From 3M Health Information Systems
Stasis vs. tension – UFOs and unusual lab observations
Ever been caught off guard hearing about UFO sightings because the physics makes no sense? The Pentagon calls UFOs by a different name: UAPs (unidentified aerial phenomena). I was surprised when I was watching the news and heard a quote from a retired Navy pilot on the frequency of his personal UFO sightings, “every day for at least a couple years.” Are the extraterrestrials just happening to encounter our world, or are they following a known pathway?
Health care terminology projects provide opportunities to resolve unexplained situations or identities as well. The puzzles make for an engaging and satisfying career. Laboratory information systems provide fields for an assay name to display on a label in shorter form than on the clinical workstation. Our clinical informatics team applies two international standards to test compendiums where applicable: Logical Observations Identifiers Names and Codes (LOINC) or Systematic Nomenclature of Medicine Clinical Terms (SNOMED CT). The use of these two terminologies creates a local map or translation of the local abbreviations to identify themselves as data results anywhere in the world.
The applications of these terminologies allow for health care data to travel to different systems (galaxies?) and be understood for computability. The basic elements, minerals, proteins and cells essential for a healthy life are expected to be contained in the test compendium. These are the stasis terms: there’s an equilibrium of analytes and existing coding. The size of the file varies according to the needs of the health care institution. Is this a 10-bed rural critical access facility, a 200-bed community hospital, a 500-bed trauma center, or a cancer research center? At the outset we examine the content of the exported test catalog: Are there signs of biochemistry? Urinalysis? Hematology differentials? Blood bank? Serology? We examine the journey before “launch” and can estimate the amount of work necessary to create their star navigational mapping.
Database administrators must get creative with limited field space when building new assays in the laboratory system The character limitations vary; it’s easy to get buried in acronyms. What might PRA stand for at your facility’s laboratory? We’ve encountered progesterone receptor antibody, percent reactive antigen or plasma renin activity at different client sites, all using the acronym PRA. Another example is PCR. Commonly known as polymerase chain reaction. It is a method of testing. The laboratory may use it as a field name for molecular testing with the actual gene or organism tested for listed in the result fields. This local creativity is documented in the “captain’s log” for usage and appended with the LOINC or SNOMED CT terminology to translate to other systems.
Will the unusual observations become usual over time? There was a time when the various bioforms of vitamin D were the latest craze of laboratory testing. There were two different naming conventions: D2, D3, D2+D3 vs. ergocalciferol, cholecalciferol, calcidiol+calciferol. Clinical interpretation dictates the terminology and display attached to the patient values and must communicate what is truly being measured. Therein lies the tension, and unlike UFOs, we cannot observe for years, we must act and gain understanding. The patient labels and values need to serve the patient’s treatment and outcomes; the patient’s safety cannot be undermined by miscommunication or misunderstanding.
In terminology projects, patient safety and effective treatment based on laboratory results are paramount. There is no guessing allowed, so it’s time to start playing 20 questions to identify the assay and compare to recent terminology release. If the client has the need, 3M either identifies the correct coding term, or applies for anew clinical terminology term. The resolution qualifies for another entry for the captain’s log; those traveling after us will have the information already deciphered for their usage.
The pandemic brought about another use case. Laboratories named their SARS-CoV-2 assays by the disease, COVID-19. It usually took only one round of questions: Is the lab measuring antigen or nucleic acids? With the invention of a 15-minute PCR assay, the term “rapid COVID-19” became a popular display. “Rapid” had never before been associated with nucleic acid detection; it was traditionally referring to an antigen detection. Clarification must be sought for the correct distinction because the sensitivity and specificity of the methods vary; this may impact clinician interpretation. Complexity also arose with the advent of testing for antibodies. Time for a new clarifying question, if the units of measure and answer format indicated as such. Suitable entries created in the captain’s log lead the way for future terminology mappers.
Most recently, unusual flow cytometry acronyms were spotted in a clinical trials laboratory system. The methodology can measure different cluster designations, or CDs, on cells to identify their function or their invasion. The reader may be familiar with helper T cells (CD4+, CD4 positive, Th cells) or natural killer cells (positive for CD16, CD56 and CD94). This clinical trial site had literally thousands of terms outside the norm of identifying T cell or B cell lymphocytes, like thousands of unknown stars in a system, which was not the usual version expected of a laboratory.
The 3M HIS team spoke with the lead scientist of this lab department and discovered a previously unknown (to us) world of special cell immunology. We discovered professional associations dedicated to the specialty. First, we found out there’s a migration of past nomenclature discussed in Human Leukocyte Antigen Workshops held over the last 10 years. The two nomenclatures are converging, as can be seen by the example displays: CD314 (NKG2D), CD117 (c-kit). The human practice of normalizing the patterns doesn’t work in this endeavor. There’s more than one way to trigger cell immunology, just as there are multiple possible routes to a travel destination.
The displays in the different laboratories describing their path don’t make a direct equivocal line to another lab using a different route. This arena is not included in the international terminologies presently, but it’s going to make for a very interesting excursion in the future.
Working through the files, one sees the parallel to navigating through the solar system and galaxies. Known areas of the lab’s data will encode easily, while unknown “landmarks” of a display cause the work to slow down. We stand still at our desks performing the work, but our minds are navigating throughout the galaxy that is laboratory medicine.
Pam Banning is a senior health care data analyst for 3M Health Information Systems and currently the co-chair of the laboratory LOINC committee.