2025-09-25 LabMCoP Meeting Notes

Date

Sep 25, 2025

Attendees

Present	Name	Organization
X	Nancy Cornish	CDC
X	Manjula Dharmawardhana	CDC
X	Riki Merrick	APHL
X	Christina Gallegos	APHL
X	Amy Liu	Inductive Health / APHL
	Raj Dash	Duke / CAP
	John Snyder - regrets
	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 If CDC is closed next week, we will cancel next week Contact for Cancer Reporting - Riki to share Samantha Spencer’s contact and NAACCR contact also
Update from HL7 WGM/FHIR ConceptMap extensions	Riki	Specimen CMT draft profile on ConceptMap: Introduced the concept of the SpecimenCMT and shared the ConceptMap - we had a lot of discussion if mappings should be 1:1, or if mapping from one concept to many is allowable; for example if you want to map from a pre-coordinated concept like “left arm” to “arm” and “left” using ConceptMap.group.element.target.dependsOn.attribute to describe the additional element that can also be mapped to it (though it would need to have a local and a standard code for the initial map), which is what the V2-SCT example map is using via .product). Trying to gather more community input via this zulip thread: <ADD ONCE POSTED> Also of interest during that quarter: https://edu.anatomymapper.com this app is accessed by user the expression can then be copied as rich text is text and AML_code (but not with the mappings to SCT and NYU number) and pasted into documentation - this is focused on skin locations on the body AJCC has very good diagrams for the organs (maybe via CAP; does the eCP include the pictures vs just lists of locations) - maybe he can add that to the app - connect CAP to Matt Molenda? Link to notes for more info: https://confluence.hl7.org/spaces/VOC/pages/358884369/Sept+2025+-+HL7+WGM+-+Thursday+Q1+Minutes Next Steps: Wait for responses on zulip thread for evaluation of the allowable multi-mapping as well as use of extensions for the additional business/implementation guidance.
CSTE presentation follow up	Nancy	Nancy submitted proposal to create a pre-analytical document for wound specimen collection to CLSI Their pre-analytical document (PRE-07) for respiratory specimen collection is in review (should come out in spring 2026) - maybe we can add the SCT coding to include; For LOINC mapping maybe we could include a link to the SARS-CoV2 LIVD file on CDC’s website as an example of LOINC coding that will be needed = https://www.cdc.gov/laboratory-systems/php/livd-test-codemapping/index.html - Nancy will ask.
Specimen CMT terms review	Christina	no topics today AIMS dB is being re-connected - considering how to make data accesisble through that smartsheet version: https://app.smartsheet.com/sheets/h6JWqw5v9pwvrqWMq9r4g85CXjv9M8VvVqvHRwc1?view=grid
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 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 (https://confluence.ihtsdotools.org/x/JZFpCg ): “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) = https://browser.ihtsdotools.org/?perspective=full&conceptId1=25469001&edition=MAIN/SNOMEDCT-US&release=&languages=en 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 https://confluence.ihtsdotools.org/x/05NpCg Anion Gap calculation (qualifier) = https://browser.ihtsdotools.org/?perspective=full&conceptId1=723205003&edition=MAIN/SNOMEDCT-US&release=&languages=en 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 https://loincsnomed.org/ ) 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 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
Previous Action Items		Nancy Follow up: Container work For EDTA we need to specify K2 or K3 Review https://aphlinformatics.atlassian.net/wiki/download/attachments/2018312270/ContainertypesListRikiEmailed20171013.xlsx?api=v2 Maybe combine with ADD EUROPEAN LIST LINK Riki’s Follow up - none of these got done yet 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 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) and also Robin for US 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 anyone 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 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 using a script to create this from dB content - Working with Clinical Architecture to model in Symedical, so can then be shared at least via their subscription, but maybe also arrange sharing via API? 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
Call Adjourned		11:53 AM ET
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
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.)

Recording:

did not record

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