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2025-04-10 LabMCoP Meeting Notes

2025-04-10 LabMCoP Meeting Notes

Owned by riki.merrick, created
Last updated: Apr 10, 2025
8 min read

Date

Apr 10, 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

Discussion topics

Upcoming OOO

 

CSTE Presentation

Riki - no update

  • 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 final list of containers - they will submit anything they need to SNOMED CT -

LOINC SNOMED Extension Follow up

 

  • Charlie Harp on common uses of generic LOINCs:

  • Use cases to support release of LOINC part code to SNOMED CT concept mappings

    • Waiting for input from Keith Campbell (SOLOR/KOMET)

    • Charlie Harp:

    • Input from Labcorp: The LOINC Scale Type of Ordinal, Nominal, Quantitative and Narrative do guide our selection of SNOMEDs for results. I am not aware of any use cases. 

Specimen CMT - review of terms with questions

Christina/Amy

  • surgical insertion site_Pacemaker - listing PLR4366, but that is a SARSCoV-2 lienage term, not for bodyfluid from surgical insertion site - submit to John

  • This applies to all the insertionSite terms

  • UrinePostProstateMassage = 2531000181101 | Urine specimen obtained after prostatic massage (specimen) found and and maybe also for collectionMethod

  • stool with 10% formalin - would this work for SPM 6? 464601000124100 | Modified polyvinyl alcohol with copper sulfate and ten percent formalin (product)

    • Labcorp does not specify the % of formalin, they have zinc formalin - these are to describe what preservatives were added to breast cancer tissue (required AOEs to know time in formalin for HER-2 testing)

    • per this webpage: CDC - DPDx - Diagnostic Procedures - Stool Specimens it seems this would NOT be the right product - seems there shoudl be 2 10% Formalin and PVS (as well as modifled PVA) _ maybe review this table and see, if all the additives exist?

    • Question for Nancy - Riki to send via email

  • Serum_Thrombin_Gel - need more info about the gel - SCT has 702281005 | Evacuated blood collection tube with thrombin and clot activator and gel separator (physical object) | , but this concept is not fully defined to grab the substance (or product off it) - Christina will email John and ask how best to submit for this

    • Alternatively there is SPM-27 (Container type) and using the physical object hierarchy to create the value set with - would need to find out if folks have support for that (should be in LIS/LIMS for compendium maintenance, but not clear if accessible for ordering / reporting) - is O in LOI / LRI

  • Smear_TissueImpression - model as it currently is in SCT and then for future request new procedure for “touchPrep) and then adjust the modeling for this term in SCT and

SCT hierarchy for methods

ask John

Observation method the thought was to map to techinque hierarchy - background from email here: A decade ago we didn’t have the LOINC/SNOMED collaboration with a SNOMED Extension, so mapping to the procedure hierarchy made perfect sense. Fast forward to where we are today.The most useful way to handle this would be to map to the “Technique” attribute value range. Right now that attribute is restricted to referencing concepts in  << 272394005 |Technique (qualifier value)|, however as we get into the clinical and radiology domain, I can see that range constraint being expanded to include << 129265001 |Evaluation - action (qualifier value)| in order to pick up the imaging method (i.e. MRI, CT, US, etc.) and possibly but unlikely other subhierarchies in the qualifier value hierarchy

Specimen collection (SPM-7) should be from procedure hierarchy, correct?

Creating Value Sets for specimen related attributes

John - no update

  • US valuesets should be in VSAC for all clinical care

  • Value sets that are used in HL7 should be in International RefSets (and are probalby easier to migrate, if they aplready exist in VSAC (but would need to make sure we promote US extension terms first)

  • Specimen reject reason table review - specimen calls on Mondays 2 PM - started a zulip chat to ask for input: <ADD LINK>

  • Containers (EU review work might have some new content - Reached out to Feijke for update)

  • Additives

  • Riki to set up her VSAC authoring log in

Previous Action Items

 Not discussed

Specimen CMT - Hosting Options

 

  • 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

  • SNOMED CT Extension and use of RefSets (start with VSAC value sets as proof of concept and then migrate over) to indicate:

    • preferred specimen types by domain

    • maybe also terms that need additional attributes (by kind of attribute) if we also write an implementation guide for it

  • 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 pilot implementers

 

Specimen CMT - education

 

  • Need education for providers and IT folks that helps with set up of the EHR-S / LIS configuration -this can be supported / accomplished? with the Implementaiton Guide we could write

  • 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

 

 

Specimen CMT - Compare to NHS Medical Terminology testing

 

 Will get updated vocab at a later date

Future projects for this call after CMT

 

  • 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

Action items

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