2026-06-25 LabMCoP Meeting Notes

Date

Jun 25, 2026

Attendees

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

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 Nancy is out for 1 more week
Working with DHQP for NHSN reporting	Nancy	Follow up list: Urine culture results for HAI requriements Gather current means to record bottle volume Biomeriuex it records the volume for each bottle, but not coming across with the instrument, no code set, lab has to record it on their own - willing to help SHIELD - no feedback received Provide feedback on NHSN IG: - Submit Jira to GET INFO FROM LAST MINUTES!!!
Question on Karius Testing	Riki/Christina	Next Steps: review the list of results and figure out where current gaps in organism hierarchy are AND identify the substance concepts that are still missing in SCT do education to get LIS and EHR-s and surveillance systems to support more than one hierarchy for results - bring this to the SHIELD Standards and Vocab WG: organism qualifer clincial findings substance let Karius know that in the future we will have substance concepts, but it is going to be a little while need to also review the LOINC and potentially adjust that
Follow up from AndesVirus codes question	Riki	John and Riki have reached out to Steven Bradfute to get the low-down on the taxonomy and then figure out how to model the disorder concepts and create submissions for anything new pathway for requesting CPT codes pathway to getting ICD-10-CM codes (when ICD-11 codes exist) Overall thoughts on setting up a code request process (across all SDOs) for emergencies (how do we ensure that Emergency Response teams include properly coded reporting in their work?)
SNOMED International proposal for Serologic terms	John	SNOMED International is purposing to revise content with “Serology” or “Serologic” in the FSN and remove this wording from FSN across clinical findings, procedures, and observable entities. I would like LabMCop team to review and provide any feedback on the topic during the meeting. Discussion today: Reviewing the immunity to X organism term personally Riki prefers “immunity to X organism” over “organism X immune”, but unsure if that’s worth pushing these are probably used in problem lists or to docuemtn reason for not administering a vaccine, so having the name of the organism in the term seems appropriate while the test result is created in the lab and shared with the provider (EHR-S) it is the provider that diagnoses on the immune status of the patient looking at the hierarchy these are under 365861007 \| Finding of immune status (finding) for some organisms there is an intermediate concept of “Organism X immune” = see blue group (or even an addtional one of “finding of organism X status” = see red group others just have the “Immunity to organism X by serology” = see green concept but the concepts to be adjusted are not fully modeled, so it is not clear, if “by serology” means that #1 antibodies are being detected (or more precise specific levels of specific antibodies) or if #2 it is the method by with the immune status was determined, not the fact that antibodies levels measured Serology is also a department in the lab immunity usually is determined by the titer result of IgG antibodies being over a specific threshold Looking at definitions for serology testing: https://aphl.org/docs/default-source/technical/id-testing-explainer_serology-testing.pdf?sfvrsn=6c4ecf5f_1 Looking at how these are used: https://www.cms.gov/files/document/mln909221-complying-documentation-requirements-lab-services.pdf Do we need to know the methodology - EIA, or IFA, DFA etc, or just the fact that these were AB measurements as compared to reviewing immunization history? Next Steps: John will post question on meaning of “by serology” to the forum (is it the grouping of methods, or is it the fact that specific levels of antibodies are looked for to determine immunity Pick back up on Jul 9, 2026
HPV screening/confirmatory testing workflow	John	Prepare for a call on Jul 2, 2026 or Jul 23, 2026 : We’d like to discuss with the group the current modeling and naming policy for procedures connected to detecting HPV and/or pre-cancerous/cancerous cells in the cervical region. Our national screening program for cervical cancer has recently updated their guidelines for testing and analyzing said tests, and currently the content in SNOMED CT that deals with these tests are defined as always being of a cytologic kind. Meanwhile, our new guidelines defer to a liquid based cell sampling from the cervix that may be used to test for the presence of HPV, and if positive, used for further (cytological) testing to look for pre-cancerous/cancerous cells. This puts us in a bit of a pickle. The procedure to obtain cell samples is the same for both the HPV test and the cytological test, and the same test tube is used for both analyses. In the cases where the HPV testing is negative, a cytological analysis is never done. Therefore, calling a procedure a “liquid based cytology” when it won’t necessarily be analyzed for cytology seems incorrect. We want to have a discussion around whether or not we’re the only ones in this predicament, or if we ought to raise the issue to SNOMED International for a thorough review of existing content. Best regards, Hanne From Andrea Pitkus' email: US protocols are usually to reflex to HPV testing with PAP Smears. Most use liquid based methods such as Thin Prep (brand). Technically, cytopathology is the term used for this area of laboratory testing. I'm sure Nancy will have more thoughts too. Robyn Temple-Smolkin (AMP) email: Our reference lab used to run HPV from ThinPrep or SurePath. Sample would go to the hospital cytopathology lab for preparation of the pap smear then the atypicals were reflexed as sendouts to us for high-risk HPV testing by PCR. The entire ThinPrep/SurePath vial was the specimen we received. We also did CT/NG off this sample when ordered. I believe this is still a very common workflow performed either within one institution or as a sendout, but defer to others' input on newer workflows as I have been away from day-to-day operations since joining AMP. Discussion today: = example of the collection kit the collection is the swab/brush/spatula of cells, this is really the collection container though Here is the labcorp example: which shows the different colelction methods depending on container used at the bottom Hologic ThinPrep package insert page: Try to see, if Jenna from Arup is available on either of those dates Note: Andrea and Riki are both out Jul 23, 2026, might hav eto find a later date, if July 2 is not working; John will call in only on Jul 2, 2026
Call adjourned		12:00 PM EDT - BELOW NOT DISCUSSED
Specimen CMT - Hosting Options	Riki	Any Updates on FU with: Clinical Architecture: They could create conceptMap based on the content model they built, need to follow up about FHIR server usage ONC: Pull up email from Carmela
Specimen CMT terms	Christina	Review collection method concepts (initiated by USCDI valueset creation: ): retired concepts: 24139008 Endoscopy of urinary bladder (procedure) 176178006 Diagnostic cystoscopy (procedure) 397394009 Bronchoalveolar lavage (procedure) 1388791008 Urine collection after prostatic massage (procedure) 1571000284107 Arterial sampling catheter procedure (procedure) 78181000284104 Cornea impression (procedure) not in procedure hierachy: 258429002 Rectal scrape specimen 261665006 Unknown Using preferred name, not FSN (these should not be an issue in the final version, since FSN or preferred name would be pulled based on the concept code, correct?): 122462000 Drainage procedure 14766002 Aspiration 232595000 Bronchoscopic lavage only NHSN terms left for questions:
CMT Governance process
CMT proposed maintenance process		Start writing this up on this confluence page: Questions from Zulip thread that should be covered by the process we come up with here: Requests for terms used in practice that are not yet in the Cross Map Table? Requests for any corrections or needed updates to terms? What type of version control will be leveraged for releases and major/minor updates? How do you plan to incorporate SNOMED CT Release Updates into Cross Map updates/releases? At what frequency will updates occur? For example, will you process SCT updates once yearly and have a subsequent Cross Map release yearly with changes or more or less often? How do you communicate differential changes between releases? Is a differential file produced or is it expected that users will be able to find changes on their own? What type of customer support for downloads is expected? Will the release entity provide or is it expected of the site hosting the content for download? Both need to work colLABoratively to ensure no blockers arise for users/consumers. User Guide starter
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
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: Collection method is now USCDI element, review proposed value set:

