| Interoperability Standards Platform (ISP)

Assessments of a health-related matter of interest, importance, or worry to a patient, patient’s authorized representative, or patient’s healthcare provider that could identify a need, problem, or condition.

Data Element
Tobacco and Nicotine Product Use Description (Please confirm or update this field for the new USCDI version) Assessment of a patient’s tobacco and nicotine product use behaviors. Such products may include smokeless tobacco, cigarettes, cigars, pipe tobacco, waterpipes (or hookah), nicotine pouches, heated tobacco products, e-cigarettes, and other electronic nicotine delivery systems. Examples include but are not limited to duration and frequency of use, mode of consumption, and type of product used, and exclude prescribed nicotine replacement therapies. Applicable Vocabulary Standard(s) Applicable Standards (Please confirm or update this field for the new USCDI version) Logical Observation Identifiers Names and Codes (LOINC®) SNOMED Clinical Terms® (SNOMED CT®) U.S. Edition View guidance on Applicable Vocabulary Standards and versioning.

Comment

Submitted by EmoryHealthcare on 2026-04-15

Emory Healthcare comments on modifications to Tobacco Use

EHC appreciates the efforts by ONC to build core data elements that recognize the use of smokeless tobacco, chewing tobacco, and vapes. We appreciate the need to balance the alignment of historical data with incorporating new data relevant for clinical and public health work, especially given the different pathways of biological harm. We support the modification of this data element.

Submitted by csnewman on 2026-03-05

Clarify expectations for tobacco use

The updates to the Tobacco Use data element are a positive step, it is unclear what the expectations for exchange truly are. Are the example attributes of tobacco use (duration and frequency of use, mode of consumption, and type of product used) required to be supported by USCDI compliant systems? Do all tobacco products mentioned need to be supported? Please clarify specific expectations for attributes related to tobacco use that must be supported

Submitted by NCQA on 2025-09-29

NCQA recommendation for Smoking Status

Recommendation: Expand the scope of the Smoking Status element to include assessment of all tobacco products, aligned to the FDA definition for tobacco use; modify the element name and description to define the expanded element as assessments of a patient’s tobacco use behaviors including use of smoke, vape, chew, or sniff tobacco products. We also recommend adding duration (number of years of use) and quit date in the list of example data elements for comprehensive tobacco use history. Add LOINC terminology to the vocabulary standards.

Rationale: Tobacco assessment and use status encompasses assessment of broader tobacco product use beyond smoked products/cigarettes defined in the existing ‘Smoking Status’ USCDI element. Comprehensive assessment of tobacco use remains a public health priority and is essential to appropriately providing cessation intervention. Intervention should be provided for any tobacco use, not just smoked products/cigarettes. NCQA recently introduced a new HEDIS® measure to incentivize routine tobacco use screening and cessation intervention; this data is routinely captured with standard terminology.

Submitted by nachcinformatics on 2024-04-16

Smoking Status and Tobacco Use

Health Status Assessments: Smoking Status

https://www.healthit.gov/isa/taxonomy/term/811/draft-uscdi-v5

NACHC supports HL7 recommendation to change the name of Smoking Status to Tobacco Assessment and Use. Not all tobacco products are combustible like cigarettes. This category should include the noncombustible products as well, such as e-cigarettes. Both the Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA) refer to the broader category of Tobacco Use. Please see:

https://www.cdc.gov/chronicdisease/resources/publications/factsheets/tobacco.htm

https://www.fda.gov/consumers/minority-health-and-health-equity-resources/tobacco-use

In addition, HL7 recommends duration (number of years of use) and quit date included in the list of example data elements. The duration is used to calculate the number of pack years, which is important for quality measurement and understanding risk. In addition, knowledge about when someone quit smoking helps to understand risk for other diseases.

Submitted by nachcinformatics on 2024-04-16

updated recommendation

Submitted by CDC_DSMH_WG on 2022-04-27

CDC's Consolidated Comment

"Smoking status" continues to be of high importance for CDC partners, programs, education campaigns, data collection, and scientific analysis and reporting to prevent and reduce smoking. This data supports the vision of a world free from tobacco-related death and disease through advancement of the goals to: prevent initiation; promote quitting; eliminate exposure to secondhand smoke; and advance health equity by identifying and eliminating tobacco product-related inequities and disparities. As such, CDC strongly supports inclusion of “smoking status” in v3 of the USCDI.
CDC is concerned about the reclassification of the “smoking status” element into the new “Health Status” class. Tobacco use disorder is a DSM-5 diagnosable substance use disorder with clear diagnostic criteria and clinical practice treatment guidelines. As such, CDC recommends classifying “smoking status” in a “Substance Use” class along with other substance use data elements. In the absence of a “Substance Use” class in the USCDI, CDC recommends retaining “smoking status” as its own class consistent with USCDI v2.
CDC also recommends inclusion of the “Tobacco Use” and “Tobacco Product Type” data elements which are more inclusive measures of tobacco use. While the predominant form of tobacco product use in U.S. adults remains cigarettes, e-cigarettes have been the predominant tobacco product used among youth since 2014. Additionally, use of smokeless tobacco is not uncommon among adults nor youth, and has known health effects including cancer, heart disease, and stroke. As such, data regarding the broader spectrum of tobacco product use in clinical data has potential benefit to both healthcare and public health in the vision of a world free from tobacco-related death and disease.

Submitted by CDC_DSMH_WG on 2021-10-07

CDC Unified Comment: California Department of Public Health

 Smoking Status: Smoking, tobacco use, alcohol use, and illicit drug use are found in multiple areas of the record ( e.g. Smoking Status, Substance Use, and Social History). Recommend streamlining all substance use items in the same part of the record, preferably the Substance Use section.

