Google Sheet review and discussion | Continued discussion from last week: For the Potassium fields, how do we want to indicate a field is not applicable (i.e. specimen source)? Use N/A, leave it blank, etc. Do we need a response that is human and computer processable? every test has a specimen source site, but it is not as important to be communicated for some tests - adding in N/A that will create confusion, because it exists for Potassium it is not needed to determine the LOINC but we want to also suggest to the lab when to report - is that in our authority? We want the table to be consistent so that any user of data understands what defines the test for systems each of the elements need to be available you can automate for specific tests if there is only one collection method
We seem to have different definitions for specimen source we MUST create operational definitions for the individual attributes of a specimen type - what is collected in the container and sent to the lab there are also derived specimen like isolates, that are cultured
We are working on the specimen cross-mapping table to help sort this out source / source site needs to be sorted out more CLIA calls it source location on the body is important for many tests source is organ system - for ser/plas it is blood; peripheral blood can be venous, artrial, capillary, line - body location matters for blood cultures
need to be clear what can be set up as default vs when it needs clinician input (extra click)
Can we get UDIs for the Potassium, other info to fill out for all applicable fields for serum and plasma examples
Notes after Riki left: Agreement that we need Specimen Type, Specimen Source (site or organ system), Specimen Collection Fields Ask: Do we need to differentiate between what is Drawn to the lab vs what is being analyzed? example capillary or whole blood drawn (specimen type collected) What is specimen type analyzed? example serum or plasma Isolate (no matter if whole blood collection or capillary, as both are spun down or serum or plasma are analyzed) Discussion about susceptibility testing on original/collected specimen. Historically this is performed on each organism isolated from the specimen type collected. In LOINC that is what is specified in the System field. Dan asks how you’d tell in messaging? LOINC on original specimen (system), vs susceptibility testing performed with molecular methods. Detect presence of gene, nothing more than that.
Question about more generic LOINCs. isolates are being tested, but clinically relevant is where in the patient’s body the isolate came from Question about more generic LOINCs. Specimen Type and Source mapped to SCT in EHR at specimen collection is requested of EHR vendors. on the order site LOINC system can be excluded / or very general - then use AOE to get specimen source 31208-2 (should be sent in the proper HL7 element (SPM-4) rather than as an AOE) important how to operationalize this more complicated system (defaulting may increase
somsome “noise“ - when for specific cases user needs to make entry and forgets to make it Andrea’s vision: specimen is being collected - type, procedure, source site is documented during item of order - that can then flow to lab / pathology / cancer protcols / then can be included in reporting - how can LIDR address this issue? Future discussion: Where specimen type (type of body fluids for cell counts), source (COVID culture) is in a different fields
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| Please see the action items at top of this page - Next deliverable is White paper outline by end of this year And we need to prioritize the use cases, so that we can finalize the requiements for the first phase of LIDR, which need to be included in the White paper |