Stream: IPS
Topic: Observation Lab Results
Sheridan Cook (Aug 04 2020 at 21:31):
@Giorgio Cangioli @Rob Hausam - I noticed that the IPS Observation (Results: Laboratory) profile includes observation.specimen as a Must Support element. I'm curious what the reasoning behind including the additional mustSupport flag?
I'm seeing a range of approaches but a lot of the international baseline/core communities don't include it as as MS: US Core, Netherlands Baseline, and German Baseline.
In the Canadian Baseline Working Group, we're struggling with whether or not to include it as a must support in the baseline when we know it would be an additional requirement that many of our vendors (who are aligned to US Core) do not currently consider MS. As we shape our own citizen access use cases to use the baseline profiles - it also creates the issue that they may not explicitly need it and may become burdened by the inheritance from the baseline when we want our other citizen-critical must support elements to have more rigid constraints.
We've looked at the IPS as a reference throughout our process to ensure we don't over-constrain our vendors out of using IPS, but I'm wondering if this is an opportunity to learn from your decision making process to better understand the areas we don't currently have 1:1 alignment on.
Rob Hausam (Aug 06 2020 at 11:45):
@Sheridan Cook Thanks for asking the question. I'm not sure that I have a definitive answer for the IPS project at the moment, as I'm not recalling the specific discussions in the group about this (but there probably were some). I think the reason that it is mustSupport is that in the case where the LOINC (or other) code in Observation.code does not include or does not sufficiently include the specimen information, then Observation.specimen will be used to provide that detail, and it will be necessary for the receiver to use that information in order to understand the intended clinical meaning of the laboratory observation. So basically, "if the specimen information is provided, it must be used." @Giorgio Cangioli and @François Macary are on holiday now and may not see this immediately, but when they return we can get their thoughts on it.
Lloyd McKenzie (Aug 06 2020 at 14:37):
Are there situations where the LOINC code, alone, would not be 'safe' - and how common would that be?
Christof Gessner (Aug 06 2020 at 23:18):
section 2.5 in https://loinc.org/kb/users-guide/major-parts-of-a-loinc-term/, using https://loinc.org/66746-9/ , also see 3.4.1.2 in https://loinc.org/kb/users-guide/special-cases/
François Macary (Aug 31 2020 at 13:42):
The Observation.specimen is mustSupport essentially to enable provision of further details regarding the specimen for microbiology results. For instance if a Staph. aureus was identified in a specimen collected from a wound, it may be relevant in the patient summary to indicate the exact body site of that wound and/or the collection method, to avoid any confusion with another infection of the patient reported in the summary.
Last updated: Apr 12 2022 at 19:14 UTC
