Smoking Status SNOMED-CT Terms
Greg Thole
In reviewing the updated SNOMED-CT release (170.207(a)(4) – Sept 2015) required for various certification criteria and CCDS elements, there have been updates to the preferred terms associated with certain codes from the subset of those specified as required for representation of patient smoking status in both 2014 Edition Common MU Data Set and 2015 Edition CCDS. Below is a breakdown of the specific differences we’ve noticed:
|
2015 Edition CCDS Specified Terms |
SNOMED-CT Sept 2015 Specified Terms |
|
Never smoker (266919005) |
Never smoked tobacco (266919005) |
|
Light tobacco smoker (428061000124105) |
Light tobacco smoker (428061000124105) |
|
Heavy tobacco smoker (428071000124103) |
Heavy tobacco smoker (428071000124103) |
|
Current every day smoker (449868002) |
Smokes tobacco daily (449868002) |
|
Current some day smoker (428041000124106) |
Occasional tobacco smoker (428041000124106) |
|
Smoker, current status unknown (77176002) |
Smoker (77176002) |
|
Former smoker (8517006) |
Ex-smoker (8517006) |
|
Unknown if ever smoked (266927001) |
Tobacco smoking consumption unknown (266927001) |
Our understanding based on guidance in the final rule and Certification Companion Guides (CCG) is that the codes themselves are the focal point, and therefore the specific associated terms listed in the CCG (e.g. “Never smoker” for code 266919005) are not mandatory for the purpose of certification and are flexible according to specifications in SNOMED-CT releases. Below are specific references from which our position has been formed:
- “To note, the adopted newer version of a minimum
standards code set will serve as the baseline for certification. As with all
adopted minimum standards code sets, health IT can be certified to newer versions of the adopted baseline
version minimum standards code sets for purposes of certification,
unless the Secretary specifically prohibits the use of a newer version.”
- 2015 Edition Final Rule (https://www.federalregister.gov/d/2015-25597/p-185)
- “Health IT developers are free to include
clinically relevant information, such as lifetime pack year exposure in their
interface and system. However, the specific SNOMED CT® codes listed are to be used to reflect the
patient’s smoking status when such data is required to be included as part of
the CCDS.”
- Common Clinical Data Set CCG (https://www.healthit.gov/sites/default/files/2015Ed_CCG_CCDS.pdf)
We're hoping to confirm our understanding that the use of associated terms as specified in the Common Clinical Data Set CCG (and elsewhere) is not mandatory and leveraging the preferred terms as specified in the September 2015 (and subsequent) SNOMED-CT release specifications is acceptable for certification (provided the codes themselves are still utilized).
Thank you
Nagesh Bashyam
Greg
The ETT tool does not produce an error if a display name does not match the regulation or the vocabulary/value set specified name. However warnings and information are provided for vendors to improve.
However it is best to use the display names from the Vocabulary standard since the regulation allows for updates to vocabularies as you pointed out.
Thanks
Dragon
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