2026-03-19 LabMCoP Meeting Notes

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Nancy Cornish

CDC

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Manjula Dharmawardhana

CDC

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Riki Merrick

APHL

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Christina Gallegos

APHL

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Amy Liu

Inductive Health / APHL

Raj Dash

Duke / CAP

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John Snyder

Pragmatic Terminologies, LLC

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Andrea Pitkus

UW

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Kathy Walsh

Labcorp

Rob Hausam

Hausam Consulting

Pam Banning

 3M

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

Specimen CMT - Hosting Options

• Follow ups:

  • Using FHIR to publish:

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

    • Ask THO to publish this as a “code system” to be hosted on the ONC FHIR terminology server?

    • Ask Clinical Architecture if they can produce FHIR resource from CMT

  • Publication behing NLMs UMLS license:

    • There is a way for another organization to host a product like the specimen cross mapping table on a different server but still have it behind the UMLS license. Here is the information that I was given: There are two ways - they can authenticate using an API key, using this API: https://documentation.uts.nlm.nih.gov/validating-licensees.html . This is the simplest way to do it. Alternatively, they can set up authentication on a website using a web browser (via https://uts.nlm.nih.gov/uts/login ). This requires some extra steps - we would need to whitelist any web domains they are using. If they are interested in this option, we can provide further instructions. Again, the API key option is the easiest to implement. 

      If we identify a group, whether it is symmedical or CDC, that wants to host the database that Manjula created we can still go down that path and have it behind the UMLS license. This would cover us from a US perspective.

    • Update on I will let you know what I find out about NLM hosting the flat files (would like to have this as tab-delimited files rather than csv - need to figure out how to deal with the special text characters) for download.

  • Have Snomed International host files to download

• Requirements for hosting sites:

  • need to be freely accessible (no cost), though licensing for the SCT concept is still required (for US use its ok)

  • need human readable access

  • need access for machines (API)

    • direct

    • download

• Get input from EHR-s and LIS vendors about best format to share:

  • 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, AMA support to get providers to adopt this

  • Reach out to IDSA, too

Specimen CMT terms

Christina

NHSN terms are missing a lot of fields- assume all should be in micro domain:

Artery Sample:

• cooridnation: partial;

• PHLIPPreferredTerm: Artery

  • it should classify under Tissue Sample in SCT, ticket to add Tissue specimen as another parent: https://request.ihtsdotools.org/#/requests/edit/976625?fromList=true

• Definition: any of the tubular branching muscular and elastic walled vessel that carriy blood from the heart to the body (Merriam-Webster)

• Collection information: Surgically collected

• require SPM-8 and if needed SPM-9

Billiary Tract Tissue Sample

• cooridnation: partial

• PHLIPPreferredTerm: BilliaryTractTissue

  • several of the more detailed terms are not children of this term - new ticket to fix

• Definition: From Cleveland Clinic: Your biliary tree is a system of branching bile ducts connected to organs. They make, store, use and distribute bile through your body. Bile plays an important role in your digestive system. It also carries waste products from your blood out of your body.

• Collection information: Surgically collected

• require SPM-8

• Keep comment for the pathology domain - preferred, partial

Blood - has a duplicate with difference - will bring back next week

Bone Marrow

• keep the NHSN term definition, have hematology and make micro for the NHSN term

• partial must have SPM-8, may have SPM-9, if needed

• hematology is a subspeciality of anatomic pathology, when it covers solid tumors - FROM CHAT

Call adjourned

11:58 PM EDT

CMT Governance process

CMT proposed maintenance process

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

There is this question in the LOINC Community: https://forum.loinc.org/t/assistance-creating-a-value-set-for-all-loinc-procedure-concepts/2993

it is related to this US Core FHIR Change request: https://jira.hl7.org/browse/FHIR-54415

Answer to this one is that in USCDI Procedure (https://isp.healthit.gov/taxonomy/term/781/uscdi-v6) does not list LOINC as applicable Vocab standard in any verion, so remove it.

Often folks think of lab tests as procedures, because they can be ordered in CPOE (and outsidde the US, in the UK for example that’s how folks have modeled those, which is why LOINC was adding more of the high level order codes in 2.81 release, so we still should tackle the LOINC community question.

John was working on creatign an intesnional valueset definition based on class + type and maybe a few other attributes

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