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Specimen CMT - SCT submission terms
John
can link all specimen to cytopathology procedure via the procedure attribute, but since speicmen can be used for more than just this
how could we look up based on collection method - only using value set constrained searches are possible, rather than relying on SCT modeling constraints
bodyfluid from insertion site - wanted a generic term, where we would then use the SPM-5 to identify the type of inserted thing
have morphologic abnormality for “insertion site”, which has children that all are drains or catheters, but all are non-tunneled - John would not want to have pacemaker in there, because a pacemaker insertion site is surgical, creating a pouch, which can get infected
would that be from surgical wound?
wounds do heal, but this pouch could still get infected after it originally healed
if there is liquid in the pouch could do needle aspirate (wouldn't that be body fluid by fine-needle aspirate?)
or could open the pouch and remove the pacemaker
if the infection is right after the surgical procedure, that should be mapped to surgical wound specimen
is there a formal name for the “pacemaker pouch” - maybe we could model this as this an acquired / artificial body structure
Postcall info from Nancy: It looks like the clinical microbiology laboratory would only see pacemakers when they get infected, and they could get body fluids from the pocket, tissue from the pocket or get the electrode lead which was inserted into the heart muscle. This could occur early or late after surgery, definitions of early versus late seem to vary as the knowledge on pacemakers evolves.
Sohail et al., in their retrospective review of 189 patients with pacemaker related infections, found out that the most common clinical presentations were generator pocket infection (69%) and device-related endocarditis (23%).
See Danish Pacemaker Register study which classifies infections “were not sub-classified as either wound infection or endocarditis, but all infections occurring within 1 year after PM implantation were considered to be Surgical Site Infections (SSIs) in accordance with current guidelines.2 Infections occurring beyond this period were categorized as late infections.
Suggest if it was the pacemaker pocket that was infected then it is an SSI, if it is the electronic lead in the heart muscle then it is endocarditis.
could we differentiate between tunneled and non-tunneled here?
collection is via aspirate or swab after cleaning the surface
tunneled are usually created for long-term care for repeated medicine administration to reduce the risk of infection
SNOMED CT currently does cover the tunnel / non-tunneled in the physical device hierarchy, which would mean they are different products (tunneled catheters have a cuff (small ring around the catheter) that allows skin to grow around it)
Creating Value Sets for specimen related attributes
John
in VSAC we can create a grouping value set, that can group all indiviudal value sets that will fall under anatomic pathology; each indivdual value set can have an intestional definition, so that new concepts in the defined hierarchies will be added with new updates to SCT
PHIN-VADS can also be used for creating value sets
Specimen reject reason table review - review the “unsatisfactory for evaluation due to …” concepts
Call Adjourned
Next call is June 12th, 2025
LOINC common maps
Not discussed
Previous Action Items
Not discussed
Andrea follow up:
Ask Stacy Robinson at ASCLS for clarification about Touch prep, vs squash prep vs smear
Nancy Follow up:
Pulling together the wound specimen presentation for CSTE ELR call on Sep 2, 2025 with Riki and Manjula
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
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:
@riki.merrick
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