2026-03-05 LabMCoP Meeting Notes

Date

Mar 5, 2026

Attendees

Present	Name	Organization
X	Nancy Cornish	CDC
X	Manjula Dharmawardhana	CDC
X	Riki Merrick	APHL
-	Christina Gallegos	APHL
X	Amy Liu	Inductive Health / APHL
	Raj Dash	Duke / CAP
X	John Snyder	Pragmatic Terminologies, LLC
X	Andrea Pitkus	UW
X	Kathy Walsh	Labcorp
	Rob Hausam	Hausam Consulting
	Pam Banning	3M
	Elissa Passiment

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
Follow up from last call		Importance of performed test date/time when same sample is being used for confirmatory testing at a later time what about Add-on testing - would need to know the exact specimen as part of the order, but then also there would be more than 1 result on the same specimen, so performed test date/time is also important for that understanding when the different parts of a panel were completed and the final report is only done when the last test is completed
STEC SNOMED CT question from OR PHL	Riki	We need a custom code and language to be closer and more specific to “Shiga toxin-producing Escherichia coli, Non-O157, unable to further serotype” to be built. Looking at the options that you’ve provided, nothing quite fits as we need it to. To elaborate, part of the testing workflow uses Latex Agglutination to confirm its “Non-O157” and then PCR is used to confirm it’s “Shiga toxin -producing”, and lastly serotyping is performed to try and identify which O antigens are present, but Micros are unable to confirm beyond “Non-O157”. Need a new concept for Shiga-toxin-producing E. coli non-O157, but need to understand, if Shiga-toxin producing always = enterohemorrhagic, or not need to understand what LOINC they are using for this overarching conclusion - maybe https://loinc.org/53946-0/ ? use of the finding hierarchy for not isolated = https://browser.ihtsdotools.org/?perspective=full&conceptId1=394870008&edition=MAIN/SNOMEDCT-US&release=&languages=en ? often not used in the LIMS, where they are just using the organism hierachy LIMS has a lot of drop down menu and not specifically coded, they are sent as free text for micro and blood bank, the LIMS often set these up as workflow steps, not a specific results (so you can add on based on the results of the earlier step in the process - often does not allow adding LOINCs and SCT codes for these For the reported result of the culture, when an organism is not isolated should be mapped to the clincal finding hierarchy (if that field is mappable) Sensitivity reporting (mapping to SCT in OBX-5, but not in OBX-8 where using HL70078) Mapping OBR-4 (orders) to LOINC for the reflex tests is desired by PHA, but often not supported in the LIMS Riki will follow up and then submit the concept to John
Specimen CMT terms	Christina	not today
Follow up items		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: 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 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
Lab tests as procedures or orderables	Do we still need this?	Recommendation by SNOMED is that the Observable entity hierarchy be used for both ordering and resulting. As for the technique hierarchy, that in no way is intended to be used for either ordering or resulting laboratory tests. Those concepts are used to model both observables and procedures. SNOMED LOINC extension: https://browser.loincsnomed.org/?perspective=full&conceptId1=363787002&edition=MAIN/LOINC/2025-09-21&release=&languages=en The problem is that major EHR-s vendors have set up CPOE using Procedures for orders to initiate a workflow (that creates the triggering event in the system) - that’s where the push-back comes from. There is a CPT to SNOMED CT mapping (as a paid mapping available from AMA), but no LOINC mapping. Can we reach out to CAP Informatics, ADLM Informatics and ASCLS Informatics to get their take on where Lab tests should live We had said we would work through the 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 For CAP cancer reporting is using SNOMED CT - would be good to look which they chose to represent the performed lab test There is this question in the LOINC Community: https://forum.loinc.org/t/assistance-creating-a-value-set-for-all-loinc-procedure-concepts/2993 it is related to this US Core FHIR Change request: https://jira.hl7.org/browse/FHIR-54415 Answer to this one is that in USCDI Procedure (https://isp.healthit.gov/taxonomy/term/781/uscdi-v6) does not list LOINC as applicable Vocab standard in any verion, so remove it. Often folks think of lab tests as procedures, because they can be ordered in CPOE (and outsidde the US, in the UK for example that’s how folks have modeled those, which is why LOINC was adding more of the high level order codes in 2.81 release, so we still should tackle the LOINC community question. John was working on creatign an intesnional valueset definition based on class + type and maybe a few other attributes
Call adjourned		12:02 PM ET _ below not discussed
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 - - zulip thread review: https://chat.fhir.org/#narrow/channel/179202-terminology/topic/Specimen.20Cross-Mapping.20Table.20in.20FHIR.20ConceptMap.20Feedback/with/542341153 Check if ConceptMap resource in FHIR R6 incorporated the coding datatype for valueset attributes Clinical Architecture has modeled the Specimen CMT in Symedical, though still need to check how to deal with the prototype additional field instructions (for nice to have elements) 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 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 try to get AMA support to get providers to adopt this Reach out to IDSA, too Need to consider long-term curation
European Semantic work		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 Confluence page: Ask if Rob can keep us updated
Specimen CMT pilot implementers		Review where we are: Vendor Connections
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 https://infobeta.cap.org/shield/
Specimen CMT - tracking implementation impact Setting baseline Define metrics
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

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