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Introduction and Overview
Daniel J. Vreeman, PT, DPT, MSc
Assistant Research Professor
, Indiana University School of Medicine Associate Director for Terminology Services
, Regenstrief Institute, Inc
© 2014loinc@loinc.org2014.06.04
Laboratory LOINC Workshop - Indianapolis, IN
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loinc.org/slideshows
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Acknowledgements
LOINC Development TeamJami Deckard, Katy Holk, Kelly Malott, DavidBaorto, Clem McDonald
RELMA Development Team
John Hook, Anandhi Sowmyan, James Dennis
LOINC Committee
Sandy Poremba
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Origins of LOINCThe lingua franca of clinical observation exchange
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photo via noshaMcDonald et al. Canopy Computing: using the Web in Clinical Practice. JAMA
. 1998;280(15):1325-1329.
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The rain forest canopy is aseamless web through which
arboreal creatures efficientlymove to reach the edible
fruits without any attentionto the individual trees.
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Arboreal Informatics Pioneers
40 years of EMR work
Indiana Network for Patient Care
Regenstrief
– the “Data Switzerland”
Nation’s most comprehensive and longest tenured HIE
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More than Meets the Eye
photo via chadlewis
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Fundamental challenge:
Local systems have different ways of
identifying the same concept.
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Only way to corral the
infinite indiosyncracies is
with standards
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A vocabulary standard
would serve as theRosetta Stone.
photo via Hans Hillewaert / CC-BY-SA-3.0
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Logical
Observation
Identifiers
Names and
CodesA universal code system that facilitates exchange,
pooling, and processing of results
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Established in 1994 byRegenstrief Institute.
Vocabulary standard forobservation identifiers.
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Similar name, different meaning…
photo via Caption Time
i i i i
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Similar name, different meaning…
meerkat meerkat mere cat meerkat
photo via Caption Time
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MEASUREMENTS US
“ R ”
photo via puuikibeach
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If an observation is a question and
the observation value is
an answer… LOINC provides codes for questions Where needed, other vocabulariesprovide codes for answers
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What is my patient’s
hemoglobin level?718-7:Hemoglobin:MCnc:Pt:Bld:Qn
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How fast does my patient
usually walk?41959-8:Walking speed:Vel:1W^mean:^Patient:Qn:Calculated
photo via Ed Yourdon
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di k f i C
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MSH|^~\&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay||||||||||||||| PID|||$patientId$||$patientName$|||||||||||||||||||| PV1|||||||$attendingDoctor$||$consultingDoctor$||||||||
OBR|1|||012^CBC/Auto Diff^HSPA^57021-8^CBC W Auto Diff^LN||$reqDate||||||||| OBX|2|NM|123^WBC^HSP_A^26464-8^Leukocytes [#/volume] in Blood^LN||10.8|K/MM3|||||F| OBX|3|NM|234^RBC^HSP_A^26453-1^Erythrocytes [#/volume] in Blood^LN||4.82|MIL/MM3|||||F| OBX|4|NM|345^HGB^HSP_A^718-7^Hemoglobin [Mass/volume] in Blood^LN||15.7|GM/DL|||||F| OBX|5|NM|456^HCT^HSP_A^20570-8^Hematocrit [Volume Fraction] of Blood^LN||45|%|||||||F|
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MSH|^~\&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay||||||||||||||| PID|||$patientId$||$patientName$|||||||||||||||||||| PV1|||||||$attendingDoctor$||$consultingDoctor$||||||||
OBR|1|||012^CBC/Auto Diff^HSPA^57021-8^CBC W Auto Diff^LN||$reqDate||||||||| OBX|2|NM|123^WBC^HSP_A^26464-8^Leukocytes [#/volume] in Blood^LN||10.8|K/MM3|||||F| OBX|3|NM|234^RBC^HSP_A^26453-1^Erythrocytes [#/volume] in Blood^LN||4.82|MIL/MM3|||||F| OBX|4|NM|345^HGB^HSP_A^718-7^Hemoglobin [Mass/volume] in Blood^LN||15.7|GM/DL|||||F| OBX|5|NM|456^HCT^HSP_A^20570-8^Hematocrit [Volume Fraction] of Blood^LN||45|%|||||||F|
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MSH|^~\&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay||||||||||||||| PID|||$patientId$||$patientName$|||||||||||||||||||| PV1|||||||$attendingDoctor$||$consultingDoctor$||||||||
