2024-01-08 Vocabulary WG Meeting Notes

Participants for today’s call:

Membership:

Name	Organization	Role
Scott Campbell	UNMC	Co-Chair Steering Committee member
Raj Dash	College of American Pathologists (CAP)	Co-Chair Steering Committee member
Dan Rutz	Epic	Steering Committee member
Muktha Natrajan	CDC
Sandy Jones (Secondary)	CDC Cancer Surveillance
Anne Peruski (Secondary)	CDC
Andrea Pitkus	University of Wisconsin-Madison	Steering Committee member
Xavier Gansel	bioMérieux	Steering Committee member
Stan Huff	Graphite Health	Steering Committee member
John Snyder	NLM	Steering Committee member
Rob Hausam	Hausam Consulting
Marjorie Rollins	Regenstrief	Steering Committee member
Amy McCormick (secondary)	Epic
Nanguneri Nirmala	Tufts Medical Center	Steering Committee member
Mehdi Nassiri	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

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Discussion topics

Item	Notes

Item

Notes

Review: Identify tangible activities for this working group

Identify use cases / challenges in lab interoperability.

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

Use case review

D-dimer re-reviewed by Dr. Dash
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.

Next steps

AST (AST - Overview: Aspartate Aminotransferase (AST) (GOT), Serum (mayocliniclabs.com))
Urine culture and susceptibility testing (DUHS Electronic Test Catalog (duke.edu))

Cloud recording:

https://duke.zoom.us/rec/share/FPNCy_3fwSFbTryQ4XBBKAgVHyKyt75SHasf0D5i6etoVjRdsz-4XHNCKomXrvcG.v77YpaTOkPRbyYRG

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 PM
https://www.beckmancoulter.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 Pam

Scott Campbell to Everyone 1:54 PM
Actually, Raj and I can actually work on vehicles

Andrea Pitkus 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?

Pam Banning - 3M Health Info Systems to Everyone 2:02 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 discussion