2026-03-12 LabMCoP Meeting Notes

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Nancy Cornish

CDC

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Manjula Dharmawardhana

CDC

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Riki Merrick

APHL

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Christina Gallegos

APHL

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Amy Liu

Inductive Health / APHL

Raj Dash

Duke / CAP

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John Snyder

Pragmatic Terminologies, LLC

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Andrea Pitkus

UW

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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

Specimen CMT - Hosting Options

• How can we publish the content in the dB?

  • Allow access 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:

    • Check if ConceptMap resource in FHIR R6 incorporated the coding datatype for valueset attributes

    • If we can do that, then can we ask THO to publish this as a “code system” to be hosted on the ONC FHIR terminology server?

  • 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

• Requirements for hosting sites:

  • need to be freely accessible (no cost), though licensing for the SCT concept is still required (for US use its ok)

  • need human readable access

  • need access for machines (API)

    • direct

    • download

• Manjula’s front end for viewing (created by AI)

  • allows viewing, searching - if we want to allow this would need to make sure this is hardened, and also need to address the licensing

  • with log in: maintenance

  • download different formats:

    • SQL + data

    • csv (this will need)

    • need to have a way to get users to accept the UMLS license for US users - if we want to use this internationally we should update on the monthly cadence (could do that automatically once the scripts are written - in MS SQL using stored procedures, should be able to be done in POSTgress)

    • NLM could host this if we provide the download packages (csv as minimum, maybe FHIR in the future) - would like to have this as tab-delimited files rather than csv - need to figure out how to deal with the special text characters

    • Could we ask SNOMED International to host the download packages - then we need to have all concepts promoted to international edition

• need to think about publication versions

  • how often?

  • in MS SQL they have a history table, which gives row versioning as automated process, then we would have to

  • assume at least twice a year after SNOMED US Edition is published

• 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:

  • need to define the governance process going forward

  • also define support processes

  • What to do when links are going stale, specifically in the definition of terms?

    • if we didn’t copy directly we don’t need to keep

    • could we separate the links from the definition text (links may be important for us internally, but don’t publish those) and keep linked in the dB - is manual process, but could do

Specimen CMT terms

Christina

next week

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:

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:

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

12:00 PM ET

European Semantic work

Link to the German FHIR IG around suceptibility testing:

Semantic Example section:

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

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