2025-08-21 LabMCoP Meeting Notes

Date

Aug 21, 2025

Attendees

Present	Name	Organization

Present	Name	Organization
	Nancy Cornish	CDC
X	Manjula Gama-Ralalage	CDC
X	Riki Merrick	APHL
	Christina Gallegos	APHL
regrets	Amy Liu	Inductive Health / APHL
X	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		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	Nancy / Riki	Sep 2, 2025 1 - 2 PM EDT on CSTE National ELR call - Riki sent to Nancy Aug 18, 2025 Nancy working on her slides - getting them into clearance
Future Topic	Manjula	Use of AI to map to LOINC or other terminologies Manjula used several AI engines to try to map lab tests to LOINC: some LM algorithms were pretty good at fininding the right LOINC, but you have to be able to write a specific script for the specific LOINC components AND the local test names would have to be specific enough - ideally representing the 6 axis needed Next version of Relma browser will be using AI, but a lot of nuances for each axis needed It would be more helpful to use AI at the patient level for data validation data, where you have all the input required - including the specimen, results - from different organizations to check for proper mappings - training the AI on this data (since we don't have an ideal set), so that you can then use it when needed for public health reporting Epic uses its own internal code system to decide if results are chartable together if we had a national compendium we could create a good data set (long term) COSMOS collects data from their patients, which maybe could be used Also need to understand what the different LOINC mapping use cases are, as incorrect mapping will affect queriy outcome We have proficiency testing data where we could include review for proper mapping (especially that here we do know the instrument etc) - compare against LIVD file, where available - could we use Manjula’s AI script on this data? Example video: SHIELD FDA BAA Year 2 The Comparison of surveillance system data elements against MMG IG: Presentation notes and slides here: PubHealthAI Collaborative Network Shared Google Drive (might need to request access) Recorded presentations and demos here: PubHealthAI Collaborative Network YouTube Channel; the specific one is this one: Using Gemini Gems for HL7 MMGs Demo - July 31, 2025 At HL7 work on PIQI: https://hl7.org/xprod/ig/uv/piqi/2025Sep/index.html - work that led to the creation of PIQI: 2024-12-10 SHIELD Topic #2 Meeting Notes had recoridng of the call and the slides for review
Lab LOINC Committee discussion	Andrea	Discussion about making more LOINCs method-less and then looking at the method in another HL7 field BUT methods are important to understand, if screening or confirmatory test, required for case definitions in public health also no extra table available to map these from (and methods are primary for the labs SOPs and decision to use a specific instrument etc) SAMSA regulation has specific cut-offs for screening vs confrimatory testing May have method-less LOINCs for ordering to allow the lab to use other information (like knowledge of prevalence) that drives the decision of what is performed On the reporting side labs are method focused, but may assign method-less LOINC in order to not make a mistake If a provider orders a wrong test (not on the menu) will reach out to the provider to request them to the order to correct test LOINC grouper terms / generic LOINC order codes may be used for higher level orders (in centralized order entry) and then pick the approppriate test for the location (or the instrumentation used for the testing - in the interfaces to the instrument the detail of CT values and instrumentation used is reported, but it is not going out of the LIS/LIMS) - the LIS has the a table for all the instruments (in Epic called “method”)
Call adjourned		12:03 PM EDT
Lab tests as procedures or orderables	not discussed	Definition from SNOMED for these hierarchies: Observable entity: Information about a quality/property to be observed and how it will be observed Evaluation procedure: No definition, other than it uses attributes that are similar to those used in the Observable entity hierarchy. Our policy is to not add any new evaluation procedures that would logically be in the Observable entity hierarchy. Technique is a separate hierarchy used to model observable entities: A technique (also called method) is a particular way of performing an activity or task. Colonoscopy example: Reference links: clinical guidelines: Official journal of the American College of Gastroenterology \| ACG Quality Indicators: Official journal of the American College of Gastroenterology \| ACG Discussion: Ask Jim Case what the difference is between these 3: Anion Gap function (observable) = https://browser.ihtsdotools.org/?perspective=full&conceptId1=102637000&edition=MAIN/SNOMEDCT-US&release=&languages=en ANSWER: The observable entity hierarchy is