2024-08-01 LabMCoP Meeting Notes

X

Nancy Cornish

CDC

X

Manjula Gama-Ralalage

CDC

X

Riki Merrick

APHL

X

Christina Gallegos

APHL

regrets

Amy Liu

Inductive Health / APHL

regrets

Raj Dash

Duke / CAP

X

John Snyder

National Library of Medicine (SNOMED CT)

X

Andrea Pitkus

UW

X

Kathy Walsh

Labcorp

Rob Hausam

Hausam Consulting

X

Doug York

APHL

Pam Banning

 3M

Sandy Jones

CDC

Upcoming OOO

 Yes

• 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

TINKAR IG

• TINKAR is developed by Deloitte under FDA (BAA)

  • Knowledgebase that combines mulitple code systems

  • similar to SOLOR

  • this is the prior version: https://confluence.hl7.org/display/VOC/TINKAR+Milestones+and+Deadlines

  • connectahon form May 2024: https://confluence.hl7.org/display/VOC/May+2024+Connectathon+Storyboard

  • current application referenced as Comet

  • Calls are Wednsedays 4-5 PM ET - next call: https://www.hl7.org/concalls/CallDetails.cfm?concall=73589

• John and Andrea have been attending the meetings (thank goodness!)

  • needed to provide clarity about the difference between

    • LIVD

    • Lab test compendium

• they are working on setting up a connectathon track

• treating PLT codes as LOINC extension, which is what APHL has been doing

  • reasons of making PLT codes:

    • very limited use across programs- not likely to make it intou other data streams (EPI specific questions)

    • order codes for panels - will submit all of these back to Regenstrief, now that the policy around this may change

    • for every submission until we have LOINC

  • we have been talking with Regenstrief about this

  • need to make sure the TINKAR folks do not sell PLT as LOINC extension (as it does not completely follow all the editorial guidelines)

  • viewer: ​https://aphl.clinicalarchitecture.com/SymedicalAPHLViewpoint/#/searchOpen

  • also Clinical Architecture can distribute PLT codes

  • PLT is in HL70396 table and also should have an OID (I will doubleckeck on that - but would need to figure out the URL for use in FHIR)

  • Consider talking with Regenstrief about including PLT mappings (the deprecated ones - or maybe all - in the LOINC SNOMED extension?

    • alternate concept identifiers may be more explicit than the main code? - it is disributed differently than a maping RefSet

  • On HL7 calls AMA has requested use of PLA codes instead of LOINC to identify orders

  • Related to LIDR work - most likely - need to compare to the LIDR Whitepaper requirements

  • CDC is working with FDA and manufacturers via their CLIAC biosafety group

    • to include industrial hygenist in development of new instruments to ensure is that these are safe to operate by the lab personnel

Previous Action Items

• Nancy Follow up:

  • Update on blood culture media bottle shortage

    • CDC via LOCS done outreach

    • CDC sent out HAN to make folks aware

    • Also alerted via APHL Infectious Disease Forum

    • FDA has been alerted

  • Update on use of NHSN speicmen terms - will be sent ouve later today

  • EDTA Stopper top

    • EDTA sufficient or do we need to specify K2 or K3?

    • Nancy can review the list in SNOMED from John

    • Need to check on completeness against the Anne/Nancy list (compare with ARUP)

      • Nancy/Anne’s list is 10 years old - may not want to compare with this outdated list and use ARUP and Labcorp lists

      • Raj: I found this at a phlebotomy certification course website: What Color Tubes Are Used for Which Tests in Phlebotomy – PhlebotomyU

        • Here's a nice one-pager (University of Colorado Health): https://www.testmenu.com/universityhospital/TestDirectory/SiteFile?fileName=sidebar\CLNLAB-2020-03-13-Blood-Tube-Color-Chart.pdf

        • Cleveland Clinic: Blood Collection Tubes - Collection | Cleveland Clinic Laboratories

    • https://phlebotomygeeks.yolasite.com/resources/PRINT OUT COMMON TUBES.pdf

      • but color is manufacturer dependent, which is why we named the tubes by the additives

      • there are container types in SNOMED under 706049005 |Blood tube (physical object)|

      • Have a start here: https://aphlinformatics.atlassian.net/wiki/download/attachments/2018312270/ContainertypesListRikiEmailed20171013.xlsx?api=v2

      • K1 or K2 might be important to differentiate

    • We should leave the top color out of it, since that is manufacturer specific

  • Contact United Network for Organ Sharing for input on donor terms (pre-coordinated or not?) = Contact - UNOS

    • Riki filled out the form - No repsonse

    • ISBT 128 | ICCBBA | Technical Documents

    • Scott’s response: “When the SNOMED representative referred to the existence of “donor codes,” they might be referring to the ISBT-128 coding standard that’s managed by ICCBBA. Please see their website: ISBT 128 | ICCBBA, and navigate to view their technical documents: ISBT 128 | ICCBBA | Technical DocumentsFDA’s regulations for human cells, tissues, and cellular and tissue-based products (HCT/Ps) in 21 CFR part 1271 require assignment of a “distinct identification code” to facilitate tracking HCT/Ps (see 21 CFR 1271.290(c)) but I don’t believe this is relevant to your question.”

    • Might be a topic for SNOMED International

    • We may need to reach out to laboratories/industry to see if the donor codes are needed (we need to show that these codes are needed.)

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

  • liquid-based cytology specimen vial = https://us-request.ihtsdotools.org/#/requests/preview/354843?fromList=truehttps://request.ihtsdotools.org/#/requests/edit/786429

  • submit a code for formalin10

  • work with John

    • new term for pacemaker insertion site sample

      • in SCT there are only swabs for insertion sites (line, drain, chest tube, vascular catheter) - this should be fixed

      • we should model it after 435971000124108 | Body fluid specimen from peritoneal dialysis insertion site (specimen) and require method, which should be aspirate

    • 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

    • IDSA has a guidelines for wound cultures (deep and superficial - related to surgical wounds) - link sent to Amy

Specimen CMT - review of terms with questions

• Amy can’t be on

Specimen CMT pilot implementers

• Review where we are: Vendor Connections

  • no update

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

  • ​@riki.merrick​ to ask Eric if he still has that or how he built it:

  • ANSWER FROM ERIC:

    • if you look in the xml source Conceptmap-example-specimen-type.xml - FHIR v6.0.0-cibuild . you can see how it is mapped. 

    • I am not sure if you mean the table rendering or creating the concept map from a spreadsheet or CSV file.  The FHIR build tool did the table rendering for that mapping, I think I entered the data by hand, or Grahame did it. It would not be hard to create a script to create a concept map from an excel or csv file if needed.  The table needs to be large enough to make it worthwhile though. you could even create formula cells in the spreadsheet to generate the XML or json for each item. and then copy to a text editor and append to the Metadata fields.

    • There will be a call Clinical Architecture on August 16th to discuss moving specimen CMT to Symedical

    • Manjula will take a look at the concept map

Specimen CMT - education

Specimen CMT - tracking implementation impact

• Setting baseline

• Define metrics

Specimen CMT - Compare to NHS Medical Terminology testing

LOINC to SNOMED CT mapping

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 (i.e., Specimen Condition table, etc.)