For producers and consumers of pathology and laboratory medicine diagnostics

Who need federated sharing of pathology requests and results within the health and care system

The Unified Test List (UTL) is a catalogue of SNOMED coded laboratory test descriptions to which numeric or text results can be assigned

That can be viewed, transmitted, received and stored across the healthcare estate as part of a standardised electronic message profile

Unlike the mix of (now frozen) Read coded results, local coding and incompletely adopted coded forms

This product provides a single, expandable interoperability standard for test and result coding, identifying test methodology and tightly defining the permitted result form and appropriate unit(s) of measurement.

UTLv0.8.0

This release includes updates to the following domains:

• Chemical pathology
• Haematology
• Microbiology

An overview presentation of the release content is available to view here and the slides from release feedback workshop can be accessed here

The human readable release was provided in three parts:

• PBCL (Pathology Bounded Code List) request codes and Covid-19 request codes

Panels/groups and high-volume single test requests – 225 concepts

Screening test requests – 131 concepts

• Outstanding PBCL reportable codes and Covid-19 reportable codes (included in the main Report code set file) – 133 concepts.
• Concepts representing the “qualitative result of presence” including Covid-19 codes – 447 concepts (including updates to codes published in 0.7.0)

The concepts representing the “qualitative interpretation of presence” were flagged as an area that may be ambiguous in use.

To establish a consensus from users and stakeholders we published this terminology pattern as Qualitative Result alongside the main content but separate from the core terminology recorded in the machine-readable form, to solicit further beta feedback on the preferred pattern for these concepts.

UTL v0.7.0 

This release included the following domains:

• Chemical pathology
• Endocrinology
• Toxicology
• Andrology
• Haematology
• Immunology
• Microbiology

The release was provided in two parts:

1. Outstanding PBCL (Pathology Bounded Code List) codes
2. Concepts representing the “qualitative interpretation of presence” (Human readable release only)

The following were not included in this release:

• Small batches of PBCL content identified by laboratory / clinical experts as obsolete, erroneous, or requiring further review.
• PBCL content already existing in the SNOMED CT UK clinical extension that are acceptable representations in line with UTL.
• New requestable codes will be included in a future update release.

The concepts representing the “qualitative interpretation of presence” were flagged as an area that may be ambiguous in use, as the value attached could potentially be overlooked, for example:

Presence of HIV 1 RNA by NAAT = negative (value)

To establish a consensus from users and stakeholders we published this terminology pattern alongside the main content but separate from the core terminology recorded in the machine-readable form, to solicit further beta feedback on the preferred pattern for these concepts.

The columns for the attributes including substance, property and specimen are included purely for information. They will ultimately be used to formally classify the SNOMED content using the observable entity concept model, where the attributes and corresponding values will be used to create the SNOMED CT machine readable description logic definitions.

UTL v0.6.0 

This release included:

UTL v0.5.0 

this release included:

1) A sample of microorganism nucleic acid SNOMED CT reporting concepts by presence of RNA/DNA. These are specimen and technology/method neutral codes adhering to a proposed design decision to capture the postcoordinated and associated specimen and technology/method SNOMED CT concepts within the message specification. However, whether or not to add precoordinated specimens to microorganism nucleic acid SNOMED CT content in future UTL releases is still under consideration.

2) A sample of microorganism susceptibility to antimicrobial SNOMED CT reporting concepts. These are organism neutral codes adhering to a proposed design decision to capture the postcoordinated and associated microorganism SNOMED CT concept within the message specification.

The columns for the attributes including substance, property and specimen are included purely for information. They are in development.  No use of these columns is planned at this stage.  They will ultimately be used to formally classify the SNOMED content using the observable entity concept model, where the attributes and corresponding values will be used to create the SNOMED CT machine readable description logic definitions.

