Content uploaded by Pamela Banning
Author content
All content in this area was uploaded by Pamela Banning on Mar 23, 2015
Content may be subject to copyright.
TEMPLATE DESIGN © 2008
www.PosterPresentations.com
IMPLEMENTING SNOMED CT IN LABORATORY SPECIMEN AND SOURCES TABLES – IF THE SHOE FITS…
Pamela Banning, BS(Biology) MLS(ASCP)CM, PMP, Elva Knight, BS(Microbiology) MLS(ASCP)
3M Health Information Systems, Salt Lake City, UT, USA
Introduction
Conclusions
Literature Cited
Materials & Methods
Contact information
1. Federal Guidelines - Meaningful Use Stage 2
requirements, Federal Register, last accessed 11/9/2014.
http://www.gpo.gov/fdsys/pkg/FR-2012-09-04/pdf/2012-
21050.pdf
2. HL7 documentation last accessed 11/9/2014.
www.HL7.org
3. Lab COP workgroup last accessed 11/9/2014.
http://www.phconnect.org/group/laboratorymessagingcom
munityofpractice
4. CliniClue Freeware Browser. www.cliniclue.com last
accessed 11/9/2014
5. 3M HDD Open Access. www.hddaccess.com last
accessed 11/9/2014
ISSUES:
•Meaningful Use incentives and secondary use
in public health reporting require addition of
SNOMED CT terminology to system embedded
sources and specimen lists.
•Facilities have the decision of where in the
terminology standard to constrict the search, as
well as where to store the mappings. The
implications are not always understood.
•Vendors of LIS and .EHR systems are not
always prepared to handle the coding
complexities of the specimen granularity.
•HL7 messaging formats offer a variety of
locations in the message to record the specimen
or source.
•There is discordant ability of the LIS or .EHR
system to segregate and populate the
messaging from its specimen/sources listings.
•Site information system (LIS or .EHR)
customizations is often required to store the multiple
triplets.
•Full source description is frequently only achieved
by combining triplets (Table 1).
•Some specimens required up to four SCT terms to
provide clarification or best match. Many of the
source terms included specimen types, morphologic
abnormalities or collection procedures by SNOMED
CT (abscess, cyst, washing, and lavage).
•Sites may build unconstrained content in their lists,
incapable of standardization (blue port, bagged, red
lumen)
•Workload Size
•Specimen list variation: 32-111 codes
•Source lists variation: 243-995 codes
•Successful mapping occurred within all files, but
with varying levels of completeness
(Table 1).
1. Four hospital sites extracted and submitted four
specimen and sources lists to 3M Health
Information Systems for terminology mapping.
(Eight lists total)
2. The LIS-exported lists were in Excel format with
identifier, mnemonic and full description of each
entry.
3. Resources include SNOMED CT terminology
content via both the 3M Healthcare Data
Dictionary and freeware browser CliniClue.
Entire process was a combination of semi-
automated and manual tasks.
4. The specimen lists were mapped to SCT
Specimen domain.
5. The sources lists were mapped to body anatomy,
substance, or physical device/object domains
initially.
6. Laterality source modifiers were added as
needed.
Domain Site A Site B Site C Site D
Specimens
93.8% 94.1% 85.7% 79.3%
Sources 96.7% 88.7% 95.0% 75.7%
Table 1. Mapping Completeness
Pamela Banning,MLS(ASCP)CM, PMP
Senior Content Developer,
3M Healthcare Data Dictionary
pdbanning@mmm.com
www.hddaccess.com
SPM Segment HL7 Name Consider for
coding Value Sets
suggested in
ELR to
PHv2.5.1
SPM-4 Specimen Type HL70487;
SCT specimen
hierarchy
HL70487;
SCT specimen
hierarchy
SPM-5
Specimen Type
Modifier SCT qualifier,
morphologic
abnormality
hierarchy
SCT qualifier
hierarchy
SPM-6 Specimen
Additives HL70371
SCT substance,
product
hierarchy
HL70371
SPM-7 Specimen
Collection
Method
HL70488
SCT procedure
hierarchy
HL70488
SCT specimen
collection
subtree
(procedure
hierarchy)
SPM-8 Specimen
Source Site SCT body site,
substance,
physical object
hierarchy
SCT body site
hierarchy (per
HITSP)
SPM-9 Specimen
Source Site
Modifier
SCT qualifier
hierarchy SCT qualifier
hierarchy
Site Term
SCT Specimen
SCT Body
structure/Substance/Physic
al Device
SCT Body Structure 2
SCT Qualifier
Urine, Clean Catch
122880004
Urine specimen obtained
by clean catch procedure
(specimen)
78014005
Urine (Substance)
-
-
Bronchial Washing, Bilateral
122609004
Specimen from lung
obtained by bronchial
washing procedure
(specimen)
955009
Bronchial structure (body
structure)
5926001
Structure of bronchial lumen
(body structure)
257916006
Bilateral sampling (qualifier
value)
Chest
Tube Drainage
447375004
Body fluid specimen
obtained via chest tube
(specimen)
51185008
Thoracic structure (body
structure)
75823008
Discharge (morphologic
abnormality)
-
Bartholin Cyst
-
87176006
Bartholin's gland structure
(body structure)
367643001
Cyst (morphologic
abnormality)
-
Subclavian
Tip
472935000
Central venous catheter tip
from subclavian vein
submitted as specimen
(specimen)
116204000
Catheter tip, device (physical
object)
9454009
Structure of subclavian vein
(body structure)
-
Results
Table 2. Combinatory Examples across SNOMED CT domains
•Some vendors had difficulty reconciling the mapping to
their constraints on SNOMED CT domains