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Contact for Cancer Reporting - Riki to share Samantha Spencer’s contact and NAACCR contact also (Check with nancy that she has them)
Specimen CMT terms review
Christina
related to container additives:
in other discussions we have said to reserve the additives for substances being added by the lab instead of the situation where the container includes the additives that are in already in the container
container modeling might change at the SCT business meeting based on the European request
so for pre-coordinated containers use SPM-27 (ContainerType) which is a CWE, where we will want to use the SCT container hierarchy terms
Rule: Look in SPM-27 first; look at SPM-6 for additives that were added by the lab
what is the issue with having the additives in both the SPM-6 and the SPM-27, when they are pre-existing
what to do, when the additive is added after collection, but before the lab gets it?
if there is a need to check the duration of sample in additive, shudl be seprate OBX?
may be handling same as if the lab adds it, before the collection happens?
what if the lab adds it after receiving the original specimen?
this would be specimen processing, creating a derived specimen
this is described in IHE APSR and the DPIA profile - this needs to get translated and included in the Cancer Pathology FHIR IG
gel separator: Christina copied Nancy’s email text to the smartsheet and will submit term
pacemaker insertion site - use the new term in SPM-4
for the other insertion sites, use body-fluid from insertion site
UrinePostProstateMassage as procedure (to fully define 2531000181101) - needs to be re-submitted
tissue smear vs tissue impression see notes from Jul 10, 2025 = 2025-07-10 LabMCoP Meeting NotesPreview - @riki.merrick to review the snomed CT submissions John assigned and make sure the procedure and these other term submissions exist
touch prep code = is under cytologic test, which we should really be moved to the specimen collection procedure hierarchy
This relates to the next topic - need to talk to SNOMED editors about this one
Call Adjourned
11:56 AM 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.
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
Previous Action Items
Not discussed, but Riki really needs to do these!
Nancy Follow up:
proposal to create a pre-analytical document for wound specimen collection to CLSI
Their pre-analytical document (PRE-07) for respiratory specimen collection is in review (should come out in spring 2026) - maybe we can add the SCT coding to include; For LOINC mapping maybe we could include a link to the SARS-CoV2 LIVD file on CDC’s website as an example of LOINC coding that will be needed = https://www.cdc.gov/laboratory-systems/php/livd-test-codemapping/index.html - Nancy will ask.
Working with Clinical Architecture to model in Symedical, so can then be shared at least via their subscription, but maybe also arrange sharing via API?
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
European Semantic work
Not discussed
Link to the German FHIR IG around suceptibility testing:
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:
did not record
Chat:
Action items
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