Representing Patient Tobacco Use (Smoking Status)

Type	Standard / Implementation Specification	Standards Process Maturity	Implementation Maturity	Federally required	Cost	Test Tool Availability
Standard for observation values	SNOMED CT®	Final	Production	Yes	Free	N/A
Standard for observations	LOINC®	Final	Production	No	Free	N/A
Implementation Specification	NCPDP SCRIPT Standard, Implementation Guide, Version 2017071	Final	Production	Yes	$	Yes

Limitations, Dependencies, and Preconditions for Consideration	Applicable Value Set(s) and Starter Set(s)
The 2015 Edition smoking status criterion (§ 170.315(a)(11)) only applies to status of use for smoked tobacco. It does not require a terminology standard. 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 III for an informational resource developed by the Health IT Standards Committee.	'Tobacco smoking status NHIS' LOINC® 72166-2 Current Smoking Status urn:oid:2.16.840.1.113883.11.20.9.38 The following smoking status value set of SNOMED CT® codes, using the preferred concept term, is only required in the context of using the Common Clinical Data Set (CCDS): Current every day smoker. 449868002 Current some day smoker. 428041000124106 Former smoker. 8517006 Never smoker. 266919005 Smoker, current status unknown. 77176002 Unknown if ever smoked. 266927001 Heavy tobacco smoker. 428071000124103 Light tobacco smoker. 428061000124105 Additional tobacco-related codes: Date quit tobacco smoking: LOINC 74010-0 Date quit smokeless tobacco: LOINC 88030-2 User of smokeless tobacco (finding): SNOMED CT® 713914004 Smokeless tobacco non-user (finding): SNOMED CT® 451381000124107 Former smokeless tobacco user (finding): SNOMED-CT® 456711000124105 Chews tobacco (finding): SNOMED-CT® 81703003 Snuff user (finding): SNOMED-CT® 228494002 User of moist powdered tobacco (finding): SNOMED-CT® 228504007 No known exposure to tobacco smoke (finding): SNOMED-CT® 711563001

Limitations, Dependencies, and Preconditions for Consideration

Applicable Value Set(s) and Starter Set(s)

The 2015 Edition smoking status criterion (§ 170.315(a)(11)) only applies to status of use for smoked tobacco. It does not require a terminology standard.
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 III for an informational resource developed by the Health IT Standards Committee.

'Tobacco smoking status NHIS' LOINC® 72166-2
Current Smoking Status urn:oid:2.16.840.1.113883.11.20.9.38
The following smoking status value set of SNOMED CT® codes, using the preferred concept term, is only required in the context of using the Common Clinical Data Set (CCDS):
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. Date quit tobacco smoking: LOINC 74010-0
2. Date quit smokeless tobacco: LOINC 88030-2
3. User of smokeless tobacco (finding): SNOMED CT® 713914004
4. Smokeless tobacco non-user (finding): SNOMED CT® 451381000124107
5. Former smokeless tobacco user (finding): SNOMED-CT® 456711000124105
6. Chews tobacco (finding): SNOMED-CT® 81703003
7. Snuff user (finding): SNOMED-CT® 228494002
8. User of moist powdered tobacco (finding): SNOMED-CT® 228504007
9. No known exposure to tobacco smoke (finding): SNOMED-CT® 711563001

Comment

Submitted by pwilson@ncpdp.org on 2021-09-29

NCPDP Comments

Substance use fields are available in NCPDP SCRIPT Standard Version 2017071 to allow tobacco use information to be transmitted via SNOMED codes
Add the following:

Type-Implementation Specification Standard Implementation/Specification- NCPDP SCRIPT Standard, Implementation Guide, Version 2017071 Standards Process Maturity – Final Implementation Maturity- Production Adoption Level – 5 Federally Required – Yes Cost – $ Test Tool Availability – Yes

Include Test Tool Link: https://tools.ncpdp.org/erx/#/home

Submitted by chris.baumgart… on 2021-09-29

WA State Department of Health Tobacco/Smoking/Vaping Comments

In 2018, e-cigarette products with nicotine concentrations of five percent or greater comprised approximately two-thirds of the e-cigarette market, while zero-nicotine products accounted for less than one percent.[1] To more accurately assess nicotine intake and potential nicotine dependence among patients, Washington State Department of Health recommends distinguishing e-cigarette use by nicotine concentration, rather than e-cigarette liquid with nicotine versus e-cigarette liquid without nicotine. Additionally, Washington State Department of Health concurs with the recommendation submitted on September 19, 2018 by Dr. Michael Fiore and Robert Adsit to implement non-overlapping values for smoking status. [1] Romberg AR, Miller Lo EJ, Cuccia AF, Willet JG, Xiao H, Hair EC . . . King BA (2019). Patterns of nicotine concentrations in electronic cigarettes sold in the United States, 2013-2018, Drug and Alcohol Dependence, 203, 1-7. doi:10.1016/j.drugalcdep.2019.05.029.

Submitted by ahayden on 2021-10-26

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