2025-04-24 LabMCoP Meeting Notes

Date

Apr 24, 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
-	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

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 No calls May 15 and May 22
CSTE Presentation	Riki - no update	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
LOINC SNOMED Extension Follow up		Charlie Harp on common uses of generic LOINCs: ) I can take a look at the data as I believe we can extract unique codes from the data. Do you only want codes that have a LOINC pattern or all codes? If I can pull code system, code, description, original text and incidence count would that work? I will check with my team if so. - my answer: We were thinking just the generic LOINCs, but if you can expand to find common non-LOINC concepts that we should request LOINCs for, that would be great! Use cases to support release of LOINC part code to SNOMED CT concept mappings Waiting for input from Keith Campbell (SOLOR/KOMET) - direct outreach to NIH Charlie Harp email response: We have not incorporated the LOINC to SCT relationships into our mapping process yet. We had experimented with the “unofficial” parts model in the past. I would be interested in a discussion on the potential uses of this content including other members of my team. I have considered this model for creating plausibility checking content for validating LOINC code and specimen SCT code in lab result messages. There are other types of Lab plausibility checks (like unit and value checking) that we are also considering for PIQI Input from Labcorp: The LOINC Scale Type of Ordinal, Nominal, Quantitative and Narrative do guide our selection of SNOMEDs for results. I am not aware of any use cases.
Specimen CMT - review of terms with questions	Christina/Amy	Follow up items: stool with 10% formalin - would this work for SPM 6? 464601000124100 \| Modified polyvinyl alcohol with copper sulfate and ten percent formalin (product) - Riki emailed Nancy, but she is OOO till 4/28 Serum_Thrombin_Gel - need more info about the gel - SCT has 702281005 \| Evacuated blood collection tube with thrombin and clot activator and gel separator (physical object) \| - Christina email follow up with John when she sends the list of? Is there a difference in techinque for the corneal impression vs corneal impression smear? Corneal impression test for rabies: PubMedarticle 472894002 \| Swab from Cornea existis, but that is different it seems, also we have term for corneal scraping 258485006 \| Corneal scraping specimen (specimen) https://pmc.ncbi.nlm.nih.gov/articles/PMC8756399/ https://www.reviewofoptometry.com/article/collecting-a-corneal-culture https://pmc.ncbi.nlm.nih.gov/articles/PMC57753/ the real specimen are the epithelial cells collected by corneal impression smear or leave as “corneal impression smear sample (specimen)” will still need procedure code for colelction method - corneal impression gel separator and clotactivator tube - is a single product - cannot purchase as separated entity, so should not model as separate additives evacuated blood tubes are modeled as physical objects, so would need to use SPM-27 (Specimen container), not sure how many would support that, in LOI this is O, so we should make change request to make RE - if needed often asked as AOE we have used container types in SPM-5 in 2 instances - for Blood_potassium_EDT and for Papsmear_ let’s ask Jen from Arup, who submitted the blood tube types how she is using these (if only in compendium, or expecting to come in as part of order) - Riki to do
SCT hierarchy for methods	ask John	Observation method the thought was to map to techinque hierarchy - background from email here: A decade ago we didn’t have the LOINC/SNOMED collaboration with a SNOMED Extension, so mapping to the procedure hierarchy made perfect sense. Fast forward to where we are today.The most useful way to handle this would be to map to the “Technique” attribute value range. Right now that attribute is restricted to referencing concepts in << 272394005 \|Technique (qualifier value)\|, however as we get into the clinical and radiology domain, I can see that range constraint being expanded to include << 129265001 \|Evaluation - action (qualifier value)\| in order to pick up the imaging method (i.e. MRI, CT, US, etc.) and possibly but unlikely other subhierarchies in the qualifier value hierarchy Specimen collection (SPM-7) should be from procedure hierarchy, correct? - yes. but not all are under specimen collection method; the biopsies and surgical removal are under 118292001\|Removal (procedure), so that should be the top level term.
Creating Value Sets for specimen related attributes	John - no update	US valuesets should be in VSAC for all clinical care Value sets that are used in HL7 should be in International RefSets (and are probalby easier to migrate, if they aplready exist in VSAC (but would need to make sure we promote US extension terms first) Specimen reject reason table review - specimen calls on Mondays 2 PM - started a zulip chat to ask for input: <ADD LINK> Containers (EU review work might have some new content - Reached out to Feijke for update) Additives Riki to set up her VSAC authoring log in
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 - 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 SNOMED CT Extension and use of RefSets (start with VSAC value sets as proof of concept and then migrate over) to indicate: preferred specimen types by domain maybe also terms that need additional attributes (by kind of attribute) if we also write an implementation guide for it 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 pilot implementers		Review where we are: Vendor Connections no update
Specimen CMT - education		Need education for providers and IT folks that helps with set up of the EHR-S / LIS configuration -this can be supported / accomplished? with the Implementaiton Guide we could write 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
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.)

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