OBR|1|||012^CBC/Auto Diff^HSPA^57021-8^CBC W Auto Diff^LN||$reqDate||||||||| OBX|2|NM|123^WBC^HSP_A^26464-8^Leukocytes [#/volume] in Blood^LN||10.8|K/MM3|||||F| OBX|3|NM|234^RBC^HSP_A^26453-1^Erythrocytes [#/volume] in Blood^LN||4.82|MIL/MM3|||||F| OBX|4|NM|345^HGB^HSP_A^718-7^Hemoglobin [Mass/volume] in Blood^LN||15.7|GM/DL|||||F| OBX|5|NM|456^HCT^HSP_A^20570-8^Hematocrit [Volume Fraction] of Blood^LN||45|%|||||||F|
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MSH|^~\&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay||||||||||||||| PID|||$patientId$||$patientName$|||||||||||||||||||| PV1|||||||$attendingDoctor$||$consultingDoctor$||||||||
OBR|1|||012^CBC/Auto Diff^HSPA^57021-8^CBC W Auto Diff^LN||$reqDate||||||||| OBX|2|NM|123^WBC^HSP_A^26464-8^Leukocytes [#/volume] in Blood^LN||10.8|K/MM3|||||F| OBX|3|NM|234^RBC^HSP_A^26453-1^Erythrocytes [#/volume] in Blood^LN||4.82|MIL/MM3|||||F| OBX|4|NM|345^HGB^HSP_A^718-7^Hemoglobin [Mass/volume] in Blood^LN||15.7|GM/DL|||||F| OBX|5|NM|456^HCT^HSP_A^20570-8^Hematocrit [Volume Fraction] of Blood^LN||45|%|||||||F|
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MSH|^~\&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay||||||||||||||| PID|||$patientId$||$patientName$|||||||||||||||||||| PV1|||||||$attendingDoctor$||$consultingDoctor$||||||||
OBR|1|||012^CBC/Auto Diff^HSPA^57021-8^CBC W Auto Diff^LN||$reqDate||||||||| OBX|2|NM|123^WBC^HSP_A^26464-8^Leukocytes [#/volume] in Blood^LN||10.8|K/MM3|||||F| OBX|3|NM|234^RBC^HSP_A^26453-1^Erythrocytes [#/volume] in Blood^LN||4.82|MIL/MM3|||||F| OBX|4|NM|345^HGB^HSP_A^718-7^Hemoglobin [Mass/volume] in Blood^LN||15.7|GM/DL|||||F| OBX|5|NM|456^HCT^HSP_A^20570-8^Hematocrit [Volume Fraction] of Blood^LN||45|%|||||||F|
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MSH|^~\&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay||||||||||||||| PID|||$patientId$||$patientName$|||||||||||||||||||| PV1|||||||$attendingDoctor$||$consultingDoctor$||||||||
OBR|1|||012^CBC/Auto Diff^HSPA^57021-8^CBC W Auto Diff^LN||$reqDate||||||||| OBX|2|NM|123^WBC^HSP_A^26464-8^Leukocytes [#/volume] in Blood^LN||10.8|K/MM3|||||F| OBX|3|NM|234^RBC^HSP_A^26453-1^Erythrocytes [#/volume] in Blood^LN||4.82|MIL/MM3|||||F| OBX|4|NM|345^HGB^HSP_A^718-7^Hemoglobin [Mass/volume] in Blood^LN||15.7|GM/DL|||||F| OBX|5|NM|456^HCT^HSP_A^20570-8^Hematocrit [Volume Fraction] of Blood^LN||45|%|||||||F|
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MSH|^~\&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay||||||||||||||| PID|||$patientId$||$patientName$|||||||||||||||||||| PV1|||||||$attendingDoctor$||$consultingDoctor$||||||||
OBR|1|||012^CBC/Auto Diff^HSPA^57021-8^CBC W Auto Diff^LN||$reqDate||||||||| OBX|2|NM|123^WBC^HSP_A^26464-8^Leukocytes [#/volume] in Blood^LN||10.8|K/MM3|||||F| OBX|3|NM|234^RBC^HSP_A^26453-1^Erythrocytes [#/volume] in Blood^LN||4.82|MIL/MM3|||||F| OBX|4|NM|345^HGB^HSP_A^718-7^Hemoglobin [Mass/volume] in Blood^LN||15.7|GM/DL|||||F| OBX|5|NM|456^HCT^HSP_A^20570-8^Hematocrit [Volume Fraction] of Blood^LN||45|%|||||||F|
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MSH|^~\&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay||||||||||||||| PID|||$patientId$||$patientName$|||||||||||||||||||| PV1|||||||$attendingDoctor$||$consultingDoctor$||||||||
OBR|1|||012^CBC/Auto Diff^HSPA^57021-8^CBC W Auto Diff^LN||$reqDate||||||||| OBX|2|NM|123^WBC^HSP_A^26464-8^Leukocytes [#/volume] in Blood^LN||10.8|K/MM3|||||F| OBX|3|NM|234^RBC^HSP_A^26453-1^Erythrocytes [#/volume] in Blood^LN||4.82|MIL/MM3|||||F| OBX|4|NM|345^HGB^HSP_A^718-7^Hemoglobin [Mass/volume] in Blood^LN||15.7|GM/DL|||||F| OBX|5|NM|456^HCT^HSP_A^20570-8^Hematocrit [Volume Fraction] of Blood^LN||45|%|||||||F|
LocalCode^LocalName^CodeSystem^LOINCcode^LOINCname^CodeSystem
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MSH|^~\&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay||||||||||||||| PID|||$patientId$||$patientName$|||||||||||||||||||| PV1|||||||$attendingDoctor$||$consultingDoctor$||||||||
OBR|1|||012^CBC/Auto Diff^HSPA^57021-8^CBC W Auto Diff^LN||$reqDate||||||||| OBX|2|NM|123^WBC^HSP_A^26464-8^Leukocytes [#/volume] in Blood^LN||10.8|K/MM3|||||F| OBX|3|NM|234^RBC^HSP_A^26453-1^Erythrocytes [#/volume] in Blood^LN||4.82|MIL/MM3|||||F| OBX|4|NM|345^HGB^HSP_A^718-7^Hemoglobin [Mass/volume] in Blood^LN||15.7|GM/DL|||||F| OBX|5|NM|456^HCT^HSP_A^20570-8^Hematocrit [Volume Fraction] of Blood^LN||45|%|||||||F|
LocalCode^LocalName^CodeSystem^LOINCcode^LOINCname^CodeSystem
