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2025-12-11 LabMCoP Meeting Notes
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2025-12-11 LabMCoP Meeting Notes

Date

Dec 11, 2025

Attendees

Present

Name

Organization

Present

Name

Organization

X

Nancy Cornish

CDC

X

Manjula Dharmawardhana

CDC

X

Riki Merrick

APHL

X

Christina Gallegos

APHL

X

Amy Liu

Inductive Health / APHL

 

Raj Dash

Duke / CAP

X

John Snyder

Pragmatic Terminologies, LLC

 

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

  • Will set up NEW invite for 2026; going forward we will record, but have folks request the recording from Riki/APHL rahter than posting to the minutes pages, since those are open to the public

  • No calls

    • Dec 18, 2025 - APHL team meeting

    • Dec 25, 2025 = Merry Christmas

    • Jan 1, 2026 = Happy New Year

    • Riki is OOO Jan 8, 2026

    • So NEXT call is Jan 15, 2026!

Follow up items

 

  • Nancy Follow up:

    • proposal to create a pre-analytical document for wound specimen collection to CLSI was submitted - in review

    • CLSI document on respiratory sampels = PRE-07 for publication in spring 2026

  • Check with Sheila Abner on NHSN terms for specimen CMT

  • Riki’s Follow up - none of these got done yet

Specimen CMT terms review

Christina

Manjula has access from home, but cannot get via CDC network - will be working on that next

Amy working on connecting the database back up to access and then update based on the smartsheet per the discussions we have been having.

nothing new - all others are completed

CMT in FHIR

 

Update from HL7 Terminology Infrastructure call last week: https://confluence.hl7.org/spaces/VOC/pages/413041001/2025-12-04+Terminology+Infrastructure+WG+Call+Agenda+Minutes

In the FHIR resource CodeSystem you can bind a valuset to additional attributes - will submit a FHIR R6 ballot comment to allow a value set to be bound to an additional attribute w/datatype = coding for ConceptMap also, which will help with setting up the .

Use of concept map should be ok to use for distribution

these ConceptMaps could be managed in THO - using SNOMED CT as target concepts (while many of the concepts in the Specimen CMT are in the GPS, the way they are distributed in the CMT enables folks to determine relationships, so that is why we’ll need to figure out the distribution to deal with IP

We reached out to the SNOMED on FHIR group - waiting for answer

We need to find out if ConceptMap is a supported resource in FHIR terminology servers; if yes, then that shaould be easy to share the content.

Lab tests as procedures or orderables

 

Answer from Jim about procedure hierarchy:

We recognize the issues with multiple hierarchies representing laboratory tests.  We have tried for over a decade to resolve this with our members, but there has been pushback from a few prominent members in that long-standing implementations in their countries have standardized on using SNOMED procedures for ordering and SNOMED Observable entities for results.  A number of proposals over the last few years to resolve the issue have been rejected so the current status is that existing laboratory procedures will be retained by SNOMED, although new ones will not be added and members will need to add them to their extensions as the preferred recommendation by SNOMED is that the Observable entity hierarchy be used for both ordering and resulting.  Part of the solution to the ongoing problem was to add panels and the current set of orderables to the LOINC extension.  SNOMED does not have plans at this time to model laboratory concepts outside of the LOINC extension.  Is the LabMCoP proposing to use SNOMED procedures for orders?  I am hoping that will go away and LOINC (and the LOINC extension) can be used.  The addition of orderable groupers, plus the existing panel codes in LOINC should go a long way to support a single terminology for orders and results.

As for the technique hierarchy, that in no way is intended to be used for either ordering or resulting laboratory tests.  Those concepts are used to model both observables and procedures.  

If there are specific things that you desire to have corrected, please feel free to send CRS requests to get them resolved.  As the goal is to have the US adopt the LOINC extension as part of the US edition of SNOMED, issues related to the extension should be forwarded to LOINC as they are the owners.

SNOMED LOINC extension: SNOMED International Browser

The problem is that major EHR-s vendors have set up CPOE using Procedures for orders to initiate a workflow (that creates the triggering event in the system) - that’s where the push-back comes from.

There is a CPT to SNOMED CT mapping (as a paid mapping available from AMA), but no LOINC mapping.

Can we reach out to CAP Informatics, ADLM Informatics and ASCLS Informatics to get their take on where Lab tests should live

 

We had said we would work through the 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

  • For CAP cancer reporting is using SNOMED CT - would be good to look which they chose to represent the performed lab test

Specimen CMT - Hosting Options

Discussed CMT concept map proposal for HL7 TI WG

  • 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

European Semantic work

 

Link to the German FHIR IG around suceptibility testing:

ARS Implementation Guide (EN)

Semantic Example section: ARS Implementation Guide (EN)

Creating Value Sets for specimen related attributes

 

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

  • the European Vocab group is working on a lot of sepcimen re,ated concepts - should check with them

  • Container follow up work:

Specimen CMT pilot implementers

no updates

Specimen CMT - education

no updates

  • 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

no updates

 

Specimen CMT - Compare to NHSN Medical Terminology

 

 Will get updated vocab at a later date - from Sheila Abner

Future projects for this call after CMT

no updates

  • 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:

not recorded

Chat:

Not copied over.

Action items

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