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Agenda

Time	Topic	Action	Lead(s)
9:00-9:05	Welcome Opening remarks	Informational	Pam Banning
9:05-9:10	SHIELD - Update	Informational	Andrea Pitkus
9:10-9:20	DrugTox Follow up OAI #2	Discussion/Informational	Pam Banning
9:20-9:30	Endocrinology: Follow up	Discussion/Informational	Stan Huff
9:30-9:40	- Coagulation - Protein: antigens and antibodies	Discussion/Informational	Stan Huff
9:40-9:55	Guidance for laborders.ontology order level codes	Discussion/Informational	Pam Banning / Jenna Rychert
9:55- 10:00	Announcements	Informational	All
10:00	Closing and adjourn	Informational	Pam Banning

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SHIELD Update�by�Andrea Pitkus

SHIELD Home Page URL here https://aphlinformatics.atlassian.net/wiki/spaces/SC/overview?homepageId=986579060

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DRUG/TOX Heuristics

Member of Drug/Tox class & in drugs of abuse

Status=Active

Any specimen type

Only those analytes for which there are screen/confirm in methods currently

Include: xyz positive, xyz present, xyz tested for

Exclude: Cutoffs

ACTIONS on Observations

Discourage codes with screen/confirm in method

Create new codes IA, Mass Spec for each relevant specimen/property

Include cutoff in the method

Analytes normalized to creatinine, only a single methodless code

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DRUG/TOX Development Progress

First pass with MS Co-Pilot was incomplete
PBanning took on manual effort – 9%
SWagers will break up remaining evaluation between February & March after LOINC release (1240 components/specimens)

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Stan Huff - Challenges

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Pathologist/Informaticist response via Andrea Pitkus

Proposed changes to Antigen and Coag LOINCs

It may be helpful to clarify the intended benefit of the proposed terminology changes (e.g., shifting from “activated” to “activity”) in user scenarios beyond code maintenance or deprecation. For example, instead of 28657-5 (the first example in the attachment), ARUP and Mayo already use 3218-5 for factor X activity, which appears to be the more common code in current use.

I appreciate the proposal’s goal to align these LOINC codes better with SNOMED. One nuance to consider is that SNOMED treats “coagulation factor X activated” as an acceptable synonym for “coagulation factor Xa” (SCTID: 5172001), which is a different substance from “coagulation factor X” (SCTID: 81444003). The analogous distinction applies to the rest of the examples in the attachment (factors IX, V, and VIII). From a test-utilization standpoint, the factor X activity assay should not be ordered for FXa levels (e.g., as indicated in order information for ARUP 0030105), though I would certainly defer to coagulation specialists for deeper interpretation

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Pathologist/Informaticist response via Andrea Pitkus

Screening vs. confirmatory

I can very much relate to this. At my previous institution, I worked directly with the state DPH during LIS & EHR go-live to ensure the correct LOINC code was used for reporting confirmed HIV-1 results. Per CDC guidance, the “confirmatory” method after an antigen/antibody combo screen is also an immunoassay (“the supplemental differentiation assay”). Because the method axis lists only “IA” - and does not distinguish “screen” versus “confirmatory” as it does with urine drug testing - end users often found it difficult to determine which LOINC represented the confirmatory result. I also agree that SAMHSA designations are important in this context.

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Laboratory Orders Background

2014 aLOINC Order codes from S&I Framework – Accessory File Universal Lab Orders Value Set https://loinc.org/usage/orders/

Definition of Panels (Batteries) https://loinc.org/kb/users-guide/panels/

2025 Orderable Grouper Concepts

https://loinc.org/kb/users-guide/new-orderable-grouper-concepts/

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Order Level Standardization

Clinical guidance: To identify people with chronic Hepatitis C infection, all adults should be screened with Anti-HCV antibody testing followed by HCV RNA PCR testing when antibody testing is positive

	Advia Centaur	Abbott Architect	Roche Elecsys	Abbott Alinity
Order	40726-2 Hepatitis C virus IgG Ab [Presence] in Serum or Plasma by Immunoassay	13955-0 Hepatitis C virus Ab [Presence] in Serum or Plasma by Immunoassay	13955-0 Hepatitis C virus Ab [Presence] in Serum or Plasma by Immunoassay	40726-2 Hepatitis C virus IgG Ab [Presence] in Serum or Plasma by Immunoassay

Qualitative Result	40726-2 Hepatitis C virus IgG Ab [Presence] in Serum or Plasma by Immunoassay	13955-0 Hepatitis C virus Ab [Presence] in Serum or Plasma by Immunoassay	13955-0 Hepatitis C virus Ab [Presence] in Serum or Plasma by Immunoassay	13955-0 Hepatitis C virus Ab [Presence] in Serum or Plasma by Immunoassay
Quantitative Result		57006-9 Hepatitis C virus IgG Ab [Units/volume] in Serum by Immunoassay

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Order Level Standardization – Challenges in Coding

LabOrders.Ontology	Panel	Both Orders/Observations
109963-9 Hepatitis C virus Ab [Measurement] in Serum	95206-9 Hepatitis C virus Ab panel - Serum or Plasma	22327-1 Hepatitis C virus Ab [Units/volume] in Serum
		5198-7 Hepatitis C virus Ab [Units/volume] in Serum by Immunoassay
109962-1 Hepatitis C virus IgG Ab [Measurement] in Serum		16936-7 Hepatitis C virus IgG Ab [Units/volume] in Serum
		57006-9 Hepatitis C virus IgG Ab [Units/volume] in Serum by Immunoassay

Too many possible choices for how to code the order

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Order Level Mapping at ARUP

70% of orderable test codes are mapped

Easy when the order has only one component
Increasingly difficult when order has multiple components or is a panel of multiple analytes
Only as good as our component mapping
May not be a code available

Among tests mapped to an order only code, 19% use LabOrders.Ontology

Standardization/Guidance needed when one analyte is measured multiple ways

Toxic elements in urine (ratio to CRT vs per volume)
Quantitative viral load assays (copies/ml vs IU/ml)
Flow cytometry (absolute count vs %)

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Announcements & Closing

Call for presentation proposals by 4/5/2026

Global Data, Local Care: Advancing Smarter Standards

6-9 October 2026, Cologne, Germany

Next meeting: February 19, 2026