1. Lab and Messaging CoP 11/29/2012

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

3. 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

4. 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 National Animal Health Lab Network (NAHLN) principle in mapping to Specimen (SPM) segment fields

5. SPM fields and SNOMED vocabulary Note: SPM-10 – Specimen Collection Site also available – will review when looking at catheter infections

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

7. 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

8. Map local terms to PHLIP preferred term

9. Map single term to ALL SPM segment fields

10. Provide education – definition/ links to collection manual

11. Provide education - preference by lab domain

12. Harmonize/standardize use of terms

13. 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

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

15. 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

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

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

18. Nationally curated vocabulary Create Governance Engage all stakeholders Engage the Subject Matter Expert (SME) community Define change control and review processes Define distribution

19. 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)

20. 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 Public Specimen Collection Manual

21. 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