2024-11-07 LabMCoP Meeting notes

Date

Nov 7, 2024

Attendees

Present	Name	Organization
X	Nancy Cornish	CDC
X	Manjula Gama-Ralalage	CDC
X	Riki Merrick	APHL
X	Christina Gallegos	APHL
X	Amy Liu	Inductive Health / APHL
	Raj Dash	Duke / CAP
X	John Snyder	National Library of Medicine (SNOMED CT)
	Andrea Pitkus	UW
X	Kathy Walsh	Labcorp
	Rob Hausam	Hausam Consulting
	Pam Banning	3M
	Sandy Jones	CDC

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
Specimen CMT - review of terms with questions	Yes	Send a reminder for concept map to Shaun - Riki to do this ear wax - review domain - change to molceular Aspirate_Nasal is post-coordinated, while NasalAspirate is pre-coordinated - ideally we would like folks to use prototype + source site, but when a lab supports only a single entry, then Usage is for clinical domain, so for pre and post-coordinated terms the usage should be the same NHSN terms are outdated, so do not import at this time - Riki to check with Sheila on progress to get updated list(s) Nodule could be a specimen for both micro and pathology - will need to write up comments for each domain as to what kind of tests this specimen is submitted for pathology = for histologic evaluation micro = for culture evaluation (bacterial, fungal, mycobacterium) OralSwab - is discouraged has 2 preferred alternatives: Saliva (we have), OralSwab_Buccal - leave as is PapSmear - currently mapped to a collection from 3 sites (confirmed - and same swabbing is also used for GC/Chlamydia testing per Riki’s OB/GYN connection) mapping to Source site will be problematic, as SPM-8 cannot repeat and we cannot get a single term in SCT for these disparate sites for HPV molecular testing will have to follow what the company recommends to collect - may need a different entry here under molecular
Call Adjourned		11:58 AM ET
Previous Action Items	No	Nancy Follow up: 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against the Anne/Nancy list (compare with ARUP) Nancy/Anne’s list is 10 years old - may not want to compare with this outdated list and use ARUP and Labcorp lists Raj: I found this at a phlebotomy certification course website: What Color Tubes Are Used for Which Tests in Phlebotomy –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 Nancy will see, if their fellow has time to review and complete the list for us (she is a phlebotomist ) 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 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 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) Riki’s Follow up - none of these got done yet Connect with CAP Informatics Committee (Riki can email Kevin Schap) and ASCP (does anyne have a connection?) 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
Specimen CMT pilot implementers	No	Review where we are: Vendor Connections no update
Specimen CMT - Hosting Options	No	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 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) https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/bulletin/2021/12/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
Specimen CMT - education	No	Need education for providers and IT folks that helps with set up of the EHR-S / LIS configuration 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	No
Specimen CMT - Compare to NHS Medical Terminology testing	No	Will get updated vocab at a later date
LOINC to SNOMED CT mapping	No
Future projects for this call after CMT	No	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:

https://aphl.zoom.us/rec/share/fH9yWXv9n2bqm6MNQR9Rzp03TvV7q6Ll99lDWQ4w3LxVBPiCe2vRMaZ7JWAOPRvG.558UEr3Z5-yt29dD
Passcode: 4xPq!9=r

From Chat:

John Snyder (NLM) to Everyone 11:08 AM
https://pmc.ncbi.nlm.nih.gov/articles/PMC7052688/

Nancy Cornish to Everyone 11:11 AM
Insights into cerumen and application in diagnostics: past, present and future prospective - PMC

Kathy Walsh - Labcorp to Everyone 11:12 AM
A laboratory test on ear wax can be a sample of ear wax that is sent to a lab for analysis. This test may be recommended if you have: Ear pain or discomfort, A persistent discharge from your ears, Hearing loss, and A suspected infection.
The sample can be collected using a sterile swab, a sterilized metal scoop, a plastic curette, a wooden spatula, or a Jobson-Horne probe. You can collect a sample at home by gently rotating a sterile swab in your ear canal a few times. However, a health professional is usually better able to collect the sample without damaging your ear or causing an infection.
Ear wax can contain many diagnostic biomarkers, including genetic material, proteins, lipids, and chemical elements. The composition of ear wax can reflect the physiology and pathophysiology of the body, and can even indicate exposure to environmental pollutants.

Nancy Cornish to Everyone 11:15 AM
In-depth proteomic analysis of the human cerumen-a potential novel diagnostically relevant biofluid - PubMed

John Snyder (NLM) to Everyone 11:27 AM
630941000124109 |Evacuated blood collection tube with spray-dried dipotassium ethylene diamine tetraacetic acid for trace element testing (physical object)|
Tube with K2EDTA (spray-dried) for trace element. Tubes for trace elements are labeled specifically for these purposes on the shelf package and case label. Use only appropriately labeled tubes for these tests.

Amy Liu 11:30 AM
1256100007 |Edetate dipotassium (substance)|

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