2024-07-01 Vocabulary and Standards WG Meeting

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

Use case review

LRI

LRI review

Device Type - current HL7 references table 961, which is empty. The consensus of the WG is to use the UDI schema proposed by the FDA (UDI Basics | FDA). We defer to the LIDR or future workgroup: extension of additional device / test kit identifiers for which different patterns of (new) data elements (for which no established standard exists) might be required.

The use of the following terminologies are defined in the LRI implementation guide v2 (release 5, May 2024) specifies coding system to be used (https://www.hl7.org/implement/standards/product_brief.cfm?product_id=279 )

Open

LOINC is slated for use in OBX-3. All non-numeric results should be coded in SCT whenever possible to support interoperability.

The workgroup recommends for all qualitative results (answers), SCT codes should be used (duplicate LOINC codes should not be used). Organisms (such as that specified in culture or molecular identification) use SCT codes. Susceptibility results to antimicrobials uses LOINC (OBX-3) for the antimicrobial name and SCT for a qualitative result (susceptible or not) or can have a numeric result (not coded).

Workgroup recommendation is to promote use of SCT codes for all qualitative answer sets and specimen related data whenever possible in support of interoperability (instead of allowing use of other schemas, such as local codes, a LOINC answer code or an HL7 table)

Excerpt for reference (as examples of options permitted that may preclude interoperability):

Code to SNOMED CT preferred; codes for Specimen Type (SPM-4) as provided in the Vendor Specimen Description column of the LOINC Mapping tab in the LIVD document. ELR allows use of both SNOMED CT codes from the specimen hierarchy (PHVS_Specimen_CDC: https://phinvads.cdc.gov/vads/ViewValueSet.action?id=1F2170E4-00A6-DF11-9BDD-0015173D1785) and HL70487 codes (PHVS_SpecimenType_HL7_2x: https://phinvads.cdc.gov/vads/ViewValueSet.action?id=E1399690-F6D4-E111-AC0B-0050568D00F8) Some labs may support the sending of source site information (SPM-8); ELR R1 uses SNOMED CT codes compiled in the HITSP body site value set (PHVS_BodySite_HITSP: https://phinvads.cdc.gov/vads/ViewValueSet.action?id=9A2D4051-3AA6-42EB-AE88-541C9094B0FB) In older versions, when using OBR-15 use HL70070 for OBR-15.1 and HL70163 for OBR-15.4. "

Specimen Type (SPM 4): "Codes from either HL70487_USL or SNOMED_CT_USL Specimen hierarchy codes may be used. It should be noted that in the future SNOMED CT Specimen hierarchy may become the only recommended value set so trading partners should consider moving in that direction. LRI_NDBS_Component Value Set Fixed to: '440500007^Blood spot specimen^SCT' "

LOINC (Home – LOINC)

SNOMED CT (Home | SNOMED International)

UCUM (Unified Code for Units of Measure (UCUM) at NLM (nih.gov))

LOINC - SNOMED agreement here (new agreement coming out 4q of 2024)

Aggregating laboratory data answer set responses across many customers and identifying missing SCT codes might be helpful. Dan Rutz will explore whether a two column data with LRR name + distinct result. Or even just a list of distinct results (one column of unique data).

Next steps

1.  Compile our recommendations, email draft to working group meetings, and schedule to present to Steering committee.

2. Identify based on steering committee discussion what best additional next steps might be helpful from this workgroup. Could potentially sunset this group if charge fulfilled.