Smoking Status Observation profile

For vaping, SNOMED has electronic cigarette codes (as of March 2020). Both are Findings

phinvads.cdc.gov/vads/http:/phinvads.cdc.gov/vads/ViewCodeSystemConcept.action?oid=2.16.840.1.113883.6.96&code=786063001
phinvads.cdc.gov/vads/http:/phinvads.cdc.gov/vads/ViewCodeSystemConcept.action?oid=2.16.840.1.113883.6.96&code=785889008

In addition, it would be interesting to know whether Canadian EMR/EHR vendors use any of these semantic standards - LOINC/pCLOCD, HL7, SCT - for smoking status, etc.

Thanks.

Hi Shamil,

Here are some comments from CIHI for your consideration:

Neither SNOMED CT or ICD-10-CA provides the full range of what would be required for data collection, however there may be a combination that could help guide forward thinking.

Vaping: ICD-10-CA does not provide enough granularity to be as specific as SNOMED CT, however, for v2022 we have updated ICD-10-CA to include two new codes:
 Please note that U07.0 is already in use to capture vaping related disorder.
 Vaping is not in the social behavior refset.

ICD-10-CA:
• U07.0 Vaping-related disorder
• (for v2022) Z72.80 Use of vaping device - Excludes: vaping-related disorder (U07.0)
SNOMED CT:
• 816134008 Vaping (event)
• 816135009 Disorder due to vaping (disorder)
*Both map to U07.0 Vaping-related disorder in ICD-10.
Smoking/tobacco use – Depending on data collection needs and the level of specificity required. ICD-10-CA captures current, history, mental health disorders including dependence, and exposure:
ICD-10-CA:
• Z72.0 Tobacco use
• Z58.7 Exposure to tobacco smoke
• F17.2 Mental and behavioural disorders due to use of tobacco, dependence syndrome
• Z86.42 Personal history of tobacco abuse

Whereas SNOMED CT provides the following:
• 8517006 Ex-smoker (finding) – in social behavior refset
• 702975009 Ex-tobacco user (finding) - in social behavior refset
• 160605003 Heavy cigarette smoker (20-39 cigs/day) (finding) - in social behavior refset
• 160603005 Light cigarette smoker (1-9 cigs/day) (finding) - in social behavior refset
• 160604004 Moderate cigarette smoker (10-19 cigs/day) (finding) - in social behavior refset
• 266920004 Trivial cigarette smoker (less than one cigarette/day) (finding) - in social behavior refset
• 160606002 Very heavy cigarette smoker (40+ cigs/day) (finding) - in social behavior refset
• 266919005 Never smoked tobacco (finding) - in social behavior refset
• 702979003 Never used tobacco (finding) - in social behavior refset
• 82302008 Pipe smoker (finding) - in social behavior refset

* All map to one of the ICD-10-CA codes above, except the “never smoked/used tobacco” concepts.

SNOMED CT also offers many more specific concepts that are not in the social behavior refset such as:
• 16090371000119103 Exposure to second hand tobacco smoke (event)
• 21481000119108 Toxic effect of secondary tobacco exposure (disorder)
• 89765005 Tobacco dependence syndrome (disorder)

From an ICD-10-CA perspective the use of tobacco and vaping device fall under category Z72 Problems related to lifestyle.

In LOINC, here are terms related to smoking, tobacco loinc.org/LG41856-2/

Our Recommendation:
Seek input from Infoway for updating the Social Behavior refset (contains 184 codes) to add any concepts that would be desirable for data collection that are not already included, and potentially create a new SNOMED CT concept (finding) to capture User of vaping device to support “smoking status” if there is interest.

During the Clinical substream meeting we came to a question regarding the Smoking Status Observation profile and what codes to use to generalize this profile to cover smoking, vaping and tobacco smoking use cases.

As you may know, US Core and FHIR IPS profiles are tightly bound to tobacco smoking only [see links below], i.e.,:
* Observation.code – [LOINC|72166-2Tobacco smoking status]
* Observation.valueCodeableConcept - www.hl7.org/fhir/us/core/ValueSet-us-core-observation-smokingstatus.html OR loinc.org/LL2201-3/

What would be the best code and value set to cover other substances as well?



www.hl7.org/fhir/us/core/StructureDefinition-us-core-smokingstatus.html
hl7.org/fhir/uv/ips/2018Sep/StructureDefinition-observation-tobaccouse-uv-ips.html