideration Applicable Value Set(s) and Starter Set(s)
  • There are limitations in SNOMED CT® for this interoperability need, which include, but not limited to:  not being able to capture severity of dependency, level of use, quit attempts, lifetime exposure, and use of e-Cigarettes.
  • LOINC® includes codes that support recording smoking status in the CDC’s preferred (and sometimes required) responses (e.g. Tobacco smoking status NHIS[76691-5]) and other kinds of observations (e.g. Have you smoked at least 100 cigarettes in your entire life [PhenX] [63581-3] or How old were you when you first started smoking cigarettes every day [PhenX] [63609-2].
  • See LOINC projects in the Interoperability Proving Ground. 
  • For more information about observations and observation values, see Appendix II for an informational resource developed by the Health IT Standards Committee. 

 

  • 'Tobacco smoking status NHIS' LOINC 72166-
  • Current Smoking Status urn:oid:2.16.840.1.113883.11.20.9.38
  • ONC’s 2015 Edition certification requirements reference the following value set for smoking status.  Codes from SNOMED CT® :
    1. Current every day smoker. 449868002
    2. Current some day smoker. 428041000124106
    3. Former smoker. 8517006
    4. Never smoker. 266919005
    5. Smoker, current status unknown. 77176002
    6. Unknown if ever smoked. 266927001
    7. Heavy tobacco smoker. 428071000124103
    8. Light tobacco smoker. 428061000124105
  • Additional tobacco-related codes: 
    1. User of smokeless tobacco (finding): SNOMED CT 713914004
    2. Smokeless tobacco non-user (finding): SNOMED CT 451381000124107
    3. Date quit tobacco smoking LOINC 74010-0

Comment

Consider adding additional tobacco concepts to this standard

Thank you for making the tobacco use (smoking status) codes and value sets a little more clear than previous versions.  We would like to recommend including standard codes for smokeless tobacco, in addition to the smoking status codes.  Clinical quality measures are interested in assessing both forms of tobacco use.  We recently requested a new LOINC code for Smokeless Tobacco Status, and was approved for a future release.  This LOINC code will have the following SNOMED CT answer list:
713914004 User of smokeless tobacco (finding)

451381000124107 Smokeless tobacco non-user (finding)

TBD Former smokeless tobacco user (finding) (this code was recently requested of SNOMED CT and was approved for their next release)

In addition to having standard codes to capture the smoking or smokeless tobacco status, we feel it is also very important to have a standard way to capture the quit date for both smoking and smokeless tobacco. Here are the recommended LOINC codes:

TBD- Date Quit Smokeless Tobacco (this code was recently requested of LOINC and was approved for a future release)

74010-0 Date Quit tobacco smoking 

The rationale for this is important, in that different quality measures may have different time frames for when they consider someone a current tobacco user or not.  For example, The Joint Commission considers a person who has used tobacco products in the past 30 days a current user and someone who needs tobacco cessation interventions.  Other measure stewards may have different thresholds.  In order to capture the data once in order to re-use many times, there needs to be a standard way to codify this data in a more granular fashion.  That way, The Joint Commission eCQM could use logic to ask the tobacco use status, if the person is a "former user", then ask for the quit date, and use logic to determine if that quit date was within the past 30 days or not.  If a measure has a different threshold, the same granular level of data could be used, and their measure could use logic with a different time frame.  This would decrease the burden on implementation, because then every measure steward would not be using a different pre-coordinated term (e.g. LOINC 68535-4 to get the past 30 days, or LOINC 54845-3 to get the past 7 days) to get the information, which forces duplication of documentation just to satisfy a measure. 

 

NCPDP - Comment

SNOMED – Not currently used in NCPDP MMA mandated standards. Future versions of the NCPDP SCRIPT standard support SNOMED.