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MSH|^~\&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay||||||||||||||| PID|||$patientId$||$patientName$|||||||||||||||||||| PV1|||||||$attendingDoctor$||$consultingDoctor$||||||||
OBR|1|||012^CBC/Auto Diff^HSPA^57021-8^CBC W Auto Diff^LN||$reqDate||||||||| OBX|2|NM|123^WBC^HSP_A^26464-8^Leukocytes [#/volume] in Blood^LN||10.8|K/MM3|||||F| OBX|3|NM|234^RBC^HSP_A^26453-1^Erythrocytes [#/volume] in Blood^LN||4.82|MIL/MM3|||||F| OBX|4|NM|345^HGB^HSP_A^718-7^Hemoglobin [Mass/volume] in Blood^LN||15.7|GM/DL|||||F| OBX|5|NM|456^HCT^HSP_A^20570-8^Hematocrit [Volume Fraction] of Blood^LN||45|%|||||||F|
LocalCode^LocalName^CodeSystem^LOINCcode^LOINCname^CodeSystem
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MSH|^~\&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay||||||||||||||| PID|||$patientId$||$patientName$|||||||||||||||||||| PV1|||||||$attendingDoctor$||$consultingDoctor$||||||||
OBR|1|||012^CBC/Auto Diff^HSPA^57021-8^CBC W Auto Diff^LN||$reqDate||||||||| OBX|2|NM|123^WBC^HSP_A^26464-8^Leukocytes [#/volume] in Blood^LN||10.8|K/MM3|||||F| OBX|3|NM|234^RBC^HSP_A^26453-1^Erythrocytes [#/volume] in Blood^LN||4.82|MIL/MM3|||||F| OBX|4|NM|345^HGB^HSP_A^718-7^Hemoglobin [Mass/volume] in Blood^LN||15.7|GM/DL|||||F| OBX|5|NM|456^HCT^HSP_A^20570-8^Hematocrit [Volume Fraction] of Blood^LN||45|%|||||||F|
LocalCode^LocalName^CodeSystem^LOINCcode^LOINCname^CodeSystem
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MSH|^~\&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay||||||||||||||| PID|||$patientId$||$patientName$|||||||||||||||||||| PV1|||||||$attendingDoctor$||$consultingDoctor$||||||||
OBR|1|||012^CBC/Auto Diff^HSPA^57021-8^CBC W Auto Diff^LN||$reqDate||||||||| OBX|2|NM|123^WBC^HSP_A^26464-8^Leukocytes [#/volume] in Blood^LN||10.8|K/MM3|||||F| OBX|3|NM|234^RBC^HSP_A^26453-1^Erythrocytes [#/volume] in Blood^LN||4.82|MIL/MM3|||||F| OBX|4|NM|345^HGB^HSP_A^718-7^Hemoglobin [Mass/volume] in Blood^LN||15.7|GM/DL|||||F| OBX|5|NM|456^HCT^HSP_A^20570-8^Hematocrit [Volume Fraction] of Blood^LN||45|%|||||||F|
LocalCode^LocalName^CodeSystem^LOINCcode^LOINCname^CodeSystem
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OBX||CE|57131-5^Newborn conditions with pos markers^LN||7573000^PKU^SCT
Result with a Coded Value
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OBX||CE|57131-5^Newborn conditions with pos markers^LN||7573000^PKU^SCT
Result with a Coded Value
Data type of result(OBX-5) is a coded
element
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OBX||CE|57131-5^Newborn conditions with pos markers^LN||7573000^PKU^SCT
Result with a Coded Value
Data type of result(OBX-5) is a coded
element
This code isfrom LOINC
Code identifying thisobservation
(what are these results?Conditions identified by
newborn screening )
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OBX||CE|57131-5^Newborn conditions with pos markers^LN||7573000^PKU^SCT
Result with a Coded Value
Data type of result(OBX-5) is a coded
element
This code isfrom LOINC
Code identifying thisobservation
(what are these results?Conditions identified by
newborn screening )
This code is fromSNOMED
Code identifying the result(Phenylketonuria )
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photo via eye of einstein
A brief aside about terminology…
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LOINC Terminology
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LOINC Terminology
LOINC (noun)
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LOINC Terminology
LOINC (noun) To LOINC, LOINCing, LOINCed (verb)
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LOINC Terminology
LOINC (noun) To LOINC, LOINCing, LOINCed (verb)
[Chief, Head, etc] LOINCer, LOINCologist (noun)
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LOINC Terminology
LOINC (noun) To LOINC, LOINCing, LOINCed (verb)
[Chief, Head, etc] LOINCer, LOINCologist (noun)
LOINCification (noun)
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LOINC Terminology
LOINC (noun) To LOINC, LOINCing, LOINCed (verb)
[Chief, Head, etc] LOINCer, LOINCologist (noun)
LOINCification (noun)
SNOMED Terminology
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LOINC Terminology
LOINC (noun) To LOINC, LOINCing, LOINCed (verb)
[Chief, Head, etc] LOINCer, LOINCologist (noun)
LOINCification (noun)
SNOMED Terminology
SNOMED (noun)
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LOINC Terminology
LOINC (noun) To LOINC, LOINCing, LOINCed (verb)
[Chief, Head, etc] LOINCer, LOINCologist (noun)
LOINCification (noun)
SNOMED Terminology
SNOMED (noun)
SNOMEDicated???
