2026-02-26 LabMCoP Meeting Notes

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Nancy Cornish

CDC

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Manjula Dharmawardhana

CDC

X

Riki Merrick

APHL

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Christina Gallegos

APHL

X

Amy Liu

Inductive Health / APHL

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Raj Dash

Duke / CAP

X

John Snyder

Pragmatic Terminologies, LLC

X

Andrea Pitkus

UW

X

Kathy Walsh

Labcorp

Rob Hausam

Hausam Consulting

Pam Banning

 3M

X

Elissa Passiment

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

Date Time requriements

Having only specimen collection time is not enough - need to have the recieved date/time so that the doc has an idea when a result can be available

if the specimen is collected and the lab doesn’t get it for 48 hours (rather than a much shorter delivery time) - it affects the specimen condition (which is a USCDI element and we have worked on the terminology for this)

lab received date is ok as a proxy, else need the specimen testing start time.

it provides confidence that the specimen was handled appropriately

WHO supported article around specimen handling for patient safety from 2015 = The Impact for Patient Outcomes of Failure to Follow Up on Test Results. How Can We Do Better? - PMC

doc needs to know when ordered > specimen collected > lab received > lab result date performed to be able to understand and use the result in clinical care

could provide some clinical examples where this timeline is important

the lab has these dates and has had them for years - and these are sent in the lab report and it is part of the interface verification before moving to production, but if these are surfaced to the provider when they look at these results.

For preliminary reports, need to send the report date and when it gets updated a new date has to be included and retained for each version.

the report covers all results, when there many results on the report, there should be date/times when results are available for each of the performed tests

When they do POC, collection and test performance time are very close - for follow up testing in labs, would also need to have the test performed date/time (they could also have different performing facility info, but they may all have been done at the same location)

How do you deal with confirmatory testing on the same specimen? Would have to have the date/time test performed to differentiate

What about specimen that are collected over time like 24 hr urine? need to capture start and end date/time, when it is tested depends on when it gets to the lab (or when the text is normally performed - some are only performed on specific days)

for some specimen, when they are shipped longer distances, pre-sending processing may occur

Specimen CMT terms review

Christina

NHSN terms left - compared against the VSAC value set:

• adiposeTissue - need to add, code looks good

• amnioticFluid - do not use vs preferred? this is a partial, so must have collection method

• artery sample - what are they testing for

• bile duct biopsy

Follow up items

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

  • 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

    • 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) and also Robin for US

    Clinical Archtecture unmapped LOINCs:

    • 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

  • 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

Lab tests as procedures or orderables

Do we still need this?

Recommendation by SNOMED is that the Observable entity hierarchy be used for both ordering and resulting. 

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.  

SNOMED LOINC extension: https://browser.loincsnomed.org/?perspective=full&conceptId1=363787002&edition=MAIN/LOINC/2025-09-21&release=&languages=en

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

• 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 using a script to create this from dB content - - zulip thread review: https://chat.fhir.org/#narrow/channel/179202-terminology/topic/Specimen.20Cross-Mapping.20Table.20in.20FHIR.20ConceptMap.20Feedback/with/542341153

    • Check if ConceptMap resource in FHIR R6 incorporated the coding datatype for valueset attributes

  • Clinical Architecture has modeled the Specimen CMT in Symedical, though still need to check how to deal with the prototype additional field instructions (for nice to have elements) 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

  • 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

  • try to get AMA support to get providers to adopt this

  • Reach out to IDSA, too

• Need to consider long-term curation

European Semantic work

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

Confluence page:

Ask if Rob can keep us updated

Specimen CMT pilot implementers

• Review where we are: Vendor Connections

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 https://infobeta.cap.org/shield/

Specimen CMT - tracking implementation impact

• Setting baseline

• Define metrics

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