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Laboratory Test Name (Observation Name)

Recommendation:

LOINC should be used as the standard coding system to identify the test (observation).

Alternative 1:

The SNOMED CT expression associated with a LOINC code may be used.

Alternative 2:

SNOMED CT concepts from the 15220000 |Laboratory test| or 363787002 |Observable entity| hierarchy may be used.

Laboratory Result Value (Observation Value)

Recommendation:

Laboratory test results are reported different value types. For example, an LDL cholesterol level may be reported as a numeric value type, the results of a blood culture might identify an organism, and the results of a genetic mutation analysis may be reported as narrative text. In LOINC, these value types are distinguished in the Scale attribute.

 When a laboratory result observation requires a coded value, SNOMED CT should be used as the standard coding system for such result values. The majority of coded results for reportable laboratory results fall into one of the following SNOMED CT hierarchies:

Implications of using SNOMED CT for result values

In laboratory test result reporting, the semantic relationship between the identification of the observation and its value is that the asserted value "refines" or "qualifies" the meaning of the laboratory test that is specified in the identification of the observation. In other words, how a particular result should be reported depends upon what is being used as an identification of the observation. This is true regardless of whether SNOMED CT is used.

When SNOMED CT is used for a coded result value, this understanding of the semantic relationship is consistent with the use of refinement as specified in the SNOMED CT Concept Model.

Examples

Example 1: Reportable Condition Mapping Table (RCMT)-Lab Test & Results. CDC Vocabulary Server

The Reportable Condition Mapping Table (RCMT) provides mappings between reportable conditions and their associated LOINC laboratory tests and SNOMED results.

The RCMTs use standards suggested for the meaningful use measure "reportable lab result reporting to public health". They can be used to filter the output of clinical labs for test results that are of interest to public health.

Figure 5.2.3-1: CDC Vocabulary Server (PHIN VADS). RCMT Tree (Navigator) e.g: Tuberculosis

Table 5.2.3-2: Relationships - Condition and Lab Tests/Results Notifiable Event (Disease/Condition) Code list: Tuberculosis

Code 1

Name 1

Relationship Type

Concept Name 2

Concept Code 2

Code System Name 2

10220

Tuberculosis

Associated Lab Test Results

Attenuated Mycobacterium bovis (organism)

33610009

SNOMED CT

10220

Tuberculosis

Associated Lab Test Results

Mycobacterium africanum (organism)

51320008

SNOMED CT

10220

Tuberculosis

Associated Lab Test Results

Mycobacterium bovis (organism)

27142009

SNOMED CT

10220

Tuberculosis

Associated Lab Test Results

Mycobacterium canetti (organism)

414789006

SNOMED CT

10220

Tuberculosis

Associated Lab Test Results

Mycobacterium caprae (organism)

430579009

SNOMED CT

10220

Tuberculosis

Associated Lab Test Results

Mycobacterium microti (organism)

70801007

SNOMED CT

10220

Tuberculosis

Associated Lab Test Results

Mycobacterium pinnipedii (organism)

430914003

SNOMED CT

10220

Tuberculosis

Associated Lab Test Results

Mycobacterium tuberculosis (organism)

113861009

SNOMED CT

10220

Tuberculosis

Associated Lab Test Results

Mycobacterium tuberculosis African I variant (organism)

243372002

SNOMED CT

10220

Tuberculosis

Associated Lab Test Results

Mycobacterium tuberculosis African II variant (organism)

243373007

SNOMED CT

10220

Tuberculosis

Associated Lab Test Results

Mycobacterium tuberculosis Asian variant (organism)

243371009

SNOMED CT

10220

Tuberculosis

Associated Lab Test Results

Mycobacterium tuberculosis classical variant (organism)

243370005

SNOMED CT

10220

Tuberculosis

Associated Lab Test Results

Mycobacterium tuberculosis complex (organism)

113858008

SNOMED CT

10220

Tuberculosis

Associated Lab Test Results

Mycobacterium tuberculosis hominis (organism)

36354002

SNOMED CT

10220

Tuberculosis

Associated Lab Tests

Gamma interferon background Bld EIA-aCnc

71776-9

LOINC

10220

Tuberculosis

Associated Lab Tests

IGNF neg cntrl Bld

74279-1

LOINC

10220

Tuberculosis

Associated Lab Tests

M bovis Ab Ser Ql

23239-7

LOINC

10220

Tuberculosis

Associated Lab Tests

M bovis Ab Ser Ql EIA

23240-5

LOINC

10220

Tuberculosis

Associated Lab Tests

M bovis Ag Bld Ql

23242-1

LOINC

10220

Tuberculosis

Associated Lab Tests

M bovis Ag Tiss Ql ImStn

23241-3

LOINC

10220

Tuberculosis

Associated Lab Tests

M bovis tuberc IGNF Pnl Bld

53703-5

LOINC

10220

Tuberculosis

Associated Lab Tests

M bovis tuberc-control IGNF Bld-aCnc

53704-3

LOINC

10220

Tuberculosis

Associated Lab Tests

M bovis-M avium tuberc IGNF Bld-aCnc

53702-7

LOINC

10220

Tuberculosis

Associated Lab Tests

M tb A60 Ab Ser Ql EIA

55224-0

LOINC

10220

Tuberculosis

Associated Lab Tests

M tb A60 IgM Ser Ql EIA

55223-2

LOINC

10220

Tuberculosis

Associated Lab Tests

M TB Cmplx DNA XXX Ql PCR

38379-4

LOINC

https://phinvads.cdc.gov/vads/ViewCodeSystemConcept.action?oid=2.16.840.1.114222.4.5.277&code=10220

Example 2: CIMI

The Clinical Information Modeling Initiative (CIMI) is an international collaboration dedicated to improving the interoperability of healthcare information systems through shared implementable clinical information models. CIMI's goal is to provide a common format for detailed specifications for the representation of health information content so that semantically interoperable information may be created and shared in health records, messages, and documents.

Figure 5.2.3-2: CIMI archetype map for laboratory results report

 

Figure 5.2.3-3: CIMI Modelling Taskforce Report

Example 3: Value set for Microorganisms/Infectious agents (PHIN-VADS CDC)

Microbiology reporting is a common example of laboratory tests that are reported with coded result values (i.e. the microorganism identified). Use of SNOMED CT to code such results enables reporting and decision support capabilities.

Table 5.2.3-2: Value Set Code PHVS_Microorganism_CDC

Concept Code

Preferred Concept Name

Code System Name

54857005

63U-11 virus

SNOMED CT

66177001

75V-2374 virus

SNOMED CT

77627007

75V-2621 virus

SNOMED CT

54454006

78V-2441 virus

SNOMED CT

11946001

Abadina virus

SNOMED CT

113714003

Abiotrophia defectiva

SNOMED CT

409815006

Abiotrophia para-adiacens

SNOMED CT

372391001

Abiotrophia species

SNOMED CT

17822001

Abras virus

SNOMED CT

https://phinvads.cdc.gov/vads/ViewValueSet.action?id=06B09CEF-0E37-E111-A720-0050568D00F8#



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