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2025-07-24 LabMCoP Meeting Notes

2025-07-24 LabMCoP Meeting Notes

Date

Jul 24, 2025

Attendees

Present

Name

Organization

Present

Name

Organization

X

Nancy Cornish

CDC

X

Manjula Gama-Ralalage

CDC

X

Riki Merrick

APHL

X

Christina Gallegos

APHL

X

Amy Liu

Inductive Health / APHL

regrets

Raj Dash

Duke / CAP

regrets

John Snyder

 

X

Andrea Pitkus

UW

X

Kathy Walsh

Labcorp

 

Rob Hausam

Hausam Consulting

 

Pam Banning

 3M

Discussion topics

Upcoming OOO

 

Presentation on CDC Forum on Lab Interoperability

 

Goal of the presentation was to highlight all dates/times that are needed for laboratory data and also identify how current USCDI representation might hinder proper implementation by developers.

Some of the data elements might also need HL7 adjustment (V2 has different definition from FHIR) and clarification on how specific types of data should be modeled.

Had sidebar email from Jim Case requesting documentation around what orders are:

argument that laboratory test orders are not orders for procedures, but are requests for observations to be made on a specimen using a particular method.  This has fallen on deaf ears for a number of reasons, not the least of which is that there are hundreds of implementations out there that use SNOMED evaluation procedures for ordering and Observable entities or LOINC Codes for resulting.  This is due to a number of reasons, but one of which was that there were no generic LOINC order codes that clinicians could use. That will be fixed in the next release of LOINC and the SNOMED LOINC extension.  For whatever reason, we have been unable to get people to move to the single approach for orders and observations.  It would be very nice if we had some rationale from another organization such as HL7 to validate our position as we are constantly getting pushback to add new lab "procedures".

USCDI did a good thing when they split up the different types of tests, need to do something similar for orders

See: Medical procedure

Colonoscopy is an investigation, which results in a report, that is different from a lab test, which may be spawned AFTER specimen collection during the colonoscopy. Include reviewing the guideline documentation

Epic decided anything that involves a surgical procedure to model it as procedure, even for the order? looking at Home - Epic on FHIR

An order is the first step - then we can link to the thing that is expected to be ordered, which can then be the respective thing: surgical procedure,

Order for the procedure → procedure results in specimen collection, which spawns a new order for performing a test on the specimen → outcome is a result

Next Steps:

  • Come up with examples what procedures are and what observables are -> bring this to HL7 (look at the EHR-Functional Model IGs) and SHIELD Standards and Vocab WG.

    • clear procedure example and describe the outcome

    • clear observable (Vital sign) example and describe the outcome

    • Colonoscopy and AP testing example and describe the outcome

  • Get crisp definitions for the terms we apply - reach out to SNOMED to get their defintions for the hierarchies: procedure / observable

Specimen CMT

not discussed

not discussed

Creating Value Sets for specimen related attributes

not discussed

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

LOINC common maps

 

Next LOINC release in August will include generic (method-less) order codes for EHR builds as trial use codes - Stan gave presentation - ADD LINK TO THE Meeting minutes once posted

It would be nice to know what all the test are that are available in US labs - is that possible?

Previous Action Items

 not discussed

Specimen CMT - Hosting Options

 

  • How can we publish the content in the dB?

  • 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 SHIELD FDA BAA Year 2

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:

Did not record

Chat:

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Action items

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