Lab and Messaging CoP

11/29/2012

Agenda

• Agenda review• Introduction to the Specimen Cross-Mapping

Table (Specimen CMT)– Background– Expected uses– Planned next steps– Discussion

IT Background

For electronic data exchange we use standards:• Information exchange standards like Health

Level 7 (HL7) – helps define where to find information

• Data standards like Logical Identifiers Names and Codes (LOINC) and Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) for the concepts we need to share

The Specimen Cross-Mapping Table (Specimen CMT)

Background:In 2009 state and CDC PHLs collected specimen terms in use and attempted to harmonize usage and map to HL7 terms (Table 70 or 487)Mapping process revealed gaps:• Missing common terms• Ambiguous termsDecision to move to use of SNOMED CTApplied National Animal Health Lab Network (NAHLN) principle in mapping to Specimen (SPM) segment fields

SPM fields and SNOMED vocabulary

Field HL7 Name Consider for coding Value sets suggested in ELR to PH v2.5.1

SPM-4 Specimen TypeHL70487SNOMED CT specimen hierarchy

HL70487SNOMED CT specimen hierarchy

SPM-5 Specimen Type ModifierSNOMED CT qualifier,morphologic abnormality hierarchy

SNOMED CT qualifier hierarchy

SPM-6 Specimen AdditivesHL70371SNOMED CT substance, product hierarchy

HL70371

SPM-7 Specimen Collection MethodHL70488SNOMED CT procedure hierarchy

HL70488SNOMED CT specimen collection subtree (procedure hierarchy)

SPM-8 Specimen Source SiteSNOMED CT body site,substance,physical object hierarchy

SNOMED CT body site hierarchy (per HITSP)

SPM-9 Specimen Source Site Modifier SNOMED CT qualifier hierarchy SNOMED CT qualifier hierarchy

Note: SPM-10 – Specimen Collection Site also available – will review when looking at catheter infections

Interoperability Problems

Background (cont):Most labs have 1 field, possibly 2 for specimen source – some labs support all SPM fieldsIdea of Specimen CMT was born to allow use of single term to map across multiple fields

The Specimen CMT

Expected uses:• Provide mapping from single term to ALL specimen source

term fields in the SPM segment• Provide education (link to collection instructions, use etc.

along with definition for each term)• Provide guidance on what specimen term to use based on

type of lab test ordered (by lab specialty; for micro test urine need to know collection method was sterile – not so important for chemistry test)

• Harmonize/standardize use of terms• Become national resource of curated vocabulary

Map local terms to PHLIP preferred term

Map single term to ALL SPM segment fields

Provide education – definition/ links to collection manual

Provide education - preference by lab domain

Harmonize/standardize use of terms

Specimen CMT - Discussion

• Balance between data entry / data analysis utility– Need few clicks on data entry side – ideal a single

term to choose from– Need to search on type / source site / collection

method separately– Balance between consistent term application and

traditional use

Specimen CMT - few clicks on data entry side

• Use pre-coordinated term in specimen type

Search Examples

• Find all submitted tissues – then find all collection method = SWAB – this would be a search to help identify incorrectly submitted specimen in micro domain

• Find all stool samples, then of those all that were bloody and liquid

• Find all urine specimen submitted• Find all specimen from the Cervix

Specimen CMT – same term on data analysis side

• Use simple term in specimen type vs. pre-coordinated

Specimen CMT – same term on data analysis side

• Use Prototype term in specimen type

Nationally curated vocabulary

• Create Governance• Engage all stakeholders• Engage the Subject Matter Expert (SME)

community• Define change control and review

processes• Define distribution

Improve SNOMED

• Specimen CMT identified:– Many new terms (all SNOMED hierarchies:

specimen, procedure, substance, morphologic abnormality)

– Issues with existing terms (better names, missing synonyms, updating relationships, modeling)

Specimen CMTPlanned Steps:Review of definitions, reference links, assignment of usage by lab domainAmerican Society of Microbiology (ASM)College of American Pathologist (CAP)American Clinical Laboratory Association (ACLA)American Association for Clinical Chemistry (AACC)Association for Molecular Pathology (AMP)

Input on feasibility for EHR and LIS/LIMS systemsPublic Specimen Collection Manual

Questions?

• Can ASM provide a SME or more for this project?

• Have asked API for help on committees to help designing good EHRsystems properly represent laboratory content