APHL 48” x 72” (4’ x 6’) Poster Template Instructions and Guidelines for Use This template is designed to present the APHL brand consistently across all APHLauthored posters. Overall, please try to maintain the formatting of text and the positioning of graphic elements. Headers and text are placeholders and can be modified/repositioned for your content (see more below). RESTRICTIONS APHL Logo in top left: do not resize Break lines (thin horizontal lines demarcating the header and footer): 3pt, 50% black Color bars (vertical left and right margins): do not move or modify Teal color: Values are: red–0; green–160; Blue–175 Background color: always white TEXT FORMATS Title Line format: Franklin Gothic Demi, 60 pt, title case, centered, teal Author line(s) format: Franklin Gothic Book, 40 pt, title case, centered, teal Header text: Franklin Gothic Demi, 32 pt, all caps, 65% black Paragraph Text: Franklin Gothic Book, 18 pt, black (or teal for highlights) Note: Text size may be modified, within reason to fit your content. Maintain the ratio of header text to paragraph text if you need to resize text to fit your content. Further, line spacing may be adjusted to decrease/increase the space to fit your text; highlight the paragraph(s) and right-click and choose “Paragraph” to adjust line spacing. SPACING Maintain existing space between columns of text. The boxes around the text will automatically fit the text you type, and if you click on the text, you can use the little handles that appear to stretch or squeeze the text boxes to whatever size you want. SIZE OF POSTER In this PowerPoint file, the poster is built at 50% of the final produced size (24” x 36”). Your vendor should reproduce this at 200% of the file size. To preview your poster in actual size, go to View/Zoom/200%. IMAGES Images should be a minimum 300 dpi resolution and jpg or tif format. CHARTS FROM EXCEL Select the chart, right-click and Edit/Copy, and then Paste into PowerPoint. The chart can then be stretched to fit as required. If you need to edit parts of the chart, it can be ungrouped. Watch out for scientific symbols used in imported charts, which PowerPoint will not recognize as a used font and may print improperly if we don’t have the font installed on our system. It is best to use the Symbol font for scientific characters. FEEDBACK If you have comments about how this template worked for you or questions on using PowerPoint for your design, email [email protected] The Specimen Cross Mapping Table – A Tool for Harmonizing the Specimen Vocabulary Domain Riki Merrick, MPH1 Eric Haas, DVM, MS2 INTRODUCTION HL7 V2 messages, starting with Version 2.5, can include a specimen segment (SPM) that contains several field to describe specimen source information, which carries more information than in the older message versions. The APHL informatics team, while working on the Public Health Interoperability Project (PHLIP), identified several deficits and issues when mapping the public health laboratory’s specimen terms to standard vocabulary during the initial design and implementation of an HL7 v2.6 electronic order message between state public health laboratories and the CDC Salmonella laboratory, as HL7 messages starting with Version 2.5 can include a specimen segment It was found that most laboratories supported one or at most 2 fields to describe specimen, and thus frequently combined specimen type and body source site into a single pre-coordinated term. Furthermore, many of these local specimen terms did not have a related concept in the existing HL7 terminologies, HL7 table 0070 and its successor HL7 table 0487. These specimen vocabularies turned out to be limited and ambiguous. For example, the common respiratory sample, “Nasopharyngeal Swab” is absent , and terms like “GEN - Genital” could be interpreted as the body site or as a genital swab specimen or tissue specimen. Therefore, the APHL informatics team decided to use the SNOMED (SCT) medical terminology for our mapping of specimen related terms, following the example set by National Animal Health Network (NAHLN), which defined SNOMED hierarchies for each of the SPM fields (Figure 1). It was also decided to use the multiple specimen descriptor fields in the SPM segment to allows for a richer and more accurate description of specimen concepts. This lead to the basis for the Specimen Cross Mapping Table (Specimen-CMT) to harmonize the various local specimen terms to core set of standard vocabulary for use in HL7 messaging. In order to accommodate the different local terms among various laboratories, a PHLIP-preferred term was created that represented a specific concept and allowed the mapping across the multiple fields in the SPM segment. In other words, one PHLIP-preferred term could map to 6 different SNOMED concepts - in essence, post coordinating local specimen terms where needed. A clear definition for each PHLIP-preferred term where added after as a result of input from the Laboratory Messaging Community of Practice (LMCoP), APHL informatics’ goal is for the Specimen-CMT to become a national resource for curated specimen related vocabulary, the establishment of a community review and long-term content oversight structure. Current efforts are underway to achieve these goals. METHODS The APHL informatics team collected varied local terms from partner labs as well as public health departments . These descriptions form the basis of the concepts considered for inclusion in the Specimen-CMT. In order to accommodate the differences among local specimen terms, a PHLIP-preferred term, along with a definition describing the standard concept, was created. Based on the definition, each PHLIP-preferred term was mapped first for specimen type to the SNOMED specimen hierarchy and, if needed to properly identify the concept, additional SPM fields. A constrained set of SCT specimen terms were created with three goals in mind: 1) Harmonization of standard specimen terms among APHL’s informatics many partners. 2) Mapping the SCT terms to the HL7 terms. 