2025-03-13 LabMCoP Meeting notes

Nancy Cornish

CDC

 X

Manjula Gama-Ralalage

CDC

X

Riki Merrick

APHL

X

Christina Gallegos

APHL

X

Amy Liu

Inductive Health / APHL

 -

Raj Dash

Duke / CAP

 X

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

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

CSTE Presentation

Riki

• CSTE ELR call presentation on wound cultures and Specimen CMT (modeled for ELR) by Nancy, Riki, and Manjula has been postponed 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

Specimen CMT - review of terms with questions

Christina

• Submaxillary abscess

  • keep comment about aspiration preferred and the synonym inidcation

• corneal impression

  • need to submit specimen and procedure codes to SNOMED - need ot clarify the FSN for the speicmen - could it be different from a corneal smear? neither exist in SCT

• endometrial curretage

  • need to submit request to update procedure (to use instead) and maybe the substance linkage

    Open

    

• Stool_ileostomy - morphologic abnormality is in the body structure hierarchy AND the reason for not bein aquired body structre is that those terms are reserved for “foreign” objects, like metal joints)

• WoundFluid_Ileostomy_Drainage - need to update the definitions for both terms, as they only describe the ileostomy, which chould be part of this

  • update the comment to indicate this is the term for wound near ileostoma

  • also need to update the definiton for stool

  • update the PHLPPrefName to drop _Drainage and not map to drainage

  • maybe use discharge for the stool and not have a procedure associated to it, though it is often collected either by aspirate (preferred) or swab

• Next time revisit remapping SPM-8 for the woundfluid from ileostoma

Access to SNOMED CT based value sets

Riki

Was asked by NIST what the best place is to create SNOMED CT based value sets - in this case for LRI testing for the specimen attributes.

Several of these are in VSAC:

Specimen type: Value Set Authority Center

Procedure: Value Set Authority Center

Problem: Value Set Authority Center

Body site = anatomical structure: Value Set Authority Center

For the topographical value set someone would have to author it as descendent of SNOMED International Browser

SNOMED CT RefSets could also be created, if there is a need to have the at the international level (I think that would be good idea) - did not discuss what next steps would be.

CALL ADJOURNED

12:00 PM ET

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) 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 SHIELD FDA BAA Year 2

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.)