Tuesday, April 17, 2012

MeaningfulUse Stage2 and Smoking Status Vocabulary

At the S&I Framework Face to Face meeting last week, Rich Elmore kept pushing for a value set for smoking status. I had tried to craft one from SNOMED CT and failed, because it seemed to me that there were some missing concepts.  Cecil Lynch (a member of the HL7 Vocabulary Workgroup) succeeded where I had failed (he knows SNOMED CT and vocabulary in general so much better than I do).  He came up with this list which I think is an awesome mapping.  We should all be proposing this value set and SNOMED CT for the exchange of Smoking Status information.

Thanks Cecil!


Current every day smoker

Smokes tobacco daily (finding)
Current some day smoker

Occasional cigarette smoker (finding)
Former smoker

Ex-smoker (finding)
Never smoker

Never smoked tobacco (finding)
Smoker, current status unknown

Tobacco smoking consumption unknown (finding)
Unknown if ever smoked

current non smoker but past smoking history unknown (finding)


  1. How about that! Very timely. Thanks, Keith.

  2. we had discussions about tobacco usage vs smoking status (e.g. tobacco chewers)... NQF if I recall, counts this in some of their measures. Any thoughts? What about level of smoking (3 packs a day). How is this represented in CCD?

  3. The best code I can find to use for a measure of level is SNOMED CT 365982000 (tobacco smoking consumption - finding).

    Representing level of smoking across methods is difficult because there are no standard units that you can associate with it. Smoking includes pipes (without a standard bowl size), cigarettes (also without a standard size), cigars (also no standard size), and packs also don't have a standard size (some have 10, others 15, most commonly have 20, yet others have 25).

    So, what do you count? Under the SNOMED CT code above are degrees for cigarette smokers: (light, moderate, heavy and others in between) measured by number of cigarettes per day, but nothing for other methods of consumption. Using a scale like that is probably better than other methods of "counting".

    In terms of tobacco usage (e.g., chew, snuff or other uses), there are other codes in SNOMED to support those kinds of findings of use, but not degree of use.

  4. I just came across this while looking for information on mapping the CDC smoking status recodes. For the record, I am a total SNOMED novice.

    I see that 405746006, "current non smoker but past smoking history unknown (finding)", is proposed. This talks specifically about smoking which is appropriate, but the finding is explicit in that the patient is currently not a smoker, unlike the CDC value which is "Unknown if ever smoked."

    SNOMED 160614008, "Tobacco consumption unknown (finding)", which addresses all forms of tobacco consumption, does state that consumption is unknown, seemingly for smoking or smokeless, over all time.

    Might this not be a valid proposal?

  5. Update: C-CDA requires a slightly different set of codes for these same six meanings:

    Two changes from what's listed above:

    230059006 --> 428041000124106
    Current some day smoker
    Occasional cigarette smoker (finding)

    405746006 --> 266927001
    Unknown if ever smoked
    current non smoker but past smoking history unknown (finding)

    Complete value set:

    Value Set: Smoking Status 2.16.840.1.113883. STATIC 2012-07-01
    Code System(s):
    SNOMED CT 2.16.840.1.113883.6.96
    This value set indicates the current smoking status of a patient
    Code Code System Print Name
    449868002 SNOMED CT Current every day smoker
    428041000124106 SNOMED CT Current some day smoker
    8517006 SNOMED CT Former smoker
    266919005 SNOMED CT Never smoker (Never Smoked)
    77176002 SNOMED CT Smoker, current status unknown
    266927001 SNOMED CT Unknown if ever smoked

  6. What if you dont know? as in, value is NULL in my _* database?
    and yet we have to spit out the section?

  7. as near as I can tell these numeric codes do not exist in SNOMED CT. what am I missing?
    Heavy tobacco smoker 428071000124103
    Light tobacco smoker 428061000124105
    Current some day smoker 428041000124106

  8. Anyone has Smokeless Status Snomed Codes ??

  9. Does anyone know what consitutes a Heavy smoker and what constitutes a Light smaoker? Is there a certain number of cigarettes per day or pack years used for the definition?

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  14. How would you document e-cigarets

    1. I would not document e-cigs, as they contain no tobacco or smoke, and are an evidence-based tool for smoking cessation. They do not meet the criteria for addiction.

  15. What does cigarette smoking snomed code 266927001 mean? Because I don't smoke