Recording:

Please reach out to riki.merrick@aphl.org for access to the recording.

Chat:

11:12:28 From Andrea Pitkus :
11:16:13 From Andrea Pitkus :
11:24:11 From Andrea Pitkus : I'm OOO Jul 23rd too
11:24:56 From Andrea Pitkus :
11:25:03 From Andrea Pitkus : may wish to share this package insert with her too
11:25:25 From Andrea Pitkus : Replying to "may wish to share this package insert with her too"

there's a US tab and Worldwide tab
11:38:08 From Andrea Pitkus : I believe there are certain AB titers considered immune too. Realize it's slightly different
11:39:08 From Andrea Pitkus :
11:41:24 From Andrea Pitkus : Replying to " "

"Rubella IgG serology testing should be used for assessing rubella immunity before, during, and after pregnancy."
11:42:41 From Andrea Pitkus : Serology is the scientific study of blood serum and other bodily fluids, primarily focusing on the detection and measurement of antibodies.
11:44:33 From Andrea Pitkus :
11:45:33 From Andrea Pitkus :
11:45:58 From Riki Merrick :
11:46:17 From Andrea Pitkus :
11:48:29 From Andrea Pitkus : https://aphl.org/docs/default-source/technical/id-testing-explainer_serology-testing.pdf?sfvrsn=6c4ecf5f_1
11:53:27 From Andrea Pitkus : Yes, physicians must document if a test is a serology for immunity. This ensures accurate insurance reimbursement and verifies that the test is medically necessary.
11:54:28 From Andrea Pitkus : Replying to "Yes, physicians must document if a test is a serology for immunity. This ensures accurate insurance reimbursement and verifies that the test is medically necessary."

https://www.cms.gov/files/document/mln909221-complying-documentation-requirements-lab-services.pdf
11:55:33 From Andrea Pitkus : Replying to "Yes, physicians must document if a test is a serology for immunity. This ensures accurate insurance reimbursement and verifies that the test is medically necessary."

This has helpful info for clinicians
11:57:27 From Andrea Pitkus : Replying to "Yes, physicians must document if a test is a serology for immunity. This ensures accurate insurance reimbursement and verifies that the test is medically necessary."

Health care providers with 2 documented doses the MMR vaccine are not recommended to be serologically tested for immunity.
11:58:10 From Andrea Pitkus : Replying to "Yes, physicians must document if a test is a serology for immunity. This ensures accurate insurance reimbursement and verifies that the test is medically necessary."

12:00:22 From Andrea Pitkus : have to run

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