Examples include but are not limited to right internal jugular, left arm, and right eye.
Applicable Vocabulary Standard(s)
Applicable Standards
Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT®) U.S. Edition, March 2023 Release
Submitted By: Nedra Garrett
/ Centers for Disease Control and Prevention
Data Element Information
Use Case Description(s)
Use Case Description
Disease reporting to public health relies on data from the EHR for identification of reportable events and to provide critical information used in confirming a diagnosis, understanding severity and classifying a case of disease that requires public health intervention for prevention, treatment, control, and outbreak identification and response. The specimen collection date is of particular importance for public health in understanding when laboratory confirmable evidence of a disease process was present in the patient. Specimen type and specimen site provides information useful in interpreting laboratory findings to determine severity and transmissibility.
Estimate the breadth of applicability of the use case(s) for this data element
Over 3000 public health agencies in the US would use these data elements for disease surveillance and control activities.
5 or more. This data element has been tested at scale between multiple different production environments to support the majority of anticipated stakeholders.
Supporting Artifacts
These data elements are standard components of HL7 electronic test order and reporting (ETOR) messages between clinical setting and clinical laboratorories and of HL7 electronic laboratory reporting (ELR) messages sent from clinical laboratories to public health. https://www.cdc.gov/elr/index.html
Potential Challenges
Restrictions on Standardization (e.g. proprietary code)
APHL fully supports inclusion of this data element and suggests to further specify the hierarchy in SNOMED CT for this data element - concepts should be from the body structure hierarchy.
CAP Comment: The CAP applauds the ONC’s decision to add this data element to USCDI v4, as this data element indicates the body location where a specimen was obtained and is required by CLIA.
The Texas Health Informatics Alliance (THIA) Policy and Standards Working Group supports the proposal for specimen source site. We support the actions to help mine data for specimens.
Disease reporting to public health relies on data from the EHR for identification of reportable events and to provide critical information used in confirming a diagnosis, understanding severity and classifying a case of disease that requires public health intervention for prevention, treatment, control, and outbreak identification and response. The specimen collection date is of particular importance for public health in understanding when laboratory confirmable evidence of a disease process was present in the patient. Specimen type and specimen site provides information useful in interpreting laboratory findings to determine severity and transmissibility. Required by CLIA for all laboratory reports, 493.1291 Standard: Test report. Link
Comments from NACCHO: NACCHO supports including the data element specimen source site but recommends using the HL7 reference standard for the specimen source site.
Comments from CSTE: CSTE agrees with CDC's recommendation for this data element.
Description: The College of American Pathologists (CAP) supports the inclusion of this Level 2 data element into USCDI v4 to align with CLIA’s Specimen Source reporting requirement. The CLIA requirements are required for laboratory reporting and should be used as the basis for laboratory and public health reporting standards.
Vocabulary Standard: For the content of the data element, the CAP recommends replacing the LOINC standard with the SNOMED CT standard. LOINC does not adequately represent specimen types or anatomic locations and relationships necessary to represent specimens and their sources, and is not intended for that purpose. SNOMED CT is a relatively complete, well-curated, and actively-managed medical ontology that has excellent coverage of concepts appropriate for description of laboratory specimens and specimen sources, and supports a rich array of hierarchical and other concept relationships.
APHL continues to support inclusion of this data element in the Laboratory class of USCDI V4; it is mentioned in CLIA as a “provide as appropriate” element.
Additional Use Case: This is a standard data item used by central cancer registries in all states. Data received through data exchange from laboratories to central cancer registries for CDC and NCI’s national cancer surveillance systems, as required by law.
CSTE supports inclusion of this measure into USCDI v3: very useful for laboratory related fields context.
This data element is critical in supporting specimentype information, when more generic types are submitted - for example a joint fuild sample or a tissue sample - rather than supporting a lot of pre-coordinated (and still potentially not detailed enough specimen types) use of source site allows for a clear identification of the sample's location - critical for treating infections and cancer for example. It has been included in V2 messages for a long time (OBR-15.4) and is an RE element in ELR R1.
Submitted by Riki Merrick on 2023-09-20
Source Site vocabulary suggestion
APHL fully supports inclusion of this data element and suggests to further specify the hierarchy in SNOMED CT for this data element - concepts should be from the body structure hierarchy.