Indiana University/Indiana University Health/Association for Molecular Pathology
Steering Committee member
Eza Hafeza
Regenstrief
Steering Committee member
Jim Case
Snomed International
Steering Committee member
Mary Kennedy
CAP
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Discussion topics
Item
Notes
Item
Notes
Review: Identify tangible activities for this working group
Identify use cases / challenges in lab interoperability.
No survey sent out (yet)!
Review of prior notes:
Xavier Gansel limitation : no agreement on coding HL7 value sets & specimens with the standards
Dan Rutz, pre/post coordination upper left lung can be represented with about 40 different combinations of SCT cods (specimen type, source, specimen collection procedure). Highly dependent on health IT functionality and what is mapped/used in those systems
Sandy Jones, CDC Agree that we need to identify what standards should be used and how. We need to eliminate the need for so many mappings/translations to exchange data.
Span of tests: for chemistry, microbiology, etc. order and result (LOINC), AOE question (LOINC), specimen type, specimen source and/or body site (SCT), specimen collection method (SCT).
How the test was performed, describe the result → interoperability gaps exist today even with standards in place today
Limitation: no agreement on coding HL7 value sets & specimens with the standards
How to address issue of free text vs discrete data capture vs discrete coded data capture?
Specimen Type and Source is another challenge for many. Also pre/pos coord recommendations, etc.
Organisms / SCT precoord/post coord (and depending which IG)
And what to do when a IVD test doesn't distinguish to a single org (A or B, but can't tell which). and mapping these.
Previously suggested efforts to focus on:
project around result codes - qualitative (all lab domains), given priority of 1 (Make recommendations regarding use of terminology for results…align HL7/LAW)
project around result codes - micro-organism (gram stain, rod/cocci)
project around result codes - AST
project around result codes - microscopic and culture observations
Review how test result is built across multiple LIS / EHR platforms.
Include any codings / mappings that are part of the build or used for reporting
SCT, LOINC, HL7 value sets, any local codes that might be helpful internally or externally in uniquely identifying the result
Document the way in which results currently transmitted
Examples of de-identified results as they appear in the chart (screenshot of what the clinical provider is able to see) to include reference ranges or alert values (if any)
Name of the result, including any short / display name forms
Sample HL7 result messages
Package insert for test being performed on instrument. Document instrument name, internal ID, device ID, test kit ID, reagent lot ID
Collate data and review at next call.
Identify challenges in interpreting results from different sources.
Propose how we would support interoperability of results of the same tests and recognition of tests that are actually different and cannot be compared as an equivalent type.
Selection of standards and terminology binding is dependent on the particular set of standards that need to be supported. E.g. the terminology binding can be different between an HL7 v2.x message and a FHIR resource.