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Ask Jen from Arup, who submitted the blood tube types, how she is using these (if only in compendium, or expecting to come in as part of order): ANSWER: It can be helpful to have the container, for example when it is protecting the sample from light, it contains additives (urine), uses a specific collection kit (aptima), or is phlebotomy. This (the submission of container types) was in preparation for using them within our compendium. I would like to get to a point where we communicate to our clients what we would expect in the SPM segment, but we aren't there yet and many of our clients are still sending 2.3.1.
often times the lab will create collection kits, where they add the additives to containers and provide those to customers, or it is part of the described collection procedure, especially for lab developed tests
for blood tubes, they are usually commercial products
SPM-27 for container type we don't currently have in the CMT, but it is O in LOI and LRI
SPM-6 is RE in ELR, but O in LOI and LRI - currently have deconstructed commercial containers into additives in the CMT - will have to revist, if we add container type
sometime the additives are added at later point in time
NHSN term - Riki to ask Nancy if we have the latest yet
Creating 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 RefSets (and are probably easier to migrate, if they already exist in VSAC (but would need to make sure we promote US extension terms first)
Specimen reject reason table review - OO decided that when the reject reason is a specimen condition, we should use the SAME concepts, so review with that in mind
review the “unsatisfactory for evaluation due to …” concepts
Containers (EU review work might have some new content - Reached out to Feijke for update - here is the latest file
Additives (Nancy reviewing the stool preservatives)
LOINC common maps
Charlie shared the LOINC mapings and the unmapped strings (will email to this group)
but some are using the panel code for these, which they shoudl not, as it intermingles discrete with non-structured results
Doc ontology review is part of the LOINC ontology work, the doctypes are currently under the clinical class, maybe we could map them to the correct domain?
Should check up with Charlie to see, if he knows where the LOINCs using the shorname in the description come from - as that is discouraged
Call Adjourned
11:56 AM ET
Next call is May 29th
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
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
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 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
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