2025-03-27 LabMCoP Meeting Notes

Date

Mar 27, 2025

Attendees

Present	Name	Organization
-	Nancy Cornish	CDC
-	Manjula Gama-Ralalage	CDC
X	Riki Merrick	APHL
-	Christina Gallegos	APHL
X	Amy Liu	Inductive Health / APHL
X	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
	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
LOINC SNOMED Ontology	Riki/Andrea/John	https://loincsnomed.org/ Seems like there are some issues, as this is still a work in progress need to make a clear intention between order items (procedure?) vs performed test (orderable) - need to find out how they implemented the order/obs flag Recording of the intro presentation: https://www.youtube.com/watch?v=d_b__dtyziQ&embeds_referring_euri=https%3A%2F%2Floinc.org%2F Clinical LOINC Committee will be working on document hierarchy (make sure they finish lab concepts) Overall this is a good step for supporting grouping of LOINCs
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	nothing for today to review Discussing option to use a SNOMED extension How would we indicate the additional attributes that define the specimen? We may not want these classfied as “AOEs”, as they would then not be reported in the specimen specific spots Like currently happens with specimen collection date/time there are other AOEs outside of specimen specific attributes like last menstrual period Have LOINCs for some, but not for all of them some of the AOEs are reported back with the result, when the lab used them in the interpretation of the result (as a statement of what was used) Review existing data sets for commonly uses of generic LOINCs that could give us insights into how folks use these (and find ones we should make LOINCs for) Ask Charlie to look at their data set Raj could look at Cosmos (Epic de-identified dataset, but might include non-US metric units - might require LOINC mapping updates based on the unit of measure received for each result) - hard to get access to this We often have folks map to the “wrong LOINC”, because they need to meet specific reporting requirements (quality measures or reporting to PHs) - would be good to capture reason for mapping to help adjudicate these LOINC part code to SNOMED CT concept mappings - are folks wanting these released? Geisinger uses these for the query quality improvement some folks may be using the LOINC part code for component searches the new release might make this harder, as several have been renamed to “observation” - where the prior component moved to a different attribute - and currently this was not applied consistently the longname and shortname didn’t change Ask Keith about SOLOR/KOMET Also ask Charlie Harp
Value Sets for specimen related attributes	John	US valuesets should be in VSAC for all clinical care Value sets that are used in HL7 should be in International ref sets Also need to get back to the specimen reject reason table review - specimen calls on Mondays 2 PM we also have containers (EU review work might have some new content - reach out to Feijke for update) and additives started
Previous Action Items	Not discussed	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	Not discussed	Review where we are: Vendor Connections no update
Specimen CMT - Hosting Options	Not discussed	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	Not discussed	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	Not discussed
Specimen CMT - Compare to NHS Medical Terminology testing	Not discussed	Will get updated vocab at a later date
Future projects for this call after CMT	Not discussed	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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