2025-03-20 Lab MCoP Meeting Notes

Date

Mar 20, 2025

Attendees

Present	Name	Organization
	Nancy Cornish	CDC
	Manjula Gama-Ralalage	CDC
X	Riki Merrick	APHL
X	Christina Gallegos	APHL
X	Amy Liu	Inductive Health / APHL
X	Raj Dash	Duke / CAP
-	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
	Carmen Pugh

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
CSTE Presentation	Riki	CSTE ELR call presentation on wound cultures and Specimen CMT (modeled for ELR) by Nancy, Riki, and Manjula has been postponed to a TBD date later
European Lab related Vocab	Riki	European Lab Terminology group working on finalizing their list of containers and asking for review - no update
Specimen CMT - review of terms with questions	Christina/Amy	Revisit remapping SPM-8 for the woundfluid from ileostoma is the wound on abdominal cavity vs the ileostoma? most common: at juncture of abdominal wall and intestine skin wound intenstinal wound Lymphfluid drainage need to request synonym for lymph fluid sample for 168145009 Serum sample decided to use the generic SCT term - in clinical practice the most common would be to have the patient, so will NOT use SCT specific to “from patient”, where available LOINC has the system ^Donor, so we might want to have donor specific serum, ser/pl, marrow, blood, XXX (so that would be the problem) those are probably used to map to the Donor crossmatch testing for example use of SPM-5 to indicate donor or pre-ccordinate terms? Most systems already have a way to track that specimen is from a donor, for example in the patient demographics or by using specific identifiers on the spamples indicating it is from donors also we have ISTB specifications https://www.isbt128.org/_files/ugd/1a7593_ae24b89aa87542039ab473e0afc46891.pdf Bring this up to the SHIELD Standards Working group Ask SNOMED CT for feedback and perspective on history of those terms Clean catch midvoid urine - need to update the FSN to mid-stream urine specimen obtained by clean catch procedure spot urine = Request SCT synonmym for random urine specimen high vaginal swab modeling to point to structure of posterior fornix and update the FSN, keep high swab as a synonym Need new additive terms in SCT: sodium polyanethol sulfonate (under Sodium compound) - for additive Mycobacterium tuberculosis antigen - for additive phytohemagglutinin (use with the Quantiferon test for Mtb) - for additive cellsave formula (product) - will need references - for additive fibrocartilage component of connective tissue (substance) Cell culture medium- for additive Rectouterine pouch fluid (specimen) - have SCT CytoChex (product) - will need references - for additive ClotActivator - will need references - for additive Donor discussions: https://cms.thebloodcenter.org/sites/default/files/2019-09/4.pdf https://terminology.hl7.org/5.0.0/CodeSystem-ib.html https://www.isbtweb.org/static/883b4072-a28f-4afe-995dcc102e0d2215/IN-003-ISBT-128-for-Blood-Components-An-Introduction-v8.pdf
Previous Action Items		Nancy Follow up: EDTA Stopper top EDTA sufficient or do we need to specify K2 or K3? - yes! 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		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 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		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
Specimen CMT - Compare to NHS Medical Terminology testing		Will get updated vocab at a later date
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.)

Recording:

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