LRI+Vocabulary+Consensus+Page

include component="page" wikiName="siframework" page="LRI Header" This consensus page discusses In Scope Tests, UCUM, and SNOMED CT vocabularies captured in the LRI Strategy and Consensus Page. To refer to the LRI Vocabulary WG page, click here.

To cast your consensus vote, click the **Edit** button in the upper right hand corner of the page. Fill in your name, organization, Yes/Yes with comments/No with comments vote, and the comments section, and click the Save button. Please note: all no votes **must** include **actionable** comments. Only committed members may cast a vote, and each organization only receives one vote.

Consensus Table
Yes - 7/14/11 || **In Scope Test list:** Approve as proposed **LOINC:** LOINC codes are communicated in OBX 03 not OBX 05 as indicated in the “Position and strategy for Use of LOINC Vocabulary”. **UCUM:** I would prefer the recommendation for the workgroup be that, “UCUM is the recommended vocabulary for Units of measure, with the pilot testing to be used to verify or refute this recommendation”. **Snomed CT:** Approve as proposed for OBX 05 when data type = CWE. Approve as proposed for SPM 04 usage. Disapprove as proposed for usage in OBX 05 1) Include the specific field valuation (i.e. OBC 05.01 = XXX, 05.02 = ZZZZZZZZZZZZZZZ, etc) as discussed 2) Description for valuation of CWE 09 when SNOMED CT differs from the usage note developed by the IG group for this field (see [|here]) Valuation and usage must be harmonized across workgroups. 3) Recommend rewording the CWE Date Types in OBX 05 to include: "If OBX.5 contains a SNOMED CT code, then OBX.2 must be CWE." As worded now, it appears to indicate the when OBX 02 = CWE, OBX 05 must contain a SNOMED CT code. I believe my proposed wording reflects our group’s intent. 4) Recommend CWE from HL7 V2.6 or higher component definition to synchronize with IG WG. 5) Provide example usage for a CWE SNOMED CT result like we did at the face to face so the acceptable usage is very clear. These examples should include a CWE result without 05.01 being valued. **HL7 tables:**  1) Approve with a recommendation for adopting tables with content published in the HL7 Version 2.7 standard. __Includes tables :__ 0078 – Abnormal Flag 0001 – Administrative Sex 0005 – Race 0289 – Country Code 0004 – Patient Class 2) Include table HL7 0487 since we are indicating that it may be an acceptable alternative in the content for SPM 04.  Added 7/7/11:  //__1) Proposed addition as a second paragraph to the “Position and Strategy for Use of HL7 Tables” section of the consensus statement:__// **//The recommendation for adopting HL7 table content to be used as vocabulary; is that table content from the HL7 Version 2.5.1 standard is the required version, unless otherwise specified below.//** **//HL7 Table Content Version exception://** //**Table / HL7 Version**// //**0078 - Abnormal Flags / 2.7**// ||
 * = **Workgroup Member** ||= **Organization** ||= **Endorsement (Yes/No)** ||= **If No, what can be done to make it Yes?** ||
 * Cindy Johns || WG Lead ||= Revision Comments for 7/15/11 || Corrected additional typos, including those recommended by Rob Hausam below. Included additional heading of "Pilot Testing Strategy" in the UCUM section to be consistent with the one added for the SNOMED section. Updated comments on Legends tab, added links to HL7 tables Appendix B and C. ||
 * Bill Ormerod || Siemens || No with comments

2. I suggest that this table be restructured so that concensus can be noted on each point of contention (tests vs UCUM vs SNOMED). Or, a separate table for each point of contention. || Yes (7/14/2011) See additional comment. || ===**Suggested re-wording under "Position and Strategy for Use of SNOMED Vocabulary/CWE Data Types in OBX.5":**=== In laboratory test result reporting, the semantic relationship between OBX-3 (Observation Identifier) and OBX-5 (Observation Value) is that the asserted value in OBX-5 "refines" or "qualifies" the meaning of the laboratory test that is specified in OBX-3. This is true regardless of whether SNOMED-CT is used. When SNOMED-CT is used for a coded result value in OBX-5, this understanding of the semantic relationship is consistent with the use of qualifiers and refinement as specified in the SNOMED-CT Concept Model. It supports the use of SNOMED-CT concepts (codes) from the "qualifier value" or another appropriate SNOMED-CT hierarchy matching the "semantic type" of the laboratory test specified by the LOINC code in OBX-3. These result value concepts may specify a presence/absence value, an organism name or, in some cases, a finding of a negative assertion (e.g., " 394869007 ^Campylobacter species not isolated^SCT").
 * Scott Robertson || Kaiser Permanente || Yes with comments || 1. I am unclear on the roadmaps for adoption (and associated pilots/studies) will be reflected in requirements. A "roadmap" implies that something will be adopted in the future. While not a requirement, will there be some statement that "systems shall/should prepare for UCUM (etc)" or "systems shall/should show preparatory work for UCUM (etc)"? Will this be reflected in regulation? (Do we want it reflected in regulation?)
 * Rob Hausam || Hausam Consulting || No, with comments

