2025-02-13 Meeting notes

Date

Feb 13, 2025

Attendees

Present	Name	Organization

Present	Name	Organization
	Nancy Cornish	CDC
	Manjula Gama-Ralalage	CDC
X	Riki Merrick	APHL
X	Christina Gallegos	APHL
X	Amy Liu	Inductive Health / APHL
-	Raj Dash	Duke / CAP
	John Snyder	National Library of Medicine (SNOMED CT)
X	Andrea Pitkus	UW
X	Kathy Walsh	Labcorp
-	Rob Hausam	Hausam Consulting
	Pam Banning	3M
	Sandy Jones	CDC
	Carmen Pugh	CDC

Discussion topics

Upcoming OOO		Reminder: We are now using https://aphlinformatics.atlassian.net/wiki/spaces/LMCOPL/calendars and everyone can just keep it updated NOTE: you will need to use type “Event” if you do not have a confluence account What about the calls on 2/20 and 2/27 - Riki will cancel both calls
CSTE Presentation	Riki	CSTE ELR call presentation on wound cultures and Specimen CMT (modeled for ELR) by Nancy, Riki, and Manjula has been postponed (not March) to a TBD date later
European Lab related Vocab	Riki	European Lab Terminology group working on finalizing their list of containers and asking for review - they are still reviewing and I forwarded our comments they are looking to get more feedback from larger groups, so we could provide more feedback Filtered on those without LabMCoP comment and “not Yes” and reviewed stool, culture swabs - file at end of review with filters on: Riki will send to Feijke for merging into their files
CALL ADJOURNED		11:32 AM ET
Specimen CMT - review of terms with questions	Not discussed	nothing new - Amy transcribing some prior decisions into data base currently
Previous Action Items	Not discussed	Nancy Follow up: EDTA Stopper top EDTA sufficient or do we need to specify K2 or K3? - yes! Nancy can review the list in SNOMED from John Need to check on completeness against the Anne/Nancy list (compare with ARUP) Nancy/Anne’s list is 10 years old - may not want to compare with this outdated list and use ARUP and Labcorp lists Raj: I found this at a phlebotomy certification course website: What Color Tubes Are Used for Which Tests in Phlebotomy – PhlebotomyU Here's a nice one-pager (University of Colorado Health): https://www.testmenu.com/universityhospital/TestDirectory/SiteFile?fileName=sidebar\CLNLAB-2020-03-13-Blood-Tube-Color-Chart.pdf Cleveland Clinic: Blood Collection Tubes - Collection \| Cleveland Clinic Laboratories https://phlebotomygeeks.yolasite.com/resources/PRINT OUT COMMON TUBES.pdf but color is manufacturer dependent, which is why we named the tubes by the additives there are container types in SNOMED under 706049005 \|Blood tube (physical object)\| Have a start here: https://aphlinformatics.atlassian.net/wiki/download/attachments/2018312270/ContainertypesListRikiEmailed20171013.xlsx?api=v2 K1 or K2 might be important to differentiate We should leave the top color out of it, since that is manufacturer specific Nancy will see, if their fellow has time to review and complete the list for us (she is a phlebotomist ) Contact United Network for Organ Sharing for input on donor terms (pre-coordinated or not?) = ISBT 128 \| ICCBBA \| Technical Documents https://www.isbt128.org/_files/ugd/1a7593_edfd176861c94dca94c34eff8fa3ad0d.pdf - for organs Might be a topic for SNOMED International We may need to reach out to laboratories/industry to see if the donor codes are needed (we need to show that these codes are needed.) Riki has some contact now with European bloodbank and biobanks = Home - BBMRI-ERIC working with the folks that define their minimum data set: MIABIS - BBMRI-ERIC - these folks shared the follwoing for the reject reason topic, but it seems they differentiate between source site and the organ: #1 Standard PREanalytical Code Version 4.0 - (version 3.0 is here: https://cdn.ymaws.com/www.isber.org/resource/resmgr/isber_2019/pdf/standard_preanalytical_code_.pdf) Riki’s Follow up - none of these got done yet Connect with CAP Informatics Committee (Riki can email Kevin Schap) and ASCP (does anyne have a connection?) liquid-based cytology specimen vial = https://us-request.ihtsdotools.org/#/requests/preview/354843?fromList=truehttps://request.ihtsdotools.org/#/requests/edit/786429 submit a code for formalin10 work with John new term for pacemaker insertion site sample in SCT there are only swabs for insertion sites (line, drain, chest tube, vascular catheter) - this should be fixed we should model it after 435971000124108 \| Body fluid specimen from peritoneal dialysis insertion site (specimen) and require method, which should be aspirate For wound modeling (see 2023-11-30 LabMCoP Meeting Notes ) create a few pre-coordinated specimen terms to cover the wound causes as children under: 119365002 \| Specimen from wound (specimen) another child term for aspirate under 445611000124106 \| Specimen from bite wound (specimen), since that is preferred over the existing swab
Specimen CMT pilot implementers	Not discussed	Review where we are: Vendor Connections no update
Specimen CMT - Hosting Options	Not discussed	How can we publish the content in the dB? Allow access somehow to query the dB as access or excel or csv Using FHIR conceptMap similar to Conceptmap-example-specimen-type - FHIR v6.0.0-cibuild - based on this profile: ConceptMap - FHIR v6.0.0-cibuild How do we decide what format to share this in - get input from EHR-s and LIS vendors. Write letter of mulitple stakeholders to request EHR-s and LIS vendors to implement indicating that this is a patient safety issue, as incorrect Abx treatment will contribute to multi-drug resistance (use CTSI findings to provide background) focus on blood, urine, wound cultures (get data from NHSN, too) Nancy is talking to DHQP about the linkage with specimen collection While we have HIT certification that is for the EHR-s there is currently no enforcement for implementation at the organizations need C-suite buy-in Professional organizations - like CAP and ACOS and AJCC get them to write the synoptic reports (better structuring of data) - for surgical aspects - similar to what CAP has done for Cancer (though they do not have the SCT codes included in the past - may be including SNOMED CT starting in 2025, but they are also using the SCT codes for observables) https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/bulletin/2021/12/synoptic-reporting-for-cancer-surgery-current-requirements-and-future-state/: The four CoC accreditation standards that include synoptic operative reporting requirements apply to sentinel lymph node biopsy for breast cancer (Standard 5.3), axillary lymph node dissection for breast cancer (Standard 5.4), wide local excision for primary cutaneous melanoma (Standard 5.5), and colonic resection for colon cancer (Standard 5.6). These accreditation standards were developed from the evidence-based recommendations for cancer surgery detailed in the Operative Standards for Cancer Surgery manuals.7,8 try to get AMA support to get providers to adopt this Reach out to IDSA, too
Specimen CMT - education	Not discussed	Need education for providers and IT folks that helps with set up of the EHR-S / LIS configuration if we have a use case of how a patient is impacted on their journey through the healthcare system - CAP created a nice video that showed how patient care was affected by incorrect data https://infobeta.cap.org/shield/
Specimen CMT - tracking implementation impact Setting baseline Define metrics	Not discussed
Specimen CMT - Compare to NHS Medical Terminology testing	Not discussed	Will get updated vocab at a later date
Future projects for this call after CMT	Not discussed	In general the call is intended as a forum for ANY messaging related issues to work out. In the past we have reviewed containers re-vive that - and how does that interact with devices (UDI identification?) review code systems around additives (HL70371 and SCT substance and product hierarchies) started work on cross-mapping between HL7 method codes and SNOMED CT procedure / technique concepts American College of Surgeons is working on procedure protocol and synoptic data elements / surgical synoptic reports - we could work with them together on that Look at other HL7 tables that we would want to migrate SCT (i.e., Specimen Condition table, etc.)

