Date

​Dec 18, 2023

Attendees

Bolded names were present

Name

Organization

Hung Luu

Children’s

Riki Merrick

Vernetzt, APHL

Andrea Pitkus

UW

Pam Banning

3M

Xavier Gansel

Biomerieux

Amy McCormick

Epic

Dan Rutz

Epic

Rob Rae

CAP

Rob Hausam

Hausam Consulting

Sandy Jones

CDC

Stan Huff

Graphite

Ed Heierman

Abbott / IICC

Andrew Quinn

 

Laurent Lardin

Biomerieux

Anthony Killeen

UMN

Craig Collom

 

Marti Velezis

 Sonrisa / FDA

Walter Sujansky

FDA

Susan Downer

JMC

Ralf Herzog

Roche

Cornelia Felder

Roche

Daniel Golson

JMC

Andrea Prada

JMC

Maria Sagat

 CAP

Raja Cholan

FDA

Russ Ott

FDA

Akila Namasivayam

FDA

Agenda and Notes

Topic

Notes

Reviewing minutes from the last call - Action Item Follow up

Google Sheet review and discussion

  • Continued discussion from last week:

  • For the Potassium fields, how do we want to indicate a field is not applicable (i.e. specimen source)? Use N/A, leave it blank, etc. Do we need a response that is human and computer processable?

    • every test has a specimen source site, but it is not as important to be communicated for some tests - adding in N/A that will create confusion, because it exists

    • for Potassium it is not needed to determine the LOINC

    • but we want to also suggest to the lab when to report - is that in our authority?

    • We want the table to be consistent so that any user of data understands what defines the test

    • for systems each of the elements need to be available

    • you can automate for specific tests if there is only one collection method

  • We seem to have different definitions for specimen source

    • we MUST create operational definitions for the individual attributes of a specimen

      • type - what is collected in the container and sent to the lab

        • cannot collect serum/plasma (only blood with specific additives)

      • there are also derived specimen like isolates, that are cultured

    • We are working on the specimen cross-mapping table to help sort this out

    • source / source site needs to be sorted out more

      • CLIA calls it source

      • location on the body is important for many tests

      • source is organ system - for ser/plas it is blood; peripheral blood can be venous, artrial, capillary, line - body location matters for blood cultures

    • need to be clear what can be set up as default vs when it needs clinician input (extra click)

      • capillary collection for pediatric / senior specimen often built as single test, but would be good if that can be overwritten

  • Can we get UDIs for the Potassium, other info to fill out for all applicable fields for serum and plasma examples

Notes after Riki left:

Agreement that we need Specimen Type, Specimen Source (site or organ system), Specimen Collection Fields

Ask: Do we need to differentiate between what is Drawn to the lab vs what is being analyzed?

  • example capillary or whole blood drawn (specimen type collected)

  • What is specimen type analyzed? example serum or plasma

  • Isolate (no matter if whole blood collection or capillary, as both are spun down or serum or plasma are analyzed)

  • Discussion about susceptibility testing on original/collected specimen. Historically this is performed on each organism isolated from the specimen type collected. In LOINC that is what is specified in the System field. Dan asks how you’d tell in messaging? LOINC on original specimen (system), vs susceptibility testing performed with molecular methods. Detect presence of gene, nothing more than that.

  • isolates are being tested, but clinically relevant is where in the patient’s body the isolate came from

  • Question about more generic LOINCs.

    • sometimes the system in LOINC is more general - when that is done, MUST have the more detailed source site must be included

  • Specimen Type and Source mapped to SCT in EHR at specimen collection is requested of EHR vendors.

  • on the order site LOINC system can be excluded / or very general - then use AOE to get specimen source 31208-2 (should be sent in the proper HL7 element (SPM-4) rather than as an AOE)

  • important how to operationalize this more complicated system (defaulting may increase some “noise“ - when for specific cases user needs to make entry and forgets to make it

  • Andrea’s vision: specimen is being collected - type, procedure, source site is documented during item of order - that can then flow to lab / pathology / cancer protcols / then can be included in reporting - how can LIDR address this issue?

    • it specifies for particular test how the information is collected

  • Future discussion: Where specimen type (type of body fluids for cell counts), source (COVID culture) is in a different fields (AOE question response or lab result value), how do we want to capture that in LIDR?


Please see the action items at top of this page - Next deliverable is White paper outline by end of this year

And we need to prioritize the use cases, so that we can finalize the requiements for the first phase of LIDR, which need to be included in the White paper

Next call

Monday 1/8/2024 9 - 10 AM ET

NO CALLS: Dec 25 and Jan 1

HAPPY NEW YEAR!!!

Adjourned

 

Chat:

 

Recording:

 

Action items



Quick decisions not requiring context or tracking

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  1. Agreement that we need Specimen Type, Specimen Source (site or organ system), Specimen Collection Fields

Decisions requiring context or tracking

For decisions that require more context (e.g., documentation of discussion, options considered) and/or tracking, use the decision template to capture more information.

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