2009 12 07 - LOINC Introduction and Overview
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LOINC® Overview and Introduction 12.07.2009 Daniel J. Vreeman, PT, DPT, MSc Assistant Research Professor | Indiana University School of Medicine Research Scientist | Regenstrief Institute, Inc Copyright © 2009 Laboratory LOINC Workshop
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Transcript of 2009 12 07 - LOINC Introduction and Overview
LOINC® Overview and Introduction
12.07.2009
Daniel J. Vreeman, PT, DPT, MSc Assistant Research Professor | Indiana University School of Medicine
Research Scientist | Regenstrief Institute, Inc
Copyright © 2009
Laboratory LOINC Workshop
Overview • Origins of LOINC – Background – Growth – Participation
• Successes – International – US
Origins of LOINC The Lingua Franca of Clinical
Observation Exchange
• Regenstrief’s 30-‐year history • The Indiana Network for Patient Care
– A working HIE for ~15 years – More than 100 sources – Regenstrief: 3rd party convener
• Local systems use idiosyncratic codes
*Smith CP, Araya-‐Guerra R, Bublitz C, et al. Missing clinical information during primary care visits. JAMA. 2005;293(5):565-‐571
Introduction
• Vocabulary standards – LOINC ® -‐ universal code system for clinical observations – The lingua franca of information exchange
• Laboratory and Radiology results* – Often unavailable at the time of a clinical visit (6%, 4%) – Often located outside of their clinical system
Indiana Network for Patient Care
From whence comes LOINC? • LOINC® – Logical Observation Identiiiers Names and Codes – A universal code system for laboratory and other clinical observations
– The lingua franca of information exchange for clinical observations
McDonald CJ, Huff SM, Suico JG, et al. LOINC, a universal standard for identifying laboratory observations: a 5-‐year update. Clin Chem. 2003;49(4):624-‐633.
Indiana Network for Patient Care
A
A
MSH|^~\&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay||||||||||||||| PID|||$patientId$||$patientName$|||||||||||||||||||| PV1|||||||$attendingDoctor$||$consultingDoctor$|||||||| OBR|1|||CBC^CBC/Auto Diff^HSPA^57021-8^CBC W Auto Diff^LN||$reqDate||||||||| OBX|2|ST|WBC^WBC^HSP_A^26464-8^Leukocytes [#/volume] in Blood^LN||10.8|K/MM3|||||F| OBX|3|ST|RBC^RBC^HSP_A^26453-1^Erythrocytes [#/volume] in Blood^LN||4.82|MIL/MM3|||||F| OBX|4|ST|HGB^HGB^HSP_A^718-7^Hemoglobin [Mass/?volume] in Blood^LN||15.7|GM/DL|||||F| OBX|5|CE|HCT^HCT^HSP_A^20570-8^Hematocrit [Volume Fraction] of Blood^LN||45|%|||||||F|
HL7 v.2.X Message
LocalCode^LocalName^CodeSystem^LOINCcode^LOINCname^CodeSystem
LOINC Purpose
• Speciiically, to provide a universal ID for the OBX-‐3 iield in HL7 ORU messages
• LOINC codes “questions”, not answers – Orders/Panels (OBR-‐4) – Questions (OBX-‐3) – NOT Values (OBX-‐5) • Numbers, organisms (E. coli)
To facilitate the exchange and pooling of results for clinical care, outcomes management, and research
McDonald CJ, Huff SM, Suico JG, et al. LOINC, a universal standard for identifying laboratory observations: a 5-‐year update. Clin Chem. 2003;49(4):624-‐633.
• If an observation is a question, and the observation value an answer: – LOINC provides codes for the questions {OBR-4, OBX-3} – Other systems (eg SNOMED) provide codes for the answers
718-‐7:Hemoglobin:MCnc:Pt:Bld:Qn
What is my patient’s hemoglobin level?
LOINC’s General Role
41959-‐8:Walking speed:Vel:1W^mean:^Patient:Qn:Calculated
How fast does my patient usually walk?
