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  • Focusing on pain points for data exchange and how SHIELD can help

    • meaning of tests be distinct, method type is important, impact on incorrect codification of lab tests results in EHR-s

  • Clinicians care about finding the right test to order, where to find the result and what the next step is for patient care

  • Focusing on how SHIELD helps improve usability of lab results for providers - example Impact of Chlamydia testing if no or incorrect LOINC is used

    • ELR

    • eCR

    • HEDIS measures

    • Insurance reimbursements

    • data quality inititatives

    • research

We could have one panelist bring up the challenges and others could bring the solutions, or we could divide the breadths of issues and address both – the problem and how SHIELD is helping to fix it – on the technical as well as on the policy level.

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·       Banning, P. In-roads: Advancing LOINC Adoption in Clinical Trials. 2023 LOINC Conference

 

  1. _________Marjorie Rallins

Relevant References:

 

  1. _________ Julia Skapik

Relevant References:

Discussion and Conclusion:

...

Suggested Discussion Questions:

Potential Ideas/Outline

  1. First panelist gives overview of SHIELD and describes the problem(s) to T up how SHIELD addresses

  2. Another panelist, Using Chlamydia as example test, briefly (few slides) describe how LIVD standard can be used by labs for LOINCs needed to map and build in LIS. Lab perspective.

    1. Also how receipt of SCT codes needed for source site and used by labs for PH reporting. value of specimen info, coding, etc. Include/expand on Jenna’s points on support of specimen info?

    2. Focus on how lab name doesn’t have complete info/meaning (maybe compare 2 different chlamydia results form different labs that have same name/difference LOINCs?) value of coding. Lab A Chlamydia vs Lab B Chlamydia

    3. Mention how SHIELD is working to build LIDR to have more complete test details. can mention UDI. (If we have 2 different IVD LIVD maps for Chlamydia, may have UDIs. Otherwise, may need to look up.)

  3. Another panelist. Show EHR receiving Lab A Chlamydia and Lab B Chlamydia in EHR. Provider perspective

    1. Are they built separately to support separate coding needs or is a single Chlamydia result built and a generic LOINC is needed? Compare/contrast what lab provides vs what is seen/used in EHR.

    2. Address provider/informaticist needs/questions/concerns

    3. HEDIS measure reporting. Are these distinct tests in the HEDIS value set/LOINCs?

      1. To Jenna’s point is the lab provided LOINC missing from the Hedis value set? and thus burden/issues with quality measure reporting as a result?

    4. What story to tell? comparability, test details, exchanges with other EHRs, HIEs, etc.? Reuse per Julia’s comments

    5. Comparability in

      1. chart review. SHIELD’s future work on flags for clinically significantly different result values. (Desired by clinicians)

      2. algorithms, See FDA AST example (or others Pam’s LOINC presentations) where clinically significant differences.

      3. External exports/exchanges and external lab imports/exchanges. completeness of data vs information loss. See Hung’s SHIELD paper

      4. research.

        1. Data warehouse/data lake Benefits: codifed data can be more easily automated ETL into research Common Data Models such as OMOP, i2b2, FHIR mCode, and PCORI

        2. Clinical research informatics queries/analysis leveraging standards, instead of data element names

        3. EHR research platforms like COSMOS leverage EHR builds/maps

        4. Coding helps reduce biases introduced where test details are lost and values are comingled. Differences due to tests, not disease or treatment effects.

  4. Another panelist Public Health Reporting. PH perspective.

    1. ELR:

      1. Briefly describe reporting requirements by law for Chlamydia (including if any source site differences)

      2. Value of LOINC/LIVD/Standards. Show PH perspective (variety of Chlamydia LOINCs they may receive and how it helps reduce their burden)? Perhaps use one of the CDC LIVD maps to show variety of IVD tests/LOINCs?

      3. Mention how standards help PH with automated receipt/processing, per SC discussion?

    2. eCR

      1. Briefly describe provider reporting requirements by law for Chlamydia

      2. Describe how LOINCs are the trigger codes for reporting to reduce clinical burden

      3. Value of LOINC/Standards for PH processing reducing PH burden.

    3. Other PH reporting to mention? Cancer? Similar benefits. Expand on Jenna’s points of (lack pf ) LOINC functionality for AP?

  5. Moderator: Summary/QA