Indiana University/Indiana University Health/Association for Molecular Pathology
Steering Committee member
Eza Hafeza
Regenstrief
Steering Committee member
Jim Case
Snomed International
Steering Committee member
Mary Kennedy
CAP
Discussion topics
Item
Notes
Identify tangible activities for this working group
What role does standards play and what gaps are we looking to close? What are the known limitations and/or areas that standards cannot address currently?
Span of tests: for chemistry, microbiology, etc. order and result (LOINC), AOE question (LOINC), specimen type, specimen source and/or body site (SCT), specimen collection method (SCT).
How the test was performed, describe the result → interoperability gaps exist today even with standards in place today
Limitation: no agreement on coding HL7 value sets & specimens with the standards
How to address issue of free text vs discrete data capture vs discrete coded data capture?
In SCT, the specimen hierarchy is suboptimal. HL7 specimen domain analysis model has been mapped to SCT with some improvements suggested.
For cancer, the specimen hierarchy does not follow editorial guidelines and has not been well-maintained. Proximal primitive parenting has not been widely applied.
Example: for “how is tissue removed?” Is biopsy considered an excision? (in a machine classifiable model this is not computable).
Missing content.
Do we need to establish concrete use cases of these challenges?
Share challenges and gaps with SCT to propose a quality improvement effort.
Define interoperability challenges and create prototypes / pilots that works in the real world and demonstrate value of going to the effort?
Lab systems don't have to store the exchange standards, but their local values stored need to be structured so they can be mapped to the national terminology standards. Many laboratory systems store their local data in a free-form text fields for specimen source and specimen type.
EHRs today don’t make best use of standards today (e.g. using UCUM to normalize units).
There is no place in information models that standardizes how laboratory device information is stored and transmitted.
Is there a standard for laboratory device nomenclature?
LOINC describes methods but not specific devices
LIVD assigns LOINC codes for in vitro devices (industry defined format to facilitate publication and exchange of LOINC codes for IVD test results)
How to include UDIs (CLSI AUTO-16 / LAW discussion today)?
How do we prevent effort in building HL7 laboratory interfaces and minimize miscommunications?
There are multiple ways to represent information; establishing equivalence or normalizing data from multiple sources is not trivial.
LOINC methodology is optional (can choose a valid method-less LOINC code but this does not support interoperability unless the method is provided elsewhere [e.g., post-coordinated expression])
We may not need new standards but we need agreement on how to use existing standards so similar data is transmitted similarly.
We are missing guidelines for standard implementation of standards!
HL7 implementation guides not followed
How do we help implementors of standards
Agree that we need to identify what standards should be used and how. We need to eliminate the need for so many mappings/translations to exchange data.
IHE (IHE.net) attempts to provide guidance (through use cases) on how to solve interoperability challenges through proper use of existing standards.
We need laboratories at the table to discuss what the issues are on their side with using the standards.
These issues could be documented as use cases.
Prioritize data elements we need, publishing how standards need to work together, versus focus on incentivizing adoption of standards. We need to articulate the short- and long-term value proposition so that it’s clear what the benefits are to all stakeholders.
This can serve as a mechanism for prioritizing this project team’s effort.
Change management and maintenance is a burden on labs too Need $$ for labs to help them.
Technical standards and capabilities are not perfect but likely sufficient. There are gaps in transmission implementations (where to get and put the UDI vs device type vs both) and vocabulary standard gaps but is that the best place to start (versus describing the problem and value proposition for doing it the right way).
What are the options we have to make the situation better?
Maybe list top 10 standards issues and rank them to start working on them?