2023-10-30 Vocabulary WG Meeting Notes

Rajesh Dash

Jim Case

Scott Campbell

Amy McCormick

Eza Hafeza, Regenstrief Ins.

Pam Banning - 3M Health Info Systems

Dan Rutz

Rob Hausam

Anne Peruski

Muktha Natrajan (DLS/CDC)

Andrea Pitkus

Xavier Gansel

Scott Campbell

UNMC

Co-Chair

Steering Committee member

Raj Dash

College of American Pathologists (CAP)

Co-Chair

Steering Committee member

Dan Rutz

Epic

Steering Committee member

Muktha Natrajan

CDC

Sandy Jones (Secondary)

CDC Cancer Surveillance

Anne Peruski (Secondary)

CDC

Andrea Pitkus

University of Wisconsin-Madison

Steering Committee member

Xavier Gansel

bioMérieux

Steering Committee member

Stan Huff

Graphite Health

Steering Committee member

John Snyder

NLM

Steering Committee member

Rob Hausam

Hausam Consulting

Marjorie Rollins

Regenstrief

Steering Committee member

Amy McCormick (secondary)

Epic

Nanguneri Nirmala

Tufts Medical Center

Steering Committee member

Mehdi Nassiri

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

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

  Specimen CMT content / adoption

  surgical synoptic reporting

  Anatomic Pathology Structured Reporting (cancer pathology)

  Structured genomics reporting (WGS, biomarkers, etc.)

  Test naming conventions

• What is the expected outcome of the group and timeline?

Selected focus areas decided upon on 10/30

1. D-dimer (DIMER - Overview: D-Dimer, Plasma (mayocliniclabs.com))

2. AST (AST - Overview: Aspartate Aminotransferase (AST) (GOT), Serum (mayocliniclabs.com))

3. Urine culture and susceptibility testing (DUHS Electronic Test Catalog (duke.edu))

• Focus on result interoperability.

• HL7 v2.x or FHIR or both

  • value sets are different

  • Current state of interoperability challenges are best documented using v2 as that is what is prevalent today in healthcare organizations

  • Focus on semantic interoperability but tag other interoperability challenges (syntax, valuesets, data types, etc)

  • Focus on v2 for “phase 1”.

  • Phase 2 will examine FHIR and what additional considerations are important

• Obtain sample results across multiple institutions (Duke-Epic EHR+LIS [Dash], Mayo-Epic EHR+Soft LIS [Banning], UNMC Epic EHR+Sunquest LIS[Campbell], ARUP Cerner LIS[Banning])

• 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.

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