2025-08-14 LabMCoP Meeting Notes

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

Jake Bunn

CDC (Acting CLIA Core team)

Joseph Michael Bryan

CDC (DLS Statistician)

Kathryn Haass

CDC (NHSN - DHQP)

Kristi Betz

CDC (NHSN - Digital Quality Measures)

Diego Arambula

CDC (Datascience team)

Beth Tolar

CDC (Datascience team)

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

Any updates / Follow up needed?

plan on reviewing the proposed algorithm when they have had a chance to think through the considerations

CSTE presentation

Nancy / Riki

​Sep 2, 2025 1 - 2 PM EDT on CSTE National ELR call - due date for slides to CDC - early next week

Specimen CMT terms submitted to SNOMED International

Christina

need to review the on-hold terms:

• tissue specimen from cardiac implantable electronic insertion site (specimen)

  • ok to use this term; the lab doesn’t need to know more detail, the EHR will have the details, which is needed on the provider side

  • if the device needs to be removed, then the entire device will be examined in gross pathology will be a different specimen

  • left comment to proceed and fix CIDE to CIED in synonym term

• body fluid specimen from cardiac implantable electronic insertion site (specimen)

  • same as above

• fibrocartilage component of connective tissue (substance)

  • left comment - ok to proceed

• sodium poslyanehole sulfonate (substance)

  • left comment - ok to proceed

• touch preparation of specimen (procedure)

  • synonym here is correct

  • still need to submit these requests:

    • deactivate: 708285007

  • already have terms for:

    • tissue impression specimen (specimen) with synonym of touch prep (preparation) specimen

    • tissue smear specimen

LOINC release Update

Andrea

• new items:

  • high level order codes ~ 2000 to support the SNOMED Ontology work in their own class

    • these will not have the components included

    • intent is to support queries

    • should not be able to include ratios, because they actually represent a panel,which are expected to be exclusive of panels

    • Methodless, but still highly focused on system (many same compnent, but different terms for system differences)

    • these should also not include challenge tests

  • some terms - like specific gravity is now in property vs component-

Future Topic

Use of AI to map to LOINC or other terminologies

Call Adjourned

12:01 PM EDT - next call ​Aug 21, 2025

Lab tests as procedures or orderables

not discussed

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) =

    • ANSWER: The observable entity hierarchy is recommended for use in both ordering lab tests and reporting results of tests. Note: there are some areas of the observable entity hierarchy which need improvement. This concept is in the “function” area of the hierarchy which has been identified as needing clean up. See the warning in the Observable entity section of the SNOMED CT Editorial Guide ( ): “Some areas of the observable entity hierarchy need clarification and remodeling. This includes upper level concepts and hierarchies such as 246464006 |Function (observable entity) and 415178003 |Process (observable entity)| as well as intermediate primitive and leaf node concepts.” There is also a content tracker covering this area which is on hold: https://jira.ihtsdotools.org/browse/IHTSDO-1210.

  • Anion Gap measurement (procedure) = 

    • ANSWER: This hierarchy is not recommended for use in ordering or reporting lab tests. This is part of legacy content that remains in the International release of SNOMED CT because some implementations in certain countries rely on it. See the “Observable entity vs. Evaluation procedure“ section of the SNOMED CT Editorial Guide for more information at 

  • Anion Gap calculation (qualifier) = 

    • ANSWER: This is a qualifier value concept and would not be used to order or result tests directly.

      This technique concept was used in the modeling of anion gap observables in the previous (2017) release of the LOINC - SNOMED CT Post-coordinated expressions Refset. In the current release of the LOINC Ontology, a different set of qualifier value concepts is used in modeling anion gap observables. Please see V1 of the LOINC Ontology (viewable in a browser at  ) for examples of the modeling, e.g., 539021010000104 |Substance concentration of anion gap in blood at point in time by calculation (observable entity)|

• 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 ) and 1 diagnostic report (what was seen - verbal and images - would be captured in )?

  • Both the procedure and the AP request would be represented by - discussed where to use LOINC, which is ServiceRequest.code - looking at US Core value set:

    • 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

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:

Semantic Example section:

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) : 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

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.)