recommended for use in both ordering lab tests and reporting results of tests. Note: there are some areas of the observable entity hierarchy which need improvement. This concept is in the “function” area of the hierarchy which has been identified as needing clean up. See the warning in the Observable entity section of the SNOMED CT Editorial Guide (https://confluence.ihtsdotools.org/x/JZFpCg ): “Some areas of the observable entity hierarchy need clarification and remodeling. This includes upper level concepts and hierarchies such as 246464006 \|Function (observable entity) and 415178003 \|Process (observable entity)\| as well as intermediate primitive and leaf node concepts.” There is also a content tracker covering this area which is on hold: https://jira.ihtsdotools.org/browse/IHTSDO-1210. Anion Gap measurement (procedure) = https://browser.ihtsdotools.org/?perspective=full&conceptId1=25469001&edition=MAIN/SNOMEDCT-US&release=&languages=en ANSWER: This hierarchy is not recommended for use in ordering or reporting lab tests. This is part of legacy content that remains in the International release of SNOMED CT because some implementations in certain countries rely on it. See the “Observable entity vs. Evaluation procedure“ section of the SNOMED CT Editorial Guide for more information at https://confluence.ihtsdotools.org/x/05NpCg Anion Gap calculation (qualifier) = https://browser.ihtsdotools.org/?perspective=full&conceptId1=723205003&edition=MAIN/SNOMEDCT-US&release=&languages=en ANSWER: This is a qualifier value concept and would not be used to order or result tests directly. This technique concept was used in the modeling of anion gap observables in the previous (2017) release of the LOINC - SNOMED CT Post-coordinated expressions Refset. In the current release of the LOINC Ontology, a different set of qualifier value concepts is used in modeling anion gap observables. Please see V1 of the LOINC Ontology (viewable in a browser at https://loincsnomed.org/ ) for examples of the modeling, e.g., 539021010000104 \|Substance concentration of anion gap in blood at point in time by calculation (observable entity)\| Is the colonoscopy report a single report or maybe 1 procedure report (the what, with what, how long it was done - would be captured in https://hl7.org/fhir/procedure.html ) and 1 diagnostic report (what was seen - verbal and images - would be captured in https://hl7.org/fhir/diagnosticreport.html )? Both the procedure and the AP request would be represented by https://hl7.org/fhir/servicerequest.html - discussed where to use LOINC, which is ServiceRequest.code - looking at US Core value set: https://build.fhir.org/ig/HL7/US-Core/ValueSet-us-core-procedure-code.html this could use some more guidance on when to use which of the referenced code systems - would like to understand when ICD would be used, and also would need guidance when to use CPT; SNOMED CT procedure codes vs LOINC should also be described For CAP cancer reporting is using SNOMED CT - would be good to look which they chose to represent the performed lab test Looking at the Colonoscopy example document (making changes in there) Got to specimen requirements part of the document
Specimen CMT terms review	not discussed
FHIR conceptMap Follow Up		Specimen CMT draft profile on ConceptMap: Bring this to HL7 Terminology Infrastructure WG? Riki will request agenda time when it works for both of us
European Semantic work	not discussed	Link to the German FHIR IG around suceptibility testing: https://nam12.safelinks.protection.outlook.com/?url=https%3A%2F%2Fsimplifier.net%2Fguide%2Fars-implementation-guide%3Fversion%3Dcurrent&data=05%7C02%7Criki.merrick%40aphl.org%7Ce11e8daf7f2d4827d07808ddcac8861c%7C434e0aedef824568a0493b17adc08ddd%7C1%7C0%7C638889684844672822%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=kZJRoBl2tMQzWQoYVkaRnEUaaBxepA9sAIu1myDQMyo%3D&reserved=0 Semantic Example section: https://nam12.safelinks.protection.outlook.com/?url=https%3A%2F%2Fsimplifier.net%2Fguide%2FARS-Implementation-Guide%2FHome%2FSemantics%3Fversion%3Dcurrent&data=05%7C02%7Criki.merrick%40aphl.org%7Ce11e8daf7f2d4827d07808ddcac8861c%7C434e0aedef824568a0493b17adc08ddd%7C1%7C0%7C638889684844702198%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=qQH%2Ff5xwG0O8DvNE4rbjZineXBhY%2BiOWmN047DRthNQ%3D&reserved=0
Creating Value Sets for specimen related attributes	not discussed	Specimen reject reason table review - review the “unsatisfactory for evaluation due to …” concepts
Previous Action Items	not discussed	Christina Follow up: submit the request to deactivate: 708285007 to SNOMED CT 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) https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/bulletin/2021/12/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 https://infobeta.cap.org/shield/
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.)

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