Welcome and role call

Introductions

Bruce Goldberg

• Allergy CRG_Jan 26 2024.pptx

SNOMED and LOINC - representing allergy testing in SNOMED

Farzaneh Ashrafi Marie-Alexandra Lambot

• SNOMED_LOINC allergy test obervables.xlsx
• Allergy testing proposal goals.docx
• SNOMED LOINC allergy testing gap analysis.docx

Jca: Is this something that would require SNOMED resources at this time? In other words, do we need to develop a project proposal to be approved by the SMT for resource allocation?  Or is it something that can be done independently and then a more formal proposal for a project can be developed once you know what is needed?  Also, it would be very nice if we could communicate to LOOINC some of the issues you note as it would be my intention that we would not create new observables directly in the International release, but we would focus on getting the LOINC parts right and then using those to generate LOINC extension concepts.  I do not see a wholesale addition of allergy observables into the international release but can see this exercise helping to improve the content in LOINC as well as SNOMED.  As for the LDTs, my impression is that if we can identify them, they should be out of scope (much as they are for the SHIELD project).

Bgo: Jim, I think there are a few considerations. Given the age of the allergy test content in SNOMED, if we intend to keep this content (now as observables rather than procedures) we should provide some needed updates in the SNOMED core to make it clinically useful. This could be undertaken independently and would be limited to adding new missing whole allergen IgE tests (e.g. Measurement of immunoglobulin E antibody to galactose-alpha-1,3 galactose (procedure)) but perhaps more importantly would be the addition of component allergen testing. Component resolved diagnostics (CRD) is an important part of in vitro allergy testing for the reasons I mentioned in my prior e-mail. Although there are hundreds of available tests, I think we could limit this to a manageable number based on importance. Further down the road we should develop a proposal to create a SNOMED extension that includes additional content from LOINC such as adding class reporting as well as adding additional tests to both the SNOMED extension and LOINC. In terms of communicating some of the issues, I did speak with Eza Hafeza, Director, Clinical Terminology Services and Operations (we used to work together in CMT) about the problem using “RAST” as a method for class results. I was told a fix will occur at some point. In terms of LDTs, I seem to remember in the past there was a field in LOINC that contained the submitters but I don’t see that at present.

Bruce Goldberg

Farzaneh Ashrafi

• Farzaneh Ashrafi discussed the creation of 416093006 |Allergic reaction caused by drug (disorder)| subtypes based on existing concepts of type << 416098002 |Allergy to drug (finding)| (and possibility of using them as template for a batch update) with Jim and Monica.

  While they are in agreement that the creation of these concepts seems to be clinically useful, they noted the following considerations:

  This work cannot be considered part of the ongoing QI project (which is related to changes to existing concepts). Therefore, this request, considering the size of requested changes i.e. creation of >1000 concept net new concepts (based on the initial estimate), requires its own project.
  While batch update is potentially applicable, there is still a requirement for manual review of all newly created concepts and their classification as well as resolving issues such as consideration of dealing with previously inactivated concepts, etc. In addition, creation of concepts of this type and number has a direct impact on the ICD mapping project. 
  For the reasons noted above, implementation of this work will require the following:

  Completion of a project charter (please see the attached template). The document needs to be completed by the CRG and submitted to the Senior Management Team for review and assignment of priority.
  The endorsement of members will be helpful in prioritization of changes of this kind. As discussed previously, member attendance in the Allergies and hypersensitivity CRG has been scarce and has declined since completion of the implementation guide. I talked with Monica and Cathy about the possibility of a presentation to the CMAG members to evaluate and endorse the buy-in for the requested change. Cathy noted that the next CMAG meeting is currently scheduled in mid April (I will send the exact date and time shortly) and that this item can definitely be added to the agenda. Will you be interested in participation in the CMAG meeting and providing a presentation?

• Allergies and hypersensitivity CRG - Content Business Case Proposal Template.docx

Bruce Goldberg

Farzaneh Ashrafi

• Allergy to cetuximab and the alpha-gal syndrome.pptx

Bruce Goldberg