2024-03-11 Vocabulary WG Meeting Notes

Raj Dash

College of American Pathologists (CAP)

Chair

Steering Committee member

Scott Campbell

UNMC

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

Kevin Schap

CAP

Review: Identify tangible activities for this working group

1. Find a co-chair for this group!

2. This workgroup is slated to comment on the roadmap’s approach to addressing educational / training gaps in the use of standards such as LOINC. Will address at next meeting!

3.  

Use case review

D-Dimer (qualitative) 

AST (quantitative)

LRI review

Went through LRI spec and identified the following elements as most relevant. We will work through the standard used to encode each one and identify recommendations for change, if any:

Administrative Sex - (as opposed to sex at birth). Some states may have different requirements (O&O discussion here discusses differences in states). USCDI Gender Identify as recommended by USCDI, references SNOMED CT US Edition as follows (Representing Patient Gender Identity | Interoperability Standards Advisory (ISA) (healthit.gov))

• Gender identity. LOINC code: 76691-5

• Male. SNOMED CT U.S. Edition code 446151000124109

• Female. SNOMED CT U.S. Edition code 446141000124107

• Female-to-Male (FTM)/Transgender Male/Trans Man. SNOMED CT U.S. Edition code: 407377005

• Male-to-Female (MTF)/Transgender Female/Trans Woman. SNOMED CT U.S. Edition code: 407376001

• Identifies as non-conforming gender (SNOMED CT U.S. Edition synonyms include: Genderqueer; Identifies as neither exclusively male nor female, Non-binary gender) SNOMED CT U.S. Edition code: 446131000124102

• Additional gender category or other, please specify. HL7 Version 3 code: OTH

• Choose not to disclose. HL7 Version 3 code: ASKU 
  Please note other systems do exist (Homosaurus Vocabulary Site)

Race - multiple races (unlimited) need to be supported ideally within information systems. Leading EHR vendors support this already. These lists of terms are not supported by any ontology (and there is no plan for future support at this time).

For USCDI both of these standards are required:

• The Office of Management and Budget Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity, Statistical Policy Directive No. 15, as revised, October 30, 1997

• CDC Race and Ethnicity Code Set Version 1.2 (July 2021)

Interpretation Codes - text based interpretation of a quantitative value (e.g. detected, not detected; positive / negative). Current value set: HL70078_USL. For semantic interoperability, the interpretation code should be put into OBX-8 using SNOMED CT as the vocabulary. Current practice may have this value in OBX-5 but that should be discouraged to support semantic interoperability. Andrea and Dan identify that some systems have limitations that are sensitive to having no value in OBX-5 (even though HL7 indicates conditional, not required). There appears to be some controversy if there is only a qualitative result (e.g. detected, not detected), whether that would go in OBX-5 vs leaving OBX-5 blank and putting the interpretation code into OBX-8. Abnormality / panic flags also fit in OBX-8 (but it can repeat). We could propose a deprecated mechanism to allow for backwards compatibility but propose the ideal future state. Could look at CLSI standards for reporting (will request Kevin Schap at CAP).

The current HL7 table 78 list of values include:

L Low H High LU  Very low HU Very high LL Critical low HH Critical high < Off scale low > Off scale high N Normal A Abnormal AA Critical abnormal U Significant change up D Significant change down B Better W Worse S Susceptible R Resistant I Intermediate EXP Expected UNE Unexpected NS Non-susceptible SDD Susceptible-dose dependent IE Insufficient evidence SYN-R Synergy – resistant SYN-S Synergy – susceptible POS Positive NEG Negative IND Indeterminate DET Detected ND Not Detected RR Reactive WR Weakly reactive NR Non-reactive MS Moderately susceptible. Indicates for microbiology susceptibilities only. VS Very susceptible. Indicates for microbiology susceptibilities only. (no longer in v2.9, but no change here) null No range defined, or normal ranges don’t apply AC Anti-complementary substances present TOX Cytotoxic substance present QCF Quality Control Failure OBX Interpretation qualifiers in separate OBX segments HM Hold for Medical Review

Observation Result Status Codes Interpretation - Final, prelim, OBX-11

Result Status

Value Type

Specimen Type

Specimen Reject Reason

Specimen Condition

Relevant Clinical Information

Device Type

LOINC

SNOMED CT

UCUM

Next steps