2024-11-14 LabMCoP Meeting Notes

X

Nancy Cornish

CDC

X

Manjula Gama-Ralalage

CDC

X

Riki Merrick

APHL

X

Christina Gallegos

APHL

X

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

Pam Banning

 3M

Sandy Jones

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

Specimen CMT - review of terms with questions

Christina / Amy

• PapSmear

  • cannot populate SPM-8 here, as these are disparate strucutres and no overarching concept can be assigned

• Pap in liquid transport container

  • cannot populate SPM-8 here, as these are disparate strucutres and no overarching concept can be assigned

  • started off as manufacturer’s proprietary test - brand-name preservative, that is added to the contianer, but very common - this is still only Hologic

  • we have 1331905008 | Cytology specimen vial containing preservative fluid (physical object)| - we can add the synonym of Liquid-based cytology specimen vial (physical object), if we think this is needed - there are different preservative based thin-prep products, so using the brand name, we don’t need it

  • different types of collecting choices brush-spatula combination or broom can be used with the collection kit

  • add the references into the collection

  • Do we need to mention regulation around Pap testing? Like the extra questions that need to be asked prior to collection? - will leave out, should be covered elsewhere

• Plasma_HeparinLithium_gel - looking for modeling of the container = no way to link physical object to substance, so not modeled in SCT

  • have SCT concept for HeparinLithium, but hard to model the gel (since we do not know the composition) - leave that out of additives?

    • you cannot buy the gel separator separately, so should be considered part of the container

    • in Denmark they are modeling the separator as a separate attribute, not as an additive

    • clotting accelerator can be spray-dried or non-spray-dried may aslo be important

  • maybe we can create a compendium of containers (Jen Rychert has been submitting for container concepts, so we have a fairly complete list in the US extension) with mappings

• Spot urine

  • can we request “random urine” as synonym for the spot urine? - John will create the submission and check if international will accept - need online reference that spot and rando are the same: = https://us-request.ihtsdotools.org/#/requests/preview/355722?fromList=true

  • random is a temporal aspect, but it would match the tempral concept of spot urine

• ToeJointSynovialFluid

  • usually collected via syringe aspiration - usually from the big toe

  • definition has mention of ganglion cyst - need to remove that from this definition and find out, where that should go

    • ganglion cyst = this can be removed by aspiration, but it is not submitted to pathologists or excision, which would be sent in - add one for the ganglion cyst excision under pathology related

    • discouraged - SynovialFluid and indicate which toe joint is being aspirated from

Call Adjourned

12:02 PM 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) : 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

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.)