2026-04-30 LabMCoP Meeting Notes

X

Nancy Cornish

CDC

X

Manjula Dharmawardhana

CDC

X

Riki Merrick

APHL

X

Christina Gallegos

APHL

-

Amy Liu

Inductive Health / APHL

-

Raj Dash

Duke / CAP

John Snyder

Pragmatic Terminologies, LLC

X

Andrea Pitkus

UW

X

Kathy Walsh

Labcorp

Rob Hausam

Hausam Consulting

Pam Banning

 3M

Elissa Passiment

Kristina Betz

CDC - NHSN

Diego Arambula

CDC

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

• Riki not available 5/21 and 5/28 - what do folks want to do with these dates?

Working with DHQP for NHSN reporting

Nancy

Follow up list:

Urine culture results for HAI - ask Kristi when we ask her to help us formulate the questions for SHIELD

SHIELD answer on blood cultures:

• Record bottle volume, per bottle or combined?

  • Harvard Children does not record

• Where shared /stored?

  • Harvard Children does not record

• What LOINC used?

  • Harvard Children: not for volume, but for culture: 11475-1^Microorganism identified in Specimen by Culture

• What is the rule?

  • CAP requirement for any blood culture to collect volume - for under 18 the volume amount should be based on weight. In the catalog the lab would note what the volume should be (regular and minimum). see chat for example

• Will the submitter of the order include the volume in the bottles?

  • Labcorp doesn’t have an AOE for volume, so probably not; they do record the specimen condition

  • Blood culture collection kits BACT-alert bottles, so using Biomerieux equipment

  • Biomerieux Vertuo instrument includes the volume measurement with the results - Nancy will ask how they are recording volume.

• How are the comments around low volume getting back to submitters?

  • Assume with NTE after the result, could we request they send this as a separate OBX with a specific LOINC https://loinc.org/94330-8/ ?

• Andrea reviewed some of the NHSN FHIR examples - propose to update those with clinically correct values:

  • https://www.cdc.gov/nhsn/fhirportal/dqm/ig/DiagnosticReport-diagnosticreport-example-ach-monthly-pass2-lab-cbc.html - a CBC does not have Hemoglobin A1c or Glucose

  • https://www.cdc.gov/nhsn/fhirportal/dqm/ig/Specimen-specimen-example-ach-monthly-pass1-blood.html - a blood culture is not collected via heel stick (that’s capillary)

  • Use of 108252007 | Laboratory Procedure in ServiceRequest.category is not helpful to get folks off thinking of lab tests as procedures

  • It would be good to understand the workflow of how this is currently done today, since it is a CAP requirement and also what exactly the expected quality measure data looks like and where it is being drawn from (EHR-s or LIS or another system?)

    • we can define the data we need and the data the clinican needs, but we need to reach out to others to understand what the current state is

      • Volume of blood collected in the set (need to decide if for each bottle or stick = one aerobe, one anaerobe bottle) as part of the report as a separate observation rather than in a comment

        • https://loinc.org/3157-5/

        • or make a volume panel to represent more details about each bottle and each set and also include the comment for example:

          • bottle 1 total vol: 10 mL

          • bottle 2 total volume: 9 mL

          • additional bottle vol - is this needed?

          • Overall Total Volume of all bottles in set: 19 mL

          • Total Vol Comment: list of suggested responses when insufficient volume - anything else?

      • if insuffcient volume add a comment to indicate that = specimen condition element (there is a data element for that in V2 = SPM-24 in FHIR = Specimen.condition that is coded) and then should include the instructions of what they need to do, which should be a queryable entry using https://loinc.org/94330-8/ in the report rather than NTE after the result - we could provide “canned language” as suggestion

      • Also need comment when contamination is found - can include “canned language” for suggestion - maybe use https://loinc.org/77202-0/

      • Result of the blood cultures:

        • https://loinc.org/17934-1/

        • https://loinc.org/17928-3/

        • https://loinc.org/93407-5/

        • https://loinc.org/92789-7/

      • antimicrobial testing results, if growth as a reflex

    • if the volume is low, this information should be communicated to the clinician at specimen receipt - this is not currenlty supported for external labs; and internal to organization may or may not use order update messages for this purpose - some web portals may have indicators for specimen receipt, not sure if comments could be added, not commonly done today

• goal is to set up the LOINC codes needed for collecting blood culture contamination data - future best practice

Call adjourned

12:08 PM EDT

Specimen CMT terms

Christina

only NHSN terms left for questions:

Specimen CMT - Hosting Options

Any Updates on FU with:

Clinical Architecture:

ONC:

CMT Governance process

CMT proposed maintenance process

Start writing this up on this confluence page: Specimen CMT Update Process

Questions from Zulip thread that should be covered by the process we come up with here:

1. Requests for terms used in practice that are not yet in the Cross Map Table?

2. Requests for any corrections or needed updates to terms?

3. What type of version control will be leveraged for releases and major/minor updates?

4. How do you plan to incorporate SNOMED CT Release Updates into Cross Map updates/releases?

5. At what frequency will updates occur? For example, will you process SCT updates once yearly and have a subsequent Cross Map release yearly with changes or more or less often?

6. How do you communicate differential changes between releases? Is a differential file produced or is it expected that users will be able to find changes on their own?

7. What type of customer support for downloads is expected? Will the release entity provide or is it expected of the site hosting the content for download? Both need to work colLABoratively to ensure no blockers arise for users/consumers.

User Guide starter Specimen Cross-Mapping-Table (Specimen CMT)

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