Recording:

Per APHL policy we are not currently allowed to record any meetings

From Chat:

Andrea Pitkus 11:05 AM
I can only stay until half hour.
also the LOINC release with LOINC-SCT Ontology is due this month
Kathy Walsh - Labcorp to Everyone 11:21 AM
1. One or more clean LabCorp-approved stool collection kits (order LabCorp N° 03192) containing a 1-gallon can, absorbent sheet, Armlock O-ring, and a leakproof plastic bag
2. Collect stool directly into can. Do not fill any can more than 2/3 full. Secure lid with pressure and firmly attach the O-ring. State collection time on the can label. Place the can and the absorbent sheet into the leakproof plastic bag and seal. Send the entire can, or if submitting aliquot, follow this procedure:
3. Weigh specimen and collection container and subtract the weight of an empty container of same type (one-gallon can weight with lid: 360 g metal or 320 g plastic container). This is the “net weight” to be recorded on the test request form.
4. Open the container and observe whether the contents are liquid. If liquid stool, secure the lid, mix, and submit an aliquot of the total collection. If solid stool, add deionized water (approximately 500 mL) to the specimen container and mix thoroughly to create a homogenous specimen. Submit a 5 to 25 mL aliquot of the total collection in an empty stool transport vial (LabCorp N° 59517) or screw-cap urine bottle (LabCorp N° 20648), sterile no additives.
5. Record on both the container and the test request form the amount of water added to liquefy the stool or if no water was required.

Action items

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Laboratory Messaging Community of Practice (LabMCoP)