We believe this is an appropriate position given the following examples:
====1. OBX-3 observations with quantitative LOINC test codes have numeric result values (plus units, if appropriate) which fully specify the observation. ==== ====2. OBX-3 observations with qualitative LOINC test codes using ordinal result scales may fully specify the analyte/component measured in OBX-3, thus only requiring a “Presence/Absence” type SNOMED-CT concept from the "qualifier value" hierarchy to fully specify the observation. ==== ====3. OBX-3 observations with "presence or identity" LOINC test codes using nominal result scales (e.g. bacterial cultures) may require a SNOMED-CT concept from the "organism" hierarchy to fully specify the observation. ====

For specific result categories:

 * Organisms
 * Identify using codes from the SNOMED-CT “organism” hierarchy
 * [This will normally exclude the use of codes from the “clinical finding” hierarchy representing the presence of a specific organism (e.g., " 312210001 ^methicillin resistant staphylococcus aureus positive^SCT”, " 431256002 ^culture positive for vancomycin resistant enterococcus^SCT”, " 441070005 ^Human enterovirus present^SCT”). However, in some cases a specific absence finding may be appropriate (e.g., " 404520004 ^no Chlamydia trachomatis found^SCT”).]
 * Organism-related substances (e.g. toxin, DNA, RNA, antigen, antibody, etc.)
 * Identify using codes from the SNOMED-CT “substance” hierarchy (e.g., "12671002^Clostridium difficile toxin^SCT”, " 121181000 ^Chlamydia trachomatis DNA^SCT”, " 121006005 ^influenzavirus A antigen^SCT”)
 * [This will normally exclude the use of codes from the “clinical finding” hierarchy representing the presence of a specific organism-related substance (e.g., " 310541005 ^Clostridium difficile toxin A detected^SCT”). Currently (as of the January 2011 release) we are not aware of any SNOMED-CT codes representing the absence of an organism-related substance.]
 * Presence and absence findings
 * Identify using codes from the SNOMED-CT “qualifier value" hierarchy (e.g., "52101004^present^SCT”, "10828004^positive^SCT”, "2667000^absent^SCT”, " 260385009 ^negative^SCT”)
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 14px;">Anatomic Pathology
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 14px;">Use of SNOMED-CT codes is recommended, but further evaluation is needed to determine which hierarchies are appropriate for use
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 14px;">The NAACCR examples list "abnormal morphology" codes
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 14px;">Clinical genomics and additional clinical areas
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 14px;">Consider whether other vocabularies in addition to or in place of SNOMED CT might apply
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 14px;">For SNOMED-CT, further evaluation is needed to determine which hierarchies are appropriate for use

7/14/2011 I am satisfied with the updated consensus statement incorporating these suggestions. The font for the last sentence in the first paragraph in this section ("We believe this is an appropriate position given the following examples:") should be adjusted so that it matches the other text. || Yes (7/14/2011) See additional comment. || The **"NOTE: Another commonly used vocabulary is HL7 table 487..."** that is under **"Specimen source in SPM.4"** seems somewhat redundant (or at least unaware) of the preceding text regarding HL7 table 0487 in bullet #2. I think that this should be re-worded slightly to make the flow of the text in the whole subsection more logical and consistent. It's also not immediately clear in the text exactly where the subsection for specimen is supposed to end. At first it appears as if the following paragraph, beginning with "The Vocab Workgroup supports the development of a process or system for correlating SNOMED CT and LOINC codes." is part of the specimen subsection, but it actually is not. Maybe we need another heading here?
 * Rob Hausam || Hausam Consulting || No, with comments

