2025-07-24 LabMCoP Meeting Notes

Date

Jul 24, 2025

Attendees

Present	Name	Organization
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
regrets	John Snyder
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
Presentation on CDC Forum on Lab Interoperability		Goal of the presentation was to highlight all dates/times that are needed for laboratory data and also identify how current USCDI representation might hinder proper implementation by developers. Some of the data elements might also need HL7 adjustment (V2 has different definition from FHIR) and clarification on how specific types of data should be modeled. Had sidebar email from Jim Case requesting documentation around what orders are: argument that laboratory test orders are not orders for procedures, but are requests for observations to be made on a specimen using a particular method. This has fallen on deaf ears for a number of reasons, not the least of which is that there are hundreds of implementations out there that use SNOMED evaluation procedures for ordering and Observable entities or LOINC Codes for resulting. This is due to a number of reasons, but one of which was that there were no generic LOINC order codes that clinicians could use. That will be fixed in the next release of LOINC and the SNOMED LOINC extension. For whatever reason, we have been unable to get people to move to the single approach for orders and observations. It would be very nice if we had some rationale from another organization such as HL7 to validate our position as we are constantly getting pushback to add new lab "procedures". USCDI did a good thing when they split up the different types of tests, need to do something similar for orders See: Colonoscopy is an investigation, which results in a report, that is different from a lab test, which may be spawned AFTER specimen collection during the colonoscopy. Include reviewing the guideline documentation Epic decided anything that involves a surgical procedure to model it as procedure, even for the order? looking at An order is the first step - then we can link to the thing that is expected to be ordered, which can then be the respective thing: surgical procedure, Order for the procedure → procedure results in specimen collection, which spawns a new order for performing a test on the specimen → outcome is a result Next Steps: Come up with examples what procedures are and what observables are -> bring this to HL7 (look at the EHR-Functional Model IGs) and SHIELD Standards and Vocab WG. clear procedure example and describe the outcome clear observable (Vital sign) example and describe the outcome Colonoscopy and AP testing example and describe the outcome Get crisp definitions for the terms we apply - reach out to SNOMED to get their defintions for the hierarchies: procedure / observable
Specimen CMT	not discussed	not discussed
Creating Value Sets for specimen related attributes	not discussed	Specimen reject reason table review - review the “unsatisfactory for evaluation due to …” concepts
LOINC common maps		Next LOINC release in August will include generic (method-less) order codes for EHR builds as trial use codes - Stan gave presentation - ADD LINK TO THE Meeting minutes once posted It would be nice to know what all the test are that are available in US labs - is that possible?
Previous Action Items	not discussed	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		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) : 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
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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