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LOINC Terminology
LOINC (noun) To LOINC, LOINCing, LOINCed (verb)
[Chief, Head, etc] LOINCer, LOINCologist (noun)
LOINCification (noun)
SNOMED Terminology
SNOMED (noun)
SNOMEDicated???
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photo via Ludovic Hirlimann
Different standards for differentparts of the elephant.
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We now return to your
regularly scheduledprogram…
photo via x-ray delta one
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Laboratory LOINC
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Clinical LOINC
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Laboratory LOINC Committee Chair:
Clem McDonald, MD
Clinical LOINC Committee Chair:
Stan Huff, MD
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LOINC CollectionsPanels, forms, surveys, and other patientassessments
photo via LuzA
Standardized Assessments and Collections
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Vreeman DJ, McDonald CJ, Huff SM. Representing patient assessments in LOINC®. AMIA Ann u Symp Proc. 2010;832-836. PMID: 21347095 . Vreeman DJ, McDonald CJ, Huff SM. LOINC® - A Universal Catalog o f Individual Clinical Observations and Uniform Representation of Enum erated Collections. Int J Funct Inform
Personal Med. 2010;3(4):273-291.
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The LOINC ApproachOpen. Nimble. Pragmatic.
Open Development
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Open Development
Worldwide distribution at no cost
New terms from end-users
Welcome all comers Committees are volunteers
Open Development
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Open Development
Worldwide distribution at no cost
New terms from end-users
Welcome all comers Committees are volunteers
Open Development
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Open Development
Worldwide distribution at no cost
New terms from end-users
Welcome all comers Committees are volunteers
It’s free, but invaluable
R i f I i
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Regenstrief Institute
Steward
Developer of content
Developer of tools
Developer of community
Distributor
Voice
F di S
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Funding Support
Main current sources are:
U.S. National Library of MedicineRegenstrief Foundation
Prior support from
Several other U.S. federal agenciesJohn A. Hartford Foundation
LOINC Codes Over Time by Release
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1
2
3
4
5
6
7
8
4 / 2 4
/ 1 9 9
5 | 1 . 0
5 / 2 4
/ 1 9 9
5 | 1 . 0 a
6 / 2 3
/ 1 9 9
5 | 1 . 0 b
6 / 2 8
/ 1 9 9
5 | 1 . 0 c
7 / 1 4
/ 1 9 9
5 | 1 . 0 d
9 / 1 5
/ 1 9 9
5 | 1 . 0 e
1 2 / 2
1 / 1 9
9 5 | 1 . 0 f
4 / 2 8
/ 1 9 9
6 | 1 . 0 g
8 / 2
9 / 1 9
9 6 | 1 . 0 h
( 2 )
1 2 /
3 / 1 9
9 6 | 1 . 0 h
( 3 )
1 / 8 /
1 9 9 9
7 | 1 . 0 i
