2025-08-07 LabMCoP Meeting Notes

Date

Aug 7, 2025

Attendees

Present	Name	Organization
X	Nancy Cornish	CDC
regrets	Manjula Gama-Ralalage	CDC
X	Riki Merrick	APHL
X	Christina Gallegos	APHL
regrets	Amy Liu	Inductive Health / APHL
regrets	Raj Dash	Duke / CAP
regrets	John Snyder
X	Andrea Pitkus	UW
X	Kathy Walsh	Labcorp
regrets	Rob Hausam	Hausam Consulting
	Pam Banning	3M
X	Jake Bunn	CDC (Acting CLIA Core team)
X	Joseph Michael Bryan	CDC (DLS Statistician)
X	Kathryn Haass	CDC (NHSN - DHQP)
X	Kristi Betz	CDC (NHSN - Digital Quality Measures)
X	Diego Arambula	CDC (Datascience team)
X	Beth Tolar	CDC (Datascience team)

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
Premier healthcare database to evaluate blood cultures	Nancy	Looking for medical codes for blood culture in DB table includes CPT codes table with LOINC and SNOMED 87040 CPT code (Blood culture) - used for billing Looking for help with creating an algorithm not all tests in a lab workflow are LOINC encoding, so where labs dont have that functionality you will not have LOINCs if CPT has a date, then look for the specimen collection date (+/- 10 days or so?) and if it’s close, then look for that Do you have encounter information? ICD-10 codes for bacteremia (identified bactremia) and sepsis (suspected, but may not be verified) CPT codes can also be added when Sensitivity testing is added (or any other additonal tests that are being performed) Could potentially also rule outut when specimen is acelluar blood Use CPT and date, look for specimen collection date (being +/- 10 days of the CPT date), then fr the patient find all LAB_TEST_CODE and then evaluate observation text for each; if no LOINC used, then can exclude where specimen source is acellular blood, cord blood, specimen, urine, body fluids, can exclude, if Isolate, then these were done on a culture could use thse LOINC component can be organism specific, then observation text would give you presence or absence finding words, if the LOINC component is generic like Bacteria If LOINC has Bld.pos.growth as sytem, all of those would be follow up on a Blood culture
Specimen CMT terms submitted to SNOMED International	Christina
CSTE presentation
Lab tests as procedures or orderables		Definition from SNOMED for these hierarchies: Observable entity: Information about a quality/property to be observed and how it will be observed Evaluation procedure: No definition, other than it uses attributes that are similar to those used in the Observable entity hierarchy. Our policy is to not add any new evaluation procedures that would logically be in the Observable entity hierarchy. Technique is a separate hierarchy used to model observable entities: A technique (also called method) is a particular way of performing an activity or task. Colonoscopy example: Reference links: clinical guidelines: Official journal of the American College of Gastroenterology \| ACG Quality Indicators: Official journal of the American College of Gastroenterology \| ACG Discussion: Ask Jim Case what the difference is between these 3: Anion Gap function (observable) = https://browser.ihtsdotools.org/?perspective=full&conceptId1=102637000&edition=MAIN/SNOMEDCT-US&release=&languages=en Anion Gap measurement (procedure) = https://browser.ihtsdotools.org/?perspective=full&conceptId1=25469001&edition=MAIN/SNOMEDCT-US&release=&languages=en Anion Gap calculation (qualifier) = https://browser.ihtsdotools.org/?perspective=full&conceptId1=723205003&edition=MAIN/SNOMEDCT-US&release=&languages=en Is the colonoscopy report a single report or maybe 1 procedure report (the what, with what, how long it was done - would be captured in https://hl7.org/fhir/procedure.html ) and 1 diagnostic report (what was seen - verbal and images - would be captured in https://hl7.org/fhir/diagnosticreport.html )? Both the procedure and the AP request would be represented by https://hl7.org/fhir/servicerequest.html - discussed where to use LOINC, which is ServiceRequest.code - looking at US Core value set: https://build.fhir.org/ig/HL7/US-Core/ValueSet-us-core-procedure-code.html this could use some more guidance on when to use which of the referenced code systems - would like to understand when ICD would be used, and also would need guidance when to use CPT; SNOMED CT procedure codes vs LOINC should also be described For CAP cancer reporting is using SNOMED CT - would be good to look which they chose to represent the performed lab test Looking at the Colonoscopy example document (making changes in there) Got to specimen requirements part of the document
Call Adjourned		12:04 PM EDT
Specimen CMT terms review	not discussed
FHIR conceptMap Follow Up	not discussed	Specimen CMT draft profile on ConceptMap: Bring this to HL7 Terminology Infrastructre WG?
European Semantic work	not discussed	Link to the German FHIR IG around suceptibility testing: https://nam12.safelinks.protection.outlook.com/?url=https%3A%2F%2Fsimplifier.net%2Fguide%2Fars-implementation-guide%3Fversion%3Dcurrent&data=05%7C02%7Criki.merrick%40aphl.org%7Ce11e8daf7f2d4827d07808ddcac8861c%7C434e0aedef824568a0493b17adc08ddd%7C1%7C0%7C638889684844672822%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=kZJRoBl2tMQzWQoYVkaRnEUaaBxepA9sAIu1myDQMyo%3D&reserved=0 Semantic Example section: https://nam12.safelinks.protection.outlook.com/?url=https%3A%2F%2Fsimplifier.net%2Fguide%2FARS-Implementation-Guide%2FHome%2FSemantics%3Fversion%3Dcurrent&data=05%7C02%7Criki.merrick%40aphl.org%7Ce11e8daf7f2d4827d07808ddcac8861c%7C434e0aedef824568a0493b17adc08ddd%7C1%7C0%7C638889684844702198%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=qQH%2Ff5xwG0O8DvNE4rbjZineXBhY%2BiOWmN047DRthNQ%3D&reserved=0
Creating Value Sets for specimen related attributes	not discussed	Specimen reject reason table review - review the “unsatisfactory for evaluation due to …” concepts
Previous Action Items	not discussed	Nancy Follow up: 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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