2025-06-26 LabMCoP Meeting Notes

Date

Jun 26, 2025

Attendees

Present	Name	Organization
-	Nancy Cornish	CDC
X	Manjula Gama-Ralalage	CDC
-	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)
X	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 Next calls: Jun 19, 2025 cancel call; Riki is out Jun 26, 2025, Nancy out 6/19- 6/30, Amy is out 7/3
Specimen CMT - SCT submission terms	John	bodyfluid from insertion site resolution - did Nancy’s answer from last week resolve this? Hold until next week can get fluid or tissue from the pacemaker pocket will create a pacemaker specific term for body fluid and one for tissue from pacemaker insertion site or pacemaker pocket? - a pocket concept does not exist in SCT, would be modeled using SNOMED also has pacemaker and pacemaker lead (would probably also have tissue on it (will be put in broth culture) as specimen (which when taken out, received at pathology lab and then forwarded to the manufacturer) https://www.research.va.gov/research_in_action/The-invention-of-the-cardiac-pacemaker.cfm#:~:text=In%201960%2C%20they%20implanted%20a,data%20on%20about%2060%2C000%20patients.&text=Selected%20publications:,Patent: What about the medication port (bubble under the skin to administer recurring medication for example for cancer patients) - do we have a term for that? Implanted Medication port google search Implantable veous access device google search NCI Dictionary of Cancer Terms - port Postcall note from John: Looking at the references provided, one reference identified a group of devices as “Cardiac implantable electronic devices” and this caught my eye. The following concept was added to SNOMED in 2021: 1162882002 \|Cardiac implantable electronic device pocket (morphologic abnormality)\| I am proposing that we change the concept requests from specifying the pacemaker to be more generic as follows: Body fluid specimen from cardiac implantable electronic device insertion site (specimen) Tissue specimen from cardiac implantable electronic device insertion site (specimen) Christina will share the question word document with Nancy,so she can do research before the next call - done Clotactivator substance - modeled as a subtyp of coagulant in addition to blood collection devices this is also used in bandages, gauze Cyto-Chex term looks ok (will add sysnonym without the registered trademark sign Phytohemagglutinin (substance) - is for SPM-6 (is part of the kit for the Quantiferon GOLD test) https://en.wikipedia.org/wiki/Phytohaemagglutinin 6/26: Touch prep (add as a synonym)- under PHLIP pref name “tissue impression smear” Descriptions “touch prep” and “tissue impression smear” have the same PHLIP pref name of “smear_tissueimpression” - not sure if synonym should be for tissue impression smear since they are different “tissue impression smear” is different from “touch preparation smear sample” Hold until next week - John will create a request a new concept “touch preparation specimen” fibrocartilage component of connective tissue (for term Cartilage) add as a child of “connective tissue” specimen substance does not recognize body structure - cartilage term request into substance hierarchy, but do we need to specify component of connective tissue or fibrocartilage tissue? Hold unto next week Cellsave Formula (product) “submit for new term in product hierarchy” do we need additional synonym that will look like “cytology tube with Na2EDTA and polyethylene glycol” - yes new term to be added: “Antigen of Mycobacterium tuberculosis (substance)” and added under parent concept “microbial antigen” may need to map to substance and physical object device
Creating Value Sets for specimen related attributes	Not discussed	Specimen reject reason table review - review the “unsatisfactory for evaluation due to …” concepts
Call Adjourned	12:05pm	Next call is July 3rd, 2025
LOINC common maps	Not discussed
Previous Action Items	Not discussed	Andrea follow up: Ask Stacy Robinson at ASCLS for clarification about Touch prep, vs squash prep vs smear Nancy Follow up: Pulling together the wound specimen presentation for CSTE ELR call on Sep 2, 2025 with Riki and Manjula Additives (Nancy reviewing the stool preservatives) 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 Clinical Archtecture unmapped LOINCs: Charlie shared the LOINC mappings and the unmapped strings (did Riki share via email?) Riki should check up with Charlie to see, if he knows where the LOINCs using the shorname in the description come from - as that is discouraged Riki to set up her VSAC authoring log in 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	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 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	Not discussed	Review where we are: Vendor Connections no update
Specimen CMT - education	Not discussed	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	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.)

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