1 0 / 9
/ 1 9 9
7 | 1 . 0 j - a
5 / 1 /
1 9 9 8
| 1 . 0 k
2 / 1 2
/ 1 9 9
9 | 1 . 0 l
7 / 2 3
/ 1 9 9
9 | 1 . 0 m
8 / 6 /
1 9 9 9
| 1 . 0 m a
2 / 4 /
2 0 0 0
| 1 . 0 n
6 / 1 3
/ 2 0 0
0 | 1 . 0 0
1 / 1 /
2 0 0 1
| 2 . 0 0
1 / 3 1
/ 2 0 0
1 | 2 . 0 1
7 / 1 /
2 0 0 1
| 2 . 0 3
1 / 1 /
2 0 0 2
| 2 . 0 4
2 / 1 /
2 0 0 2
| 2 . 0 5
2 / 1 9
/ 2 0 0
2 | 2 . 0 6
8 / 1 /
2 0 0 2
| 2 . 0 7
9 / 1 /
2 0 0 2
| 2 . 0 8
5 / 1 /
2 0 0 3
| 2 . 0 9
1 0 / 1
/ 2 0 0
3 | 2 . 1 0
1 / 1 /
2 0 0 4
| 2 . 1 1
2 / 1 /
2 0 0 4
| 2 . 1 2
1 2 / 1
/ 2 0 0
4 | 2 . 1 3
1 2 / 1
/ 2 0 0
4 | 2 . 1 4
6 / 1 /
2 0 0 5
| 2 . 1 5
1 2 / 1
/ 2 0 0
5 | 2 . 1 6
6 / 1 /
2 0 0 6
| 2 . 1 7
1 2 / 2
1 / 2 0
0 6 | 2 . 1 9
6 / 2 1
/ 2 0 0
7 | 2 . 2 1
1 2 / 0
3 / 2 0
0 7 | 2 . 2 2
7 / 1 0
/ 2 0 0
8 | 2 . 2 4
1 / 1 0
/ 2 0 0
9 | 2 . 2 6
0 7 / 0
6 / 2 0
0 9 | 2 . 2 7
1 2 / 3
0 / 2 0
0 9 | 2 . 2 9
2 / 2 6
/ 2 0 1
0 | 2 . 3 0
6 / 1 5
/ 2 0 1
0 | 2 . 3 2
1 2 / 2
9 / 2 0
1 0 | 2 . 3 4
0 6 / 3
0 / 2 0
1 1 | 2 . 3 6
1 2 / 3
0 / 2 0
1 1 | 2 . 3 8
6 / 3 0
/ 2 0 1
2 | 2 . 4 0
1 2 / 3
0 / 2 0
1 2 | 2 . 4
2
0 6 / 2
9 / 2 0
1 3 | 2 . 4
4
1 2 / 2
6 / 2 0
1 3 | 2 . 4
6
LOINC Codes
Only Lab LOINC Codes
y
laboratory terms only
LOINC Codes Over Time by Release
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1
2
3
4
5
6
7
8
4 / 2 4
/ 1 9 9
5 | 1 . 0
5 / 2 4
/ 1 9 9
5 | 1 . 0 a
6 / 2 3
/ 1 9 9
5 | 1 . 0 b
6 / 2 8
/ 1 9 9
5 | 1 . 0 c
7 / 1 4
/ 1 9 9
5 | 1 . 0 d
9 / 1 5
/ 1 9 9
5 | 1 . 0 e
1 2 / 2
1 / 1 9
9 5 | 1 . 0 f
4 / 2 8
/ 1 9 9
6 | 1 . 0 g
8 / 2
9 / 1 9
9 6 | 1 . 0 h
( 2 )
1 2 /
3 / 1 9
9 6 | 1 . 0 h
( 3 )
1 / 8 /
1 9 9 9
7 | 1 . 0 i
1 0 / 9
/ 1 9 9
7 | 1 . 0 j - a
5 / 1 /
1 9 9 8
| 1 . 0 k
2 / 1 2
/ 1 9 9
9 | 1 . 0 l
7 / 2 3
/ 1 9 9
9 | 1 . 0 m
8 / 6 /
1 9 9 9
| 1 . 0 m a
2 / 4 /
2 0 0 0
| 1 . 0 n
6 / 1 3
/ 2 0 0
0 | 1 . 0 0
1 / 1 /
2 0 0 1
| 2 . 0 0
1 / 3 1
/ 2 0 0
1 | 2 . 0 1
7 / 1 /
2 0 0 1
| 2 . 0 3
1 / 1 /
2 0 0 2
| 2 . 0 4
2 / 1 /
2 0 0 2
| 2 . 0 5
2 / 1 9
/ 2 0 0
2 | 2 . 0 6
8 / 1 /
2 0 0 2
| 2 . 0 7
9 / 1 /
2 0 0 2
| 2 . 0 8
5 / 1 /
2 0 0 3
| 2 . 0 9
1 0 / 1
/ 2 0 0
3 | 2 . 1 0
1 / 1 /
2 0 0 4
| 2 . 1 1
2 / 1 /
2 0 0 4
| 2 . 1 2
1 2 / 1
/ 2 0 0
4 | 2 . 1 3
1 2 / 1
/ 2 0 0
4 | 2 . 1 4
6 / 1 /
2 0 0 5
| 2 . 1 5
1 2 / 1
/ 2 0 0
5 | 2 . 1 6
6 / 1 /
2 0 0 6
| 2 . 1 7
1 2 / 2
1 / 2 0
0 6 | 2 . 1 9
6 / 2 1
/ 2 0 0
7 | 2 . 2 1
1 2 / 0
3 / 2 0
0 7 | 2 . 2 2
7 / 1 0
/ 2 0 0
8 | 2 . 2 4
1 / 1 0
/ 2 0 0
9 | 2 . 2 6
0 7 / 0
6 / 2 0
0 9 | 2 . 2 7
1 2 / 3
0 / 2 0
0 9 | 2 . 2 9
2 / 2 6
/ 2 0 1
0 | 2 . 3 0
6 / 1 5
/ 2 0 1
0 | 2 . 3 2
1 2 / 2
9 / 2 0
1 0 | 2 . 3 4
0 6 / 3
0 / 2 0
1 1 | 2 . 3 6
1 2 / 3
0 / 2 0
1 1 | 2 . 3 8
6 / 3 0
/ 2 0 1
2 | 2 . 4 0
1 2 / 3
0 / 2 0
1 2 | 2 . 4
2
0 6 / 2
9 / 2 0
1 3 | 2 . 4
4
1 2 / 2
6 / 2 0
1 3 | 2 . 4
6
LOINC Codes
Only Lab LOINC Codes
y
Slope = 600
laboratory terms only
LOINC Codes Over Time by Release
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1
2
3
4
5
6
7
8
4 / 2 4
/ 1 9 9
