1. Lab and Messaging CoP 10/25/2012

2. Agenda Agenda review Introduction to the Specimen Cross-Mapping Table (Specimen CMT) – Background – Expected uses – Planned next steps – Discussion Other Topics

3. 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 terms Decision to move to use of SNOMED CT Applied NAHLN principle in mapping to SPM segment fields

4. SPM fields and SNOMED vocabulary

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

6. The Specimen CMT Expected uses: Provide mapping from single term to ALL fields in the SPM segment Provide education (link to collection instruction, use etc. along with definition for each term) Provide preference for some terms based on type of lab test ordered (lab domain) Harmonize/standardize use of terms Become national resource of curated vocabulary

7. Map local terms to PHLIP preferred term

8. Map single term to ALL SPM segment fields

9. Provide education – definition/ links to collection manual

10. Provide education - preference by lab domain

11. Harmonize/standardize use of terms

12. 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

13. Specimen CMT - few clicks on data entry side Use pre-coordinated term in specimen type

14. 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

15. Specimen CMT – same term on data analysis side Use simple term in specimen type vs. pre-coordinated

16. Specimen CMT – same term on data analysis side Use Prototype term in specimen type

17. Nationally curated vocabulary Create Governance Engage all stakeholders Engage the SME community Define change control and review processes Define distribution

18. 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)

19. Specimen CMT Planned Steps: Review of definitions, reference links, assignment of usage by lab domain American 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 systems

20. Questions? Can single term assignment user side – still have all fields filled in? On both data entry and data receiver side? Search capacity – use SNOMED hierarchical structure (e.g: search for urine and all its descendants?) Any gaps in our process/approach? Issues/suggestions for improvement?