UTL v0.4.0

UTL0.4.0_20200316 is a minor interim release with a modest increase in new content of over 130 rows including the following:

• Coagulation factors
• Acylcarnitines by blood spot
• CD counts,
• Calculi (stones)
• Complement
• Haemoglobin variants.The columns for substance, property and specimen etc are included purely for information.  They are in development. No use of these columns is planned at this stage. They will ultimately be used to formally classify the SNOMED content using the observable entity concept model and SNOMED’s powerful description logic definitions. 
• Please use the discussion forum below to provide any feedback on this release as a whole, or the links in the review content for item-specific comments or questions.
• In response to feedback we have also taken the opportunity to undertake a revision of previously published content to remove some technical errors introduced during term creation and to remove some duplicate rows.  This is in preparation for a larger release in line with the publication of the 29.0.0 UK Edition of SNOMED CT in April 2020.  We are upgrading our production and publication processes in line with the growing size of the product in preparation for that release.

UTL v0.3.0 

• The UTL (v0.3.0) was published both in human readable form on our Pathology collaborative workspace, and as a Pathology and Laboratory Medicine SNOMED CT RF2 In Development extension module on TRUD  alongside the main UK SNOMED CT Edition.

  The UTL v3.0 contained over 1600 items, with more than 720 concepts added in this release with a particular emphasis on allergens.

UTL v0.2 

• The second release of the UTL continues in line with the first, significantly expanding the blood sciences content as a priority previously set out.  Development of further content has continued with most welcome contributions of local lists from Epsom & St Helier (SW London), York & Hull and from the Greater Manchester Partnership, along with a very valuable drill-down into Renal Dataset requirements from the  Renal Association leads which led to development of the model for capturing specialist test methods and then higher method specificity requirements.  Their support and commitment is gratefully acknowledged here.

  For those familiar with Read and SNOMED coding, the SNOMED terms will seem more specific than those in the PBCL or elsewhere (and they will ultimately succeed them) but this conforms to a well-defined SNOMED structure with the key aim of tightly defining and constraining what result value can be appended to a result code, in what format it is allowed to appear and what unit of measurement (if any) it is permitted to have assigned.  A major difficulty in the past has been the potential for variation in these constraints across many systems making results comparison difficult and causing the sharing of results outside very tightly defined pathways to be done only with great caution in case of misinterpretation.

• As mentioned  in our September newsletter we have published this version of the UTL as a  Pathology and Laboratory Medicine SNOMED CT RF2 beta extension module on TRUD  

  alongside the main UK SNOMED CT Edition to enable access to the codes that you need and allow more frequent releases as required.

• A PDF of the Draft Editorial Principles for the UTL is available to view here

UTL v0.13

• The first release of the UTL (v0.13) was published in February 2019 and formally released in June 2019 in alignment with the main biannual 1/10/2019 SNOMED UK Edition. 

  The list of 350 SNOMED coded terms published here is a proposed basis of the UTL, focused  initially on ‘blood sciences content (i.e. principally chemical pathology and haematology with a small sample of virology and immunology and other domains) that is eventually expected to contain perhaps 5000 codes or more.  It is a starter set derived from a combination of some ‘top 100’ blood sciences tests and example specialist result requirements at a more granular level (e.g. PTH).  The aim in getting both generalist and specialist dimensions covered is to provide a list for open consultation that can show how it would work in both contexts.

• Please note these SNOMED CT concepts are draft only and not for use in live systems

• This version of the UTL was  published as part of the biannual SNOMED CT release on TRUD as a technical refset artefact for download. (note: not available as a separate download). This was available to TRUD subscribers as part of the 1/6/2019 (27.0) biannual release.
  (Refset ID: 999004541000000101 UTL (Unified Test List) result observables simple reference set)

• we designed a results model for SNOMED that embeds methods, scale types and measurement properties to meet clinical safety and activity reporting requirements for laboratory result values, units of measurement and how tests were analysed

• More PBCL mapping and gap analysis work
• Continued collaboration with Epsom & St Helier and York & Hull trusts to incorporate contents from their own local test lists into the UTL