5 | 1 . 0
5 / 2 4
/ 1 9 9
5 | 1 . 0 a
6 / 2 3
/ 1 9 9
5 | 1 . 0 b
6 / 2 8
/ 1 9 9
5 | 1 . 0 c
7 / 1 4
/ 1 9 9
5 | 1 . 0 d
9 / 1 5
/ 1 9 9
5 | 1 . 0 e
1 2 / 2
1 / 1 9
9 5 | 1 . 0 f
4 / 2 8
/ 1 9 9
6 | 1 . 0 g
8 / 2
9 / 1 9
9 6 | 1 . 0 h
( 2 )
1 2 /
3 / 1 9
9 6 | 1 . 0 h
( 3 )
1 / 8 /
1 9 9 9
7 | 1 . 0 i
1 0 / 9
/ 1 9 9
7 | 1 . 0 j - a
5 / 1 /
1 9 9 8
| 1 . 0 k
2 / 1 2
/ 1 9 9
9 | 1 . 0 l
7 / 2 3
/ 1 9 9
9 | 1 . 0 m
8 / 6 /
1 9 9 9
| 1 . 0 m a
2 / 4 /
2 0 0 0
| 1 . 0 n
6 / 1 3
/ 2 0 0
0 | 1 . 0 0
1 / 1 /
2 0 0 1
| 2 . 0 0
1 / 3 1
/ 2 0 0
1 | 2 . 0 1
7 / 1 /
2 0 0 1
| 2 . 0 3
1 / 1 /
2 0 0 2
| 2 . 0 4
2 / 1 /
2 0 0 2
| 2 . 0 5
2 / 1 9
/ 2 0 0
2 | 2 . 0 6
8 / 1 /
2 0 0 2
| 2 . 0 7
9 / 1 /
2 0 0 2
| 2 . 0 8
5 / 1 /
2 0 0 3
| 2 . 0 9
1 0 / 1
/ 2 0 0
3 | 2 . 1 0
1 / 1 /
2 0 0 4
| 2 . 1 1
2 / 1 /
2 0 0 4
| 2 . 1 2
1 2 / 1
/ 2 0 0
4 | 2 . 1 3
1 2 / 1
/ 2 0 0
4 | 2 . 1 4
6 / 1 /
2 0 0 5
| 2 . 1 5
1 2 / 1
/ 2 0 0
5 | 2 . 1 6
6 / 1 /
2 0 0 6
| 2 . 1 7
1 2 / 2
1 / 2 0
0 6 | 2 . 1 9
6 / 2 1
/ 2 0 0
7 | 2 . 2 1
1 2 / 0
3 / 2 0
0 7 | 2 . 2 2
7 / 1 0
/ 2 0 0
8 | 2 . 2 4
1 / 1 0
/ 2 0 0
9 | 2 . 2 6
0 7 / 0
6 / 2 0
0 9 | 2 . 2 7
1 2 / 3
0 / 2 0
0 9 | 2 . 2 9
2 / 2 6
/ 2 0 1
0 | 2 . 3 0
6 / 1 5
/ 2 0 1
0 | 2 . 3 2
1 2 / 2
9 / 2 0
1 0 | 2 . 3 4
0 6 / 3
0 / 2 0
1 1 | 2 . 3 6
1 2 / 3
0 / 2 0
1 1 | 2 . 3 8
6 / 3 0
/ 2 0 1
2 | 2 . 4 0
1 2 / 3
0 / 2 0
1 2 | 2 . 4
2
0 6 / 2
9 / 2 0
1 3 | 2 . 4
4
1 2 / 2
6 / 2 0
1 3 | 2 . 4
6
LOINC Codes
Only Lab LOINC Codes
y
Slope = 600
Slope = 2200
laboratory terms only
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Lots Cooking…Always more lab tests
Genetic reporting
Lots of survey instruments, forms, and assessments
More radiology reportsStructured document titles
…
photo via liber
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32,000+ users in 162 countries
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32,000 users in 162 countries
loinc.org registered users
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0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
6 / 1 / 0 8
1 2 / 1 / 0 8
6 / 1 / 0 9
1 2 / 1 / 0 9
6 / 1 / 1 0
1 2 / 1 / 1 0
6 / 1 / 1 1
1 2 / 1 / 1 1
6 / 1 / 1 2
1 2 / 1 / 1 2
6 / 1 / 1 3
1 2 / 1 / 1 3
g g
loinc.org registered users
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0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
6 / 1 / 0 8
1 2 / 1 / 0 8
6 / 1 / 0 9
1 2 / 1 / 0 9
6 / 1 / 1 0
1 2 / 1 / 1 0
6 / 1 / 1 1
1 2 / 1 / 1 1
6 / 1 / 1 2
1 2 / 1 / 1 2
6 / 1 / 1 3
1 2 / 1 / 1 3
g g
725 new users per month8,700 new users per year
loinc.org registered users
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0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
6 / 1 / 0 8
1 2 / 1 / 0 8
6 / 1 / 0 9
1 2 / 1 / 0 9
6 / 1 / 1 0
1 2 / 1 / 1 0
6 / 1 / 1 1
1 2 / 1 / 1 1
6 / 1 / 1 2
1 2 / 1 / 1 2
6 / 1 / 1 3
1 2 / 1 / 1 3
g g
725 new users per month8,700 new users per year
Doubled in 19 months!