3) Identifying and filling any gaps in the SCT specimen terminology. Although many local concepts can be expressed with a single specimen SCT concept, other local and HL7 concepts need additional data elements such as specimen source site to fully describe them. An Examples of terms in the Specimen-CMT are shown in Figure 2 below. After presentation of this Specimen-CMT to the ELR2PH 2.5.1 guide authors and the LMCoP, more terms spanning human, animal and environmental samples were collected for inclusion. Inspired by the success of the Reportable Condition Mapping Table (RCMT) review format, the Specimen-CMT is presented to the Public Health Lab community through LMCoP webinars and phConnect in order to work through several outstanding issues. We have invited attendees with subject matter expertise in environmental and animal testing, pathology and SNOMED to help facilitate discussion, refine, and standardize the specimen vocabulary across the community. The Specimen-CMT is being leveraged by APHL Informatics’ ELR technical assistance team to help many Public Health Laboratories map there local specimen term to standard SNOMED vocabulary. By using the Specimen-CMT, the standard specimen terminology among the various public health laboratories has become more harmonized. Additionally, through the process of using the Specimen-CMT, it became more comprehensive because new additions were made to it and the cross-mapping of HL7 table 0070 and 00487 terms to SNOMED via the PHLIP-preferred terms nearly completed. Through this process many new specimen type concepts have been identified and will be submitted to SNOMED CT by the APHL informatics team for consideration. By developing and implementing of the Specimen-CMT, several key issues with ELR2PH251 vocabulary constraints were uncovered and forwarded to the National ELRtaskforce for discussion and resolution. Through the process of development and use of the Specimen-CMT the standard specimen terminology is being applied consistently across the public health domain. Figure 2: HL7 SPM Fields with the Identified Vocabularies from HL7 and SNOMED Hierarchies Specimen CMT Examples HL7 Name SPM.4 Specimen Type SPM.5 Specimen Type Modifier SPM.6 Specimen Additives SPM.7 SPM.8 SPM.9 Specimen Collection Method Specimen Source Site Specimen Source Site Modifier Value set defined by ELR2PH251 HL7 table 0487 SNOMED CT Specimen Hierarchy SNOMED CT Qualifier Hierarchy possibly SNOMED CT morphologic abnormalities Hierarchy HL7 table 0371 HL7 Table 0488 SNOMED CT Specimen Collection Hierarchy SNOMED CT Body Site Hierarchy SNOMED CT Modifier and Qualifier Hierarchy PHLIP Preferred Name Acknowledgements / Sources PHLIP@ APHL.ORG http://www.phconnect.org/group/laboratorymessagingcommunityofpractice/forum/topics/specimen-crossmap Consulting, (Contractor to APHL), San Francisco, CA 2The St John’s Group (Contractor to APHL, Atlanta, GA) Definition HL7 SPM.4 HL7 SPM.5 Specimen type Specimen type (SNOMED) modifier or qualifier (SNOMED) Stool or Feces, also known as excrement, is a waste product from an animal's digestive tract expelled Stool specimen Stool through the anus or cloaca during a process called (specimen) defecation. http://en.wikipedia.org/wiki/Feces NASOPHARYNGEAL SWAB COLLECTION: Nasopharynge Nasopharyngeal 1. Insert dry swab through one nostril straight back al swab swab (specimen) (not upwards … Specimen from The 3 major forms of liver abscess, classified by Abscess_Liver abscess etiology, .. (specimen) For diffuse and relatively uniform lung involvement Bronchoalveola with the disease process, the right middle lobe and Bronchoalveolar r lingula of the left upper lobe are typically chosen lavage fluid Lavage_Middle as convenient sites that are easily accessed for sample Lobe_Right wedge positioning of the distal bronchoscope in (specimen) segmental bronchi…. For More Information 1iConnect The LMCoP is partnering with CDC programs working on education through the creation of a specimen collection manual. The long term deliverable is a proposed set of preferred specimen concepts for use as a the recommended vocabulary on a national scale that will be made publically available for inclusion in LIMS and EHR system products. RESULTS Figure1: Field To encourage standardization of specimen term coding outside of the Public Health domain, participation in the LMCoP was expanded through the vocabulary group of the Lab Results Interface (LRI) WG of the Standards and Interoperability (S&I) Framework to include commercial and hospital labs as well as LIMS vendors. Current work continues in the LMCoP to create guidance around proper specimen submission based on the lab domain in question – for example a specimen collected one way may be suitable for testing in the chemistry lab, but may not be suitable for microbiological tests like culturing. CONCLUSION The LMCoP will continue to work on the Specimen-CMT until the long term goal of a national preferred specimen vocabulary is achieved and then turn to other messaging issues involving specimens, including how to express whether the sample is a clinical specimen vs. a derivative like an isolate or DNA, and how to message environmental samples. So join us! HL7 SPM.6 Specimen Additives (SNOMED) HL7 SPM.7 Specimen Collection Method (SNOMED) Hl7 SPM.8 Source site/Body site (SNOMED) HL7 SPM.9 Specimen type modifier or qualifier (SNOMED) - - - - - - - - - - - Liver structure (body structure) - - - Bronchoalveolar lavage (procedure) HL7 Table 0070 HL7 Table 0487 Stool = Fecal Stool = Fecal Structure of middle lobe of right (qualifier) lung (body structure) PHLIP is supported by Cooperative Agreement #CCU303019 from the Centers for Disease Control and Prevention (CDC). LTIAPH is supported by Cooperative Agreement #1U50HK000105 from Centers for Disease Control and Prevention (CDC). The findings and conclusions in this poster are those of the authors and do not necessarily represent the official position of CDC or the Agency for Toxic Substances and Disease Registry © Copyright 2012, Association of Public Health Laboratories. All Rights Reserved.