TEMPLATE DESIGN © 2008
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
Materials & Methods
1. Federal Guidelines - Meaningful Use Stage 2
requirements, Federal Register, last accessed 11/9/2014.
2. HL7 documentation last accessed 11/9/2014.
3. Lab COP workgroup last accessed 11/9/2014.
4. CliniClue Freeware Browser. www.cliniclue.com last
5. 3M HDD Open Access. www.hddaccess.com last
•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
•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
•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
•Specimen list variation: 32-111 codes
•Source lists variation: 243-995 codes
•Successful mapping occurred within all files, but
with varying levels of completeness
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
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
5. The sources lists were mapped to body anatomy,
substance, or physical device/object domains
6. Laterality source modifiers were added as
Domain Site A Site B Site C Site D
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
SPM Segment HL7 Name Consider for
coding Value Sets
SPM-4 Specimen Type HL70487;
Modifier SCT qualifier,
Source Site SCT body site,
SCT body site
hierarchy SCT qualifier
SCT Body Structure 2
Urine, Clean Catch
Urine specimen obtained
by clean catch procedure
Bronchial Washing, Bilateral
Specimen from lung
obtained by bronchial
Bronchial structure (body
Structure of bronchial lumen
Bilateral sampling (qualifier
Body fluid specimen
obtained via chest tube
Thoracic structure (body
Bartholin's gland structure
Central venous catheter tip
from subclavian vein
submitted as specimen
Catheter tip, device (physical
Structure of subclavian vein
Table 2. Combinatory Examples across SNOMED CT domains
•Some vendors had difficulty reconciling the mapping to
their constraints on SNOMED CT domains