2025-05-29 LabMCoP Meeting Notes

X

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)

Andrea Pitkus

UW

X

Kathy Walsh

Labcorp

Rob Hausam

Hausam Consulting

Pam Banning

 3M

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 September 2, 2025

Specimen CMT - terms

Christina/Amy

• Submissions to SNOMED CT:

  • Lymph specimen

    • add synonym for existing term: lymph fluid specimen

    • adding defintion link: Lymph

  • Touch prep - synonym for procedure code https://browser.ihtsdotools.org/?perspective=full&conceptId1=430854000&edition=MAIN/SNOMEDCT-US&release=&languages=en ?

    • differentiate from blood smear (tissue smear, squash prep)

    • cytologic material is collected and then processed in the smear

    • An update on touch preparations of small biopsies - table 2 differentiates between smear, biopsies, and touch prep, so should keep separate

    • https://www.sciencedirect.com/science/article/abs/pii/S221329452030065X - provides different use cases for touch prep

    • https://wrair.health.mil/Portals/87/Documents/Leish_Biopsy_Procedures.pdf?ver=tYt9Q1e53Zf6E6UIW2ZLJQ%3D%3D - micro related, but usually done in path lab - refered to as Tissue Impression Smears as a Supplementary Diagnostic Method for Histopathology in Cutaneous Leishmaniasis in Sri Lanka

    • Sample Collection and Preparation

    • Ask Stacy Robinson at ASCLS for clarification - Andrea to send email

    • same sample collected, then 2 preps done - one smmear, one touch prep, so definetly not the same

  • bodyfluid specimen from insertion site

    • need references:

      • https://journals.sagepub.com/doi/pdf/10.3747/pdi.2016.00120

      • https://journals.sagepub.com/doi/pdf/10.3747/pdi.2016.00120

    • need to indicate the insertion site as to what is being inserted, which we are currenlty including in the CMT under SPM-5

      • also would need one for CSF shunt

      • might also need the various catheters for central lines

      • morphological abnormality concepts - John will try to moel

Creating Value Sets for specimen related attributes

John - next time

• Specimen reject reason table review - review the “unsatisfactory for evaluation due to …” concepts

LOINC common maps

 next time

Call Adjourned

12:02 AM ET

Next call is June 5th, 2025

Previous Action Items

 Not discussed

• Nancy Follow up:

  • Additives (Nancy reviewing the stool preservatives)

  • 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

  • Clinical Archtecture unmapped LOINCs:

    • Charlie shared the LOINC mappings and the unmapped strings (did Riki share via email?)

    • Riki 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

  • Riki to set up her VSAC authoring log in

  • 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 - 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

• 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

 Not discussed

• Review where we are: Vendor Connections

  • no update

Specimen CMT - education

 Not discussed

• 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.)