LOINC Background • Organized by Regenstrief Institute in 1994
– Ongoing support from NLM and Regenstrief – Guided by the LOINC Committee (Lab + Clinical)
• Covers domain of Clinical Observations – Laboratory observations (since 1995) – Clinical observations (since 1996) – HIPAA Claims Attachments (NPRM in 2005)
• LOINC development is a highly ‘open source’ model – Open, nimble, pragmatic – LOINC and RELMA program are freely available – Much work is done by volunteers – Additions to the database are end-‐user driven
LOINC Submissions 2003-2008
67 Organizations, 13 Countries
Active Translation Efforts
16 Countries
Laboratory LOINC ― Chemistry ― Allergy Testing ― Urinalysis ― Blood Bank ― Toxicology ― Cell Markers ― Hematology ― Skin Tests ― Microbiology ― Coagulation ― Antibiotic Susceptibilities ― Cytology ― Immunology/Serology ― HLA Antigens ― Molecular Genetics ― Surgical Pathology ― Cell Counts
Clinical LOINC ― Vital Signs ― EKG
― Hemodynamic Measurements ― Cardiac Ultrasound
― Fluid Intake/Output ― Obstetrical Ultrasound
― Body Measurements ― Discharge Summary
― Emergency Department Variables ― History and Physical
― Respiratory Therapy ― Pathology Findings
― Tumor Registry ― Colonoscopy/Endoscopy
― Patient Assessment Instruments ― Clinical Documents
― Ophthalmology Measurements ― Document Sections
― Radiology Reports ― Patient Assessment Instruments
Slope = 600
Slope = 2200
Downloads: 875/month
~ 80 Organizations Listed
3,121 email addresses
Current Initiatives/Successes
International and US Adoption
International Adoption
Existing Translations • Spanish
– BiTAC (Spain); 39,000 terms – Conceptum Medical Terminology Center; 38,000 terms, Users’ Guide – Mexican Institute of Social Security; Users’ Guide
• French – Canada Health Infoway; 38,000 terms, Documentation – Société Française d'Informatique de Laboratoires; 4,000 terms
• Simpliiied Chinese – Bethune International Peace Hospital; 38,000 terms, Users’ Guide, tutorial
• Korean – Korean Ministry for Health, Welfare and Family Affairs; 27,000 terms
• German – DIMDI; Companion website, Users’ Guide
New Translations (this release)
• Estonian – Estonian LOINC working group of the Estonian Society for Clinical Chemistry; Users’ Guide, Tutorial
• Portuguese – Brazilian Federal Agency for Health Plans and Insurance, Brazilian Clinical Analysis Society, Brazilian Clinical Pathology Society, and Diagnóstico das Américas (DASA); 2,800 terms
• German, French, Italian, Spanish – CUMUL (Switzerland); 5000 common terms
In-‐progress Translations • French
– Assistance Publique-‐Paris Hospitals (PMID: 18999107)
• Estonian – University of Tartu; Lab terms
• Dutch – SKML (the Dutch Foundation for Quality Assessment in Medical Laboratories); Lab terms
• Catalan – BiTAC; Lab terms
• Russian – Donetsk National Medical University, corTTex
How do you say “glucose?” Component Linguistic Variant Glukose German (Switzerland) Glucose French (Switzerland) Glucosio Italian (Switzerland) Glucosa Spanish (Switzerland) 葡萄糖 Simpliiied Chinese (China) Glucosa Spanish (Argentina) Glükoos Estonian (Estonia) Glicose Portuguese (Brazil) -‐ Draft Glucosa Spanish (Spain) 포도당 Korean (Korea, South)
New Translation Approach • Prior Method – Translate whole name as one string
• New Method – Break LOINC terms into their constituent Parts – Remove duplicate strings in Part list – Translate the Part strings – Reassemble the full LOINC name
• Beneiits – Reduced translation work – Enables multilingual searches in RELMA
US Adoption a few recent highlights
Consolidated Health Informatics Initiative
• CHI Goal: – Adopting interoperability standards to enable all agencies in the federal health enterprise to “speak the same language”
• In 2006, adopted LOINC as standard: – Laboratory test order names – Medications: Structured Product Labeling Sections
Consolidated Health Informatics Initiative
• In 2007, CHI adopted LOINC as standard for federally-‐required assessments: – questions and answers – assessment forms that include functioning and disability content
Other Key US Adoptions • UMLS • VA • CDC PHIN Initiatives
– Implement CHI standards
• IHS – Embarking on ~250 facility mapping process
• NCQA/HEDIS – Healthcare Effectiveness Data and Information Set – Used 90% of health plans to measure quality
Other Key US Adoptions • ARRA “Meaningful Use” • HITSP
– C80: vital signs, lab results, lab orders, genetic results, other results – IS92: newborn screening
• eLINCS – Standard for results delivery from LIS to an EHR
• NAACCR • CDISC
– Pharmaceutical research specs • NCI – caBIG
– Lab portion adopted as caBIG vocab standard
Other Key US Adoptions • HL7 – many implementation guides, CDA, etc • HIPAA Claims Attachments • Many Regional HIEs