Simply recording smoking status is insufficient given the evolving types of nicotine products and dual use and should be replaced with response to the question, “In the PAST 12 MONTHS, how often have you used any tobacco product (for example, cigarettes, vapes, cigars, pipes, or smokeless tobacco)?” Values of frequency are to be identified as appropriate.
Follow-up questions on types and frequency of tobacco products used (e.g. cigarettes, vapes, cigars, pipes, smokeless tobacco)
Specific response on marijuana use similar to the tobacco question: "In the PAST 12 MONTHS, how often have you used any marijuana product (for example, smoked, vaped, dabbed, or ingested)?"
Follow-up questions on types and frequency of marijuana products used

Last report of active alcohol use
Last report of recreational opioid use
Last report of methamphetamine use

Form Guide

1. Optional: Background Text / Cover Letter

The "Optional Background Text / Cover Letter" field provides space for additional context or introductory information related to your comment.

If you wish to provide context, explanation, or an introduction to your comment, enter this information in the field labeled "Optional Background Text / Cover Letter." This is entirely optional and is most useful when submitting multiple related comments or when additional background would help reviewers understand your feedback.

If you are only commenting on a single data class or element, you may leave this field blank.

2. Select the Data Class

To specify which data class your comment addresses:

In the "Data Class" drop-down menu, select the appropriate data class you want to comment on.
If you are providing a general comment that is not specific to a data element, select "General" from the options. Comments with this designation will be displayed on the USCDI landing page.
Note that the Data Class field will automatically populate based on your current location in the platform:
1. If you are on a data class page, the field will be set to that specific data class
2. If you are on a data element page, the corresponding data class will be pre-selected

3. Select the Data Element

To specify which data element your comment addresses:

In the "Data Element" drop-down menu, select the specific data element you want to comment on.
The drop-down menu will display only the elements available under the data class you selected in the previous step.
You can use the search function within the drop-down to quickly locate a specific data element.
If you are commenting on the data class itself rather than a specific element, you may leave this field blank.

Note: Comments on a specific data element will appear on the respective data element page, while comments on a data class (without a specific element selected) will appear on the landing page for that data class.

Fig 1 The "Data Class" and "Data Element" dropdown menus allow users to specify the exact content they wish to comment on.

4. Optional: Propose New Data Class or Element

If you cannot find the appropriate data class or element for your comment:

Instead of clicking the "Comment On An Existing Data Class Or Element" button, click the adjacent button labeled "Propose a New Data Class or Data Element."
This will redirect you to the ONDEC (ONC New Data Element and Class) Submission System.
In the ONDEC system, follow the provided instructions to submit your proposal for a new data class or element.
Once your proposal is submitted through ONDEC, it will be reviewed separately from the commenting process.

Fig 2 The "Propose a New Data Class or Data Element" button redirects users to the ONDEC Submission System for proposing new data elements not currently available in the system.

5. Complete the Comment Form

Fill out the required fields in the comment form:

Subject: Enter a brief, descriptive title that summarizes your comment. This helps reviewers quickly understand the nature of your feedback.

Comment: In this field, provide the full details of your comment or feedback. Be as clear and specific as possible about your suggestions, concerns, or observations. Include any relevant details that support your position.

6. Optional: Add Additional Comments

If you need to comment on multiple data classes or elements:

After completing your first comment, click the link labeled "Comment on another data element" at the bottom of the form.
A new comment section will appear, allowing you to enter details for your additional comment.
For each additional comment, you must select the appropriate data class and data element from the drop-down menus.
Complete the Subject and Comment fields for your additional comment.
Repeat this process for each additional comment you wish to submit.

Fig 3 The "Comment on another data element" link enables users to create multiple comments addressing different elements within a single submission.

7. Optional: Upload Supporting Files

The platform allows you to upload supporting documentation to enhance your comment:

Locate the "File Upload" section at the bottom of the comment form.
Click to upload any files (such as PDFs or documents) that provide additional context, evidence, or clarification for your comment.

Important: If you have already entered your comments using the form fields, there is no need to upload duplicate content in PDF format. The file upload feature is intended for supplementary materials only. Please avoid uploading files that contain the same information already provided in your comment text.

Fig 4 The "File Upload" section permits users to attach supporting documentation that supplements their written comments.

8. Optional: Save and Exit

If you need to pause your work and return to complete your comment later:

Click the "Save and Exit" button at the bottom of the form.
Your comment will be saved as a draft that you can access and complete later.
When you return to the platform, you will see a red triangle with an exclamation mark next to the “Return to saved Comment” button, indicating that you have saved comments in draft status.
Click this button to continue working on your draft.
You will be taken to a review page where you can:
1. Select "Submit Comment" to officially submit your feedback.
2. Click "Edit" to return to the comment form and make changes
3. Select "Discard Draft" to delete the saved draft and start fresh

Fig 5 A red triangle with exclamation mark indicator appears next to the “Return to saved Comment” button when draft comments are saved in the system.

9. Review and Submit

Once you have completed your comment:

Click the "Review and Submit" button at the bottom of the form.
This will take you to a review screen displaying your comment(s) in full.
Review all information for accuracy and completeness.
On this review screen, you have three options:
1. Click "Submit Comment" to officially submit your feedback
2. Click "Edit" to return to the comment form and make changes
3. Click "Discard Draft" to delete the comment and start fresh
The review screen also includes a "Print" button that allows you to create a printed copy of your comments for your records.
If you choose to submit, your comment will be recorded in the system and made available for review by the appropriate stakeholders.

Fig 6 The review screen allows users to verify comment content and make any necessary modifications before final submission.

Data Element

Comment