loinc.org registered users
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0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
6 / 1 / 0 8
1 2 / 1 / 0 8
6 / 1 / 0 9
1 2 / 1 / 0 9
6 / 1 / 1 0
1 2 / 1 / 1 0
6 / 1 / 1 1
1 2 / 1 / 1 1
6 / 1 / 1 2
1 2 / 1 / 1 2
6 / 1 / 1 3
1 2 / 1 / 1 3
725 new users per month8,700 new users per year
Ave growth/mo:
2009 = 2762010 = 307
2011 = 3792012 = 5002013 = 667
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Tools forImplementers
photo via Robert S Donovan
loinc.org/downloads
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loinc.org/downloads
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d wnl ad 1400/ nth
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loinc.org/get-started
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g g
search.loinc.org
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g
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Alternate Language Search
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Alternate Language Search
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Everything in Italian!
loinc.org/mailing-lists
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N ! N l tloinc.org/mailing-lists
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No spam! News + release notices
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@LOINC
loinc.org/slideshows
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loinc.org/adopters
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loinc.org/adopters
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List your organization. Free!
forum.loinc.org
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loinc.org/usage
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loinc.org/usage
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loinc.org/usage
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loinc.org/usage
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loinc.org/usage
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Wisdom of the HerdCan it help novice LOINCers?
photo via suffolktouristguide.com
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photo via jdhancock
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Fidahussein M, Vreeman DJ. A corpus-based approach for automated LOINC mapping. J Am Med Inform Assoc. 2013 May 15. [Epub ahead of print] PubMed PMID: 23676247.
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Maxent vs Lucene
Mapping Performance on 3 INPC LabsC 101 d t with b t 80 00 l l t
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Corpus = 101 code sets with about 80,00 local terms
Mapping Performance on 3 INPC LabsC r 101 de et with ab t 80 00 l al ter
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~79% = Not bad!
Corpus = 101 code sets with about 80,00 local terms
57%
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57% of local lab codes would always have
the correct LOINC ranked first byusing a Maxent cutoff of 0.46
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Connecting RELMA to acommunity repository
of LOINC MappingsDaniel J. Vreeman, PT, DPT, MSc
Masoud Hosseini, MS
John HookAnandhi Sowmyan
James Dennis
Brian E. Dixon, MPA, PhD, FHIMSS
photo via jamescridland
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RELMA®REgenstrief LOINC Mapping Assistant
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22 organizations, 5 countries, 102,000 mappings
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# of codes and institutions mapped to this LOINC
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# of codes and institutions mapped to this LOINC
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# of codes and institutions mapped to this LOINC
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Click here to see the local codes!
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When you’ve got a decent number of mappings,share them back with the community
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share them back with the community
When you’ve got a decent number of mappings,share them back with the community
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share them back with the community
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LOINC PremiumMembership Programmembers.loinc.org
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What’s still free?
All the Usual Awesomeness
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LOINC Table
Accessory Files
RELMA Program
DocumentationWeb search app (search.loinc.org)
Participation in the LOINC Community
Access to submit new concepts to LOINC
Share the love.
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Donate to LOINC.members.loinc.org/donate
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loinc.org/terms-of-use
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photo via 917press
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Just kidding.
Copyright is a good thing for
standards. It’s the licensing part that isinteresting.
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No cost
Worldwide
In perpetuity
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Use
Copy
Distribute
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Any purpose:
commercial
non-commercialphoto via Refracted Moments™
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CANNOT use anyLicensed Material to
develop or promulgate adifferent standard for
orders or observations.
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That would defeat
the purpose ofhaving a standard!
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International Adoptionparticipation, translation, implementation
LOINC Submitters
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Si 2009 150 i ti
LOINC Translators
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22 organizations.
C ntly t n l ti n int 18 i nt f 11 l n
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Vreeman DJ, Chiaravalloti MT, Hook J, McDonald CJ. Enabling international adoption of LOINC through translation. J Biomed Inform.
2012 Aug;45(4):667-73. PMID: 22285984.
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Vreeman DJ, Chiaravalloti MT, Hook J, McDonald CJ. Enabling international adoption of LOINC through translation. J Biomed Inform.
2012 Aug;45(4):667-73. PMID: 22285984.
1st International
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Vreeman DJ, Chiaravalloti MT, Hook J, McDonald CJ. Enabling international adoption of LOINC through translation. J Biomed Inform.