7/14/2011 The rewording is helpful. It does still seem, though, that the end of the specimen section is not clearly indicated. I believe that the text beginning with "Successful pilot testing will be defined as:" should be a separate section. An additional heading of "**Pilot testing**" immediately preceding that text would clarify that. || <span style="font-family: 'Calibri','sans-serif'; font-size: 14px;">... <span style="font-family: 'Calibri','sans-serif'; font-size: 14px;">2. SNOMED CT is successful received... -change to: SNOMED is successfully received <span style="font-family: 'Calibri','sans-serif'; font-size: 14px;">Position and Strategy for Use of HL7 Tables: <span style="font-family: 'Calibri','sans-serif'; font-size: 14px;">Appendix B needs to be linked to from here || (7/13/11) || Abnormal Flags - It is interesting that "N" and "null" are considered Abnormal in HL7 2.5.1. //Table Name has been change to Test Interpretation in HL7 2.7.// ... In review of the HL7 Tables, I compared them to the current proposed CalREDIE ELR IG. It should be noted that the Tables are not consistent. We are again seeing different requirements between agencies; causing issues for the sending, receiving and reporting entities. I would like to discuss the definition of Commercial Account in the Patient Class Table. It is not clear whether this Value/Description in an ambulatory setting is: referring to referral lab OR third party billed? Should we infact recommend an additional Value to distinguish the two? || See additional comment below (7/15/11) || 1. What is the correct representation of SNOMED CT? Is it SNOMED CT or SNOMED-CT? Should be consistent on how it's written within the document. 2. Under Specimen Source in SPM.4 section, successful pilot testing --- I'm not entirely sure I'm understanding what the first bullet is trying to say. 3. Under In-Scope Tests list section, last paragraph --- Should we remove "preliminary" from the recommendation sentence? || I think the first sentence should have an extra space removed following the hyperlink, and a comma added following "laboratories": "The Lab and Messaging Community of Practice (LMCoP) [], a group currently consisting of Public Health Laboratories, CDC and the national ELR working group, but open to all laboratories, is currently working on a cross-map of HL7 terms to SNOMED CT." The third sentence should be separated into two sentences: "These are not always one-to-one mappings because terms and settings are not always compatible. There will be a need to separate the following: specimen, site and collection method." Periods probably also should be added at the ends of the final sentences in both paragraphs, immediately following the hyperlinks. || Yes (7/19/11) || It appears that we have an inconsistency in one of our statements in our SNOMED section. In the first sentence under "Specimen Source in SPM.4", to be consistent with the statements in the opening paragraph under "Position and Strategy for Use of SNOMED Vocabulary", I think it should be revised to say "When the specimen source is transmitted as CWE data types in SPM.4, the use of SNOMED CT for specimen type **is recommended**." (instead of "should be required".) We have indicated that pilot testing is necessary to fully resolve potential issues in the first part of that section, and I'm worried that it could be misconstrued to say we require SNOMED for SPM.4 if the statement is taken out of the context of the rest of our document. || No with comments || See Cindy Johns statement. || Yes (7/20/11) || In agreement with Cindy Johns statement. || (7/19/11) || It's my understanding the IG Analysis team requested Vocabulary to review “0289 –CountyCode” as associated with the PID segment (PID-12, IS data type), based on the list they created at the f2f meeting in DC. However, PID-12 is flagged as retained for backward compatibility. Beginning with V2.3, County/Parish is an IS component of the XAD data type, but County/Parish is also used in other HL7 data types, sometimes as a ST (string). HL7 0289 is the HL7 User defined Table for County/Parish. I suggest we specify the code system as HL70289, and state the LRI Implementation Guide is using the content of FIPS6-4 for County as the User Defined table, **IF** agreed to by the LRI IG Analysis WG,and after clarifying with the IG Analysis their intent (PID-12, XAD, or everywhere County/Parish is used).
 * Riki Merrick || iConnect Consulting || <span style="font-family: 'Calibri','sans-serif'; font-size: 14px;">Yes, with comments || <span style="font-family: 'Calibri','sans-serif'; font-size: 14px;">SNOMED Use- Successful pilot testing will be defined as
 * Virginia Sturmfels || Quest Diagnostics || Yes, with comments on HL7 Tables
 * Cindy Johns || LabCorp || Yes, with comments (7/14/11)
 * Rob Hausam || Hausam Consulting || Yes, with comments (7/14/2011) || Under the "**Cross-mapping Efforts for SNOMED CT with other Vocabulariies**" heading there are a couple of style issues.
 * John Ritter / Andrea Pikus || CAP || Yes ||  ||
 * Cindy Johns || LabCorp || No with comments
 * Ken McCaslin || ACLA || Yes 7/21/11
 * Virginia Sturmfels || Quest Diagnostics || No with comment
 * Freida Hall || Quest Diagnostics || Yes
 * In the “Position and Strategy for Use of HL7 Tables”, change “Public Health table FIPS6_4” to 0289 (County). Also, correct type “relevence” to “relevance”.** ||

Nikolay Lipskiy CDC/OSELS Yes, with support of Cindy Johns comments <span style="display: block; height: 1px; left: -10000px; overflow: hidden; position: absolute; top: 0px; width: 1px;">http://wiki.siframework.org/LRI+Vocabulary+WG

include component="page" wikiName="siframework" page="space.template.inc_contentleft_end"