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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.
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.
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
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)|
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
Christina
Serum - updated the comment to retain the note that we will add serum from donor
ToejointSynovialFluid - do we just want to have the more generic synovial fluid term? septic arthritis - we might have made all the pre-coordinated ones if they are common - the toejoint is related to gout
do we need to know which toe it was collected from (for testing maybe not, but it is always important to match what is in the clinical notes)
we may want to add the common uses for synovial fluid testing for each of the domain
VenousBlood_PulmonaryArteryCatheter_RightSubclavianVein - is one of many pre-coordinated terms, which we added to paovide the most common entry points, as they carry different risk of contamination
VenousBlood_tunnelCentralVounousCatheter - ok as is
VenousBlood_UmbilicalCatheter - ok as is
GanglionCyst_Excision - is the correct PHLIPPreferredName
when they collect the ganglionfluid tht is not usually sent to the lab
used to be called the bible-thumper lesion (cause that would burst the cyst)
FHIR conceptMap Follow Up
Riki
Specimen CMT draft profile on ConceptMap:
Added to the TI Agenda for Thursday Q1 (so Manjula will not be able to attend), but that’s what TI suggested
Call adjourned
11:55 AM ET - NEXT CALL September 25!
European Semantic work
not discussed
Link to the German FHIR IG around suceptibility testing:
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) 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
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.)
Recording:
did not record
Chat:
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