2012 Aug;45(4):667-73. PMID: 22285984.
1 International LOINC PhD student
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Adopted as National Standard
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Australia
Austria
Belgium
Brazil
Canada
Cyprus
Estonia
Finland
France
Germany
Iceland
India
Mexico
Mongolia
The Netherlands
New Zealand
Philippines
Portugal
Rwanda
Slovakia
Slovenia
Spain
Thailand
Turkey
United States
Large Implementations
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SIGA Saúde project
7+ Provincial systems in Canada
8+ Regional Health Information Exchanges in Spain
ePSOS
Assistance publique - Hôpitaux de Paris
Hong Kong Hospital Authority
Philippine Health Insurance Corporation
InFSE Project in 5 regions in Italy (LOINC Italia)
Many more...
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For the last few years the AP-HP has
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For the last few years, the AP-HP has
been using the LOINC internationalnomenclature…
Thanks to this catalogue, the AP-HP isable to use the nomenclature in its
treatment processes, whenever
biology analyses and test results arerequested.
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Vandenbussche PY, Cormont S, André C, et al. Implementation and management of a biomedical observation dictionary in a large healthcare information system.
J Am Med Inform Assoc. 2013 May 1. PMID: 23635601.
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Vandenbussche PY, Cormont S, André C, et al. Implementation and management of a biomedical observation dictionary in a large healthcare information system.
J Am Med Inform Assoc. 2013 May 1. PMID: 23635601.
The results of our workvalidate the choice made to
develop a local dictionaryaligned with LOINC.
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Vandenbussche PY, Cormont S, André C, et al. Implementation and management of a biomedical observation dictionary in a large healthcare information system.
J Am Med Inform Assoc. 2013 May 1. PMID: 23635601.
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Members of the Korean National StandardsCommittee have enthusiastically embraced LOINC
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Some serious LOINCing in Hong Kong
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S t LOINC
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Talking about LOINC at the Thai Ministry of
I f t d C t T h l
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D C l d LOINC C
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US AdoptionA few key highlights
Some Key US Adoptions
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All the “big” labs
All health-related federal agencies
Lots of care organizations
HIE’s
Insurance companies
EHR vendors
Instrument manufacturers (nascent)
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In USA, major driver ofeHealth standards adoption is EHR Incentive Program
a.k.a. “Meaningful Use”
Blumenthal D, Tavenner M. The "meaningful use" regulation for electronic health records. N Engl J Med. 2010 Aug 5;363(6):501-4. Epub 2010 Jul 13. PubMed PMID: 20647183.
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Stage 12011-2012
Data capture
and sharing
Stage 22014
Advance clinical
processes
Stage 32016
Improved care
outcomes
progressive requirements for data standards
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Stage 2starting 2014
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LOINC adopted for:
1. View, download, transmit data to third party
2.Cancer case reporting to state registry
3.Send/receive electronic lab results inambulatory settings
4.Provide a care summary at care transition
5.Provide clinical summaries for patients
6.Submit reportable lab results to public health
Lab reporting to EHRs
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Use in Quality Measures
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LOINC Adopted ForP ti t Ch t i ti
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Patient Characteristics
[Non-lab] Diagnostics studies
Patient experience
Family history
Functional status
Health record component
Interventions (that produce an assessment or measured results)
Laboratory tests
Physical exam
Patient preference
Risk evaluation
System resources (healthcare resources)
An Example Quality MeasureN ti l C itt f Q lit A
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National Committee for Quality Assurance
Diabetes: Hemoglobin A1c
Poor ControlPercentage of patients 18-75 years of age with diabetes who had
hemoglobin A1c > 9.0% during the measurement period.
Find HbA1c in the EHR with LOINC
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Everyone loves LOINC
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photo via mccaughan
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Key Lessons for Today
photo via IMLS DCC
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Not just an I.T. problem
If Murky, Don’t Assume
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Units of measure are critical.
Sample results can help identify thecorrect LOINC Scale.
Local experts, package inserts can bevery informative.
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photo via Fishking_1
Upstream standardization.
Ask instrument or test kitmanufacturers.
ivdconnectivity.org
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A journey.
Not a destination.
Ongoing Journey
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Plan for updating as your testing
changes (less common), or your localcode identifiers change (more common).
Prioritization
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Local or national policies may helpprioritize mapping subsets.
For example:
common results
+ panel elements
+ public health reportable testsVreeman DJ, Finnell JT, Overhage JM. A rationale for parsimonious laboratory term mapping by frequency.
AMIA Annu Symp Proc. 2007 Oct 11:771-5. PubMed PMID: 18693941.
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Need to be mindful ofSecondary Data Usespublic health reporting | electronic quality measures
photo via pagedooley
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Wu J, Finnell JT, Vreeman DJ. Evaluating Congruence Between Laboratory LOINC Value Sets for Quality Measures, Public Health Reporting, and Mapping Common Tests. AMIA Annu Symp Proc. 2013; 1525-1532.
n=2852
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n=2852
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LOINC Top 2000 Results + LOINC Top 300 Orders +
NCD 1 VSAC Q l t LOINC
In closing...
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photo via janeandd
Glad you’re here to at leastget your feet wet
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photo via gmayster01 on & off ...
get your feet wet...
Jump In!
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photo via Justin Ornellas
The Race is On!
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Happy LOINCing!photo via ryarwood
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