Data Element
Tobacco/Nicotine Product Use
Description

Use of the tobacco plant leaf or its products. The predominant use of tobacco is by smoke inhalation of cigarettes, pipes, and cigars. Smokeless tobacco refers to a variety of tobacco products that are either sniffed, sucked, or chewed. An electronic cigarette is a vaporizer device that simulates smoking by providing some of the aspects of smoking that includes nicotine but without combusting tobacco. These products include psychoactive ingredient, nicotine. Question Prompt: Any use of tobacco (or nicotine-containing) products? Permissible Values: o Never (SNOMED: 702979003) An individual who has never consumed tobacco products in their lifetime. o Former (SNOMED: 702975009) An individual who has consumed tobacco products in his or her lifetime but who had quit consumption at the time of question. o Current - Daily (SNOMED: TBD) An individual who has consumed tobacco products in his or her lifetime, and who does so every day. o Current - Occasionally (SNOMED: TBD) An individual who has consumed tobacco products in his or her lifetime, who uses now, but does not use every day. o Unknown (SNOMED: TBD) An individual for whose tobacco product use is unknown.
Submitted By: Anita walden / HL7 Common Clinical Registry Framework project
Data Element Information
Use Case Description(s)
Use Case Description Currently, smoking status is collected in a variety of formats across healthcare settings, making it difficult to accurately aggregate information within and across health systems. The current USCDI broadly indicates smoking as a data element but organizations need specific minimum basic information concerning smoking that should be consistently collected. For primary patient care situations, clinicians are interested in a general understanding of nicotine and smoking use rather than trying to obtain exact information that may be difficult for patients to accurately report for a practical purpose. It is critical to collect reliable tobacco/nicotine use from patients in a manner that is easy for them to recall and provide. For example, patients often don’t remember historical dates, but generally, remember the age when they first started using tobacco/nicotine products.

Tobacco/Nicotine use information should be available across all EHRs in a standard format and made available to additional stakeholders such as registry stewards for quality reporting. Currently, tobacco/nicotine use is captured in various formats making it difficult to aggregate and understand use across patient care settings. Not only does this increase the cost of data collection and sharing with stakeholders, but mapping data can lead to data quality issues and data reduction.
Registries are one of the major stakeholders, routinely collecting tobacco/nicotine information from provider settings. Standardizing these data elements should reduce data exchange costs, resources, and improve quality data collection from patients and quality reporting. This information was collected as part of the HL7 CIC Common Clinical Registry Framework Initiative in partnership with Duke University and the Pew project.

Estimate the breadth of applicability of the use case(s) for this data element All of the US healthcare systems and national quality registries could use these data elements if they are made available in EHR systems.
Link to use case project page https://www.hl7.org/ and https://dcri.org/registry-data-standards/
Use Case Description Researchers may also use Tobacco/Nicotine Use directly from healthcare settings. If data was collected in a standard format for all US patients this would increase interoperability and create the ability to accurately compare data across various entities. They can use this information as cohort identification for patient populations adding additional questions for research protocols.
Estimate the breadth of applicability of the use case(s) for this data element It is difficult to measure the number of stakeholders across the pharmaceutical and clinical research community.
Healthcare Aims
  • Improving patient experience of care (quality and/or satisfaction)
  • Improving the health of populations
  • Reducing the cost of care
  • Improving provider experience of care
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) There are SNOMED and LOINC Codes for most of the data elements but new codes will be requested for eCigarette use.
http://bioportal.bioontology.org/ontologies/SNOMEDCT/?p=classes&conceptid=http%3A%2F%2Fpurl.bioontology.org%2Fontology%2FSNOMEDCT%2F365980008
Additional Specifications HL7 CCRF DAM, HL7 FHIR have some of these data elements and we are hoping to expand those to the list we are proposing.
HL7 US Core is available through EHR systems. Not sure of the number of organizations that are using HL7 US Core
https://www.hl7.org/fhir/us/core/StructureDefinition-us-core-smokingstatus.html
Current Use Not currently captured or accessed with an organization
Extent of exchange N/A
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) There should not be any limitations because SNOMED and LOINC will be used
Restrictions on Use (e.g. licensing, user fees) No Restrictions in the US
Privacy and Security Concerns No privacy concerns
Estimate of Overall Burden Updating the HL7 US CORE to include these data elements will lower the burden of Providers who have and will implement HL7 FHIR. The downstream users of the information should experience cost savings and see improvements in data quality if the information is collected in a standard format directly from the patient.
Other Implementation Challenges The biggest challenge is getting EHR vendors to agree to standardize their data collection systems to use the standard. Downstream users such as Registry stewards would have to change their systems and agree to accept the Tobacco/Nicotine data elements directly from the EHR without mapping to a proprietary codelist.

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