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Notes

 

Review: Identify tangible activities for this working group

Identify use cases / challenges in lab interoperability.

  1. D-dimer (DIMER - Overview: D-Dimer, Plasma (mayocliniclabs.com))

 

Use case review

  1. D-dimer re-reviewed by Dr. Dash

  2. Andrea Pitkus described how LIDR is envisioned to be used. Taking POC use cases as a next step. What constitutes uniqueness (unique ID for LIDR - might have multiple rows with same LOINC code but different LIDR IDs). Different specimens, reference ranges, methodologies may result in different LIDR ID. No resource in government or healthcare organizations to go through package inserts and determine equivalency. National level - registry needed for coordination. Some discussion of private vs public dissemination of data from IVD manufacturers.

  3. https://www.mayocliniclabs.com/test-catalog/overview/602174
    Mayo has a few different d-dimer orders, so would be good to connect which one is in each report
    https://www.mayocliniclabs.com/test-catalog/overview/40936
    https://ltd.aruplab.com/Tests/Pub/0030057

  4. Standards required for harmonization:

    1. Source of information (Duke, Mayo, ARUP, UNMC, etc)

    2. LOINC code

    3. Reference range (what “type” being specified in the result?)

      1. the standard distribution for “normal” population

      2. expected value for the specific patient, given demographics, history, disease conditions

    4. Methodology

    5. Instrument w/ test kit specific to the test (as specified by manufacturer)

    6. Some type of harmonization status (LIDR “ID” as described above)

    7. Preferred display name (as specified in LOINC code?) - TruLab’s focus

  5. Will adapt above list into a spreadsheet for comparison of results

Next steps

  1. Pull package inserts from D-dimers

  2. Sample report, HL7 interface message, Instrument name, model, “ID” would be ideal to compare

  3. AST (AST - Overview: Aspartate Aminotransferase (AST) (GOT), Serum (mayocliniclabs.com))

  4. Urine culture and susceptibility testing (DUHS Electronic Test Catalog (duke.edu))

Cloud recording:

https://duke.zoom.us/rec/share/FPNCy_3fwSFbTryQ4XBBKAgVHyKyt75SHasf0D5i6etoVjRdsz-4XHNCKomXrvcG.v77YpaTOkPRbyYRGAbhNNb-EQfdji3r09Kl_74oDv7dxW9Dw6A22TR5OZ948j8rbtaCk59cnU941WkgJ.pShneM6sotQqR-08

From Chat:

Andrea Pitkus to Everyone 1:31 PM
thanks Pam, for forwarding info
https://testcatalog.duke.edu/#/test-detail/LAB131/1230100036 You to Everyone 1:35 36 PM
Is this in addition to the culture susceptibilities that Xavier and BMX originally requested?

Jim Case to Everyone 1:36 PM
I have to leave at the top of the hour for another call.

Andrea Pitkus to Everyone 1:38 PM
https://www.beckmancoultertestmenu.com/wsrportal/techdocs?docname=/cis/A18460/%%/EN_AST.pdf

Andrea Pitkus to Everyone 1:41 PM
so d-dimer specimen tested is platelet poor plasma, right?
you should have documentation of instrument change if that occurred as well as communication to providers of the changes
PPP is used on most coag analyzers uncless point of care testing

Andrea Pitkus to Everyone 1:48 PM
Do you all have the IVD devices and model info for these assays?
Does your coag technical specialist/supervisor?
know? agree w Pamnebraska/Tests/277430
same here
Stan, here's UNL's D-Dimer. They have two different ways of reporting warranting 2 different LOINCs, but only have one in their online catalog

Scott Campbell to Everyone 1:40 PM
I claim ingnorance
LOL

Scott Campbell to Everyone 1:54 47 PM
Actually, Raj and I can actually work on vehiclesAndrea Pitkus I think the old coca-cola jingle works for “harmony"

Pam Banning - 3M Health Info Systems to Everyone 1:57 PM
Have you done literature reviews between the different methods, different units here like reported by CAP in literature for d-dimer, etc.?
one way is to convert all values from different units to one set of units. (Not that I'm advocating for it)

You to Everyone 2:00 PM
^ that will not guarantee interoperability
but is necessary
necessary but not sufficient

Andrea Pitkus to Everyone 2:01 PM
right, because there may be other factors
Do you have the IVD info from the IVD vendor such as the package inserts for these per the original homework?

50 PM
I think i missed a November assignment from this call to get more hospitals examples of D-Dimer and possible historical display of method changes. will work on that.

Pam Banning - 3M Health Info Systems to Everyone 21:02 PM
I didn't go that far Andrea in gathering from the reference labs.

Andrea Pitkus to Everyone 2:02 PM
The other need I hear is how do we indicate apples to apples and apples to organges

Scott Campbell to Everyone 2:02 PM
That's a good call, Andrea. We should get our package inserts for the tests in our homework

Andrea Pitkus to Everyone 2:03 PM
Let's do that, Scott. Pam, I started looking up the one's from Mayo as they overlap with the Roche LIVD maps you provided

Jim Case to Everyone 2:03 PM
I am not sure you can make a pure equivalence between test results from year to year. Things change all the time

Scott Campbell to Everyone 2:04 PM
@Jim Case True, but could/should there be something that indicates a change in process over time?

Amy McCormick to Everyone 2:05 PM
Unit conversions concern me. Especially when there are reference ranges in the component-related comments (because that won't be converted).

Andrea Pitkus to Everyone 2:06 PM
or a clinical decision support tool per the use case
challenge, tied, stimulant results versus not
timed

Scott Campbell to Everyone 2:09 PM
brb

Andrea Pitkus to Everyone 2:14 PM
the research community is trying to use generic methodless codes as a grouper as they think it provides a parent-child relationship like SCT.

You to Everyone 2:15 PM
Does anyone know if we can attach word documents onto the web site?

Andrea Pitkus to Everyone 2:15 PM
It's desired
faint

Scott Campbell to Everyone 2:16 PM
ECL = expression constraint language...a way of really digging into SNOMED...graphy

Andrea Pitkus to Everyone 2:19 PM
Thanks for sharing ECL Scott. Seems like similar issue with the lab test knowledge you mentioned earlier. If curated groups, it would help the end user.
One other aspect I mentioned this am, is how we name things (will be discussing in future). D-dimer by FEU vs D-dimer DDU for example so we know the distinctions that would be grouped/flagged, etc.
Jim, good point. a number of order LOINCs are methodless for that order user case
I'd recommend starting with similar tests (avoid reflex and complexities but work that way ) once we get the foundation/building blocks established
focus on units used in US
exclude intl used units
start with IFCC harmonized results/methods

Andrea Pitkus to Everyone 2:25 PM
I wouldn't expect labs to use ECL
many don't have resources or expertise
especially critical access hospitals

Jim Case to Everyone 2:30 PM
gotta run...

Andrea Pitkus to Everyone 2:31 PM
great discussion52 PM
There are d-dimer examples from reference labs under the "ellipsis" of attachments. We just started with Duke and Nebraska natively on that past call

Pam Banning - 3M Health Info Systems to Everyone 1:56 PM
https://aphlinformatics.atlassian.net/wiki/pages/viewpageattachments.action?pageId=2128838819

Scott Campbell to Everyone 1:56 PM
No, I completely unplugged for the holidays

Andrea Pitkus to Everyone 1:58 PM
https://www.mayocliniclabs.com/test-catalog/overview/602174
Mayo has a few different d-dimer orders, so would be good to connect which one is in each report
https://www.mayocliniclabs.com/test-catalog/overview/40936
https://ltd.aruplab.com/Tests/Pub/0030057