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Seems like there are some issues, as this is still a work in progress
need to make a clear intention between order items (procedure?) vs performed test (orderable) - need to find out how they implemented the order/obs flag
Clinical LOINC Committee will be working on document hierarchy (make sure they finish lab concepts)
Overall this is a good step for supporting grouping of LOINCs
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 - no update
Specimen CMT - review of terms with questions
Christina/Amy
nothing for today to review
Discussing option to use a SNOMED extension
How would we indicate the additional attributes that define the specimen?
We may not want these classfied as “AOEs”, as they would then not be reported in the specimen specific spots
Like currently happens with specimen collection date/time
there are other AOEs outside of specimen specific attributes like last menstrual period
Have LOINCs for some, but not for all of them
some of the AOEs are reported back with the result, when the lab used them in the interpretation of the result (as a statement of what was used)
Review existing data sets for commonly uses of generic LOINCs that could give us insights into how folks use these (and find ones we should make LOINCs for)
Ask Charlie to look at their data set
Raj could look at Cosmos (Epic de-identified dataset, but might include non-US metric units - might require LOINC mapping updates based on the unit of measure received for each result) - hard to get access to this
We often have folks map to the “wrong LOINC”, because they need to meet specific reporting requirements (quality measures or reporting to PHs) - would be good to capture reason for mapping to help adjudicate these
LOINC part code to SNOMED CT concept mappings - are folks wanting these released?
Geisinger uses these for the query quality improvement
some folks may be using the LOINC part code for component searches
the new release might make this harder, as several have been renamed to “observation” - where the prior component moved to a different attribute - and currently this was not applied consistently
the longname and shortname didn’t change
Ask Keith about SOLOR/KOMET
Also ask Charlie Harp
Value Sets for specimen related attributes
John
US valuesets should be in VSAC for all clinical care
Value sets that are used in HL7 should be in International ref sets
Also need to get back to the specimen reject reason table review - specimen calls on Mondays 2 PM
we also have containers (EU review work might have some new content - reach out to Feijke for update) and additives started
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
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
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.)
Recording:
Per APHL policy we are not currently allowed to record any meetings
From Chat
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