2013 02 19 - LOINC - Introduction and Overview

8/12/2019 2013 02 19 - LOINC - Introduction and Overview

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[email protected] 02 19

INFO 581

Introduction and Overview
mailto:[email protected]:[email protected]:[email protected]


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Objectives

Describe Regenstriefs approach to LOINC development

Explain the role of LOINC in the context of messaging

standards such as HL7

Discuss key successes and adopters of LOINC

Appreciate the challenges in mapping local vocabularies

to standard terminologies and potential opportunities

for success with automated tools


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photo via noshaMcDonald et al. Canopy Computing: using the Web in Clinical Practice.JAMA

. 1998;280(15):1325-1329.

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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photo via beckstei
http://www.flickr.com/photos/beckstei/6269438822/sizes/o/in/photostream/http://www.flickr.com/photos/beckstei/6269438822/sizes/o/in/photostream/http://www.flickr.com/photos/beckstei/6269438822/sizes/o/in/photostream/


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40 years of EMR workndiana etwork for atient are

Arboreal Informatics Pioneers

Regenstrief

the Data Switzerland

Nations most comprehensive and longest tenured HIE


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Fundamental challenge:Local systems have different ways ofidentifying the same concept.


11/148photo via pfarrell95
http://www.flickr.com/photos/65005341@N03/http://www.flickr.com/photos/65005341@N03/http://www.flickr.com/photos/65005341@N03/


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A vocabulary standard

would serve as theRosetta Stone.

Image Hans Hillewaert / CC-BY-SA-3.0
http://creativecommons.org/licenses/by-sa/3.0/http://creativecommons.org/licenses/by-sa/3.0/http://creativecommons.org/licenses/by-sa/3.0/


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ogical

bservation

dentifiers

ames and

odesA universal code system that facilitates exchange,

pooling, and processing of results


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Established in 1994 byRegenstrief Institute.

Vocabulary standard for

observation identifiers.


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Similar name, different meaning

meerkat meerkat mere cat meerkat

photo via Caption Time
http://captiontime.tumblr.com/http://captiontime.tumblr.com/http://captiontime.tumblr.com/


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MEASUREMENTS

US

R

photo via puuikibeach
http://www.flickr.com/photos/puuikibeachhttp://www.flickr.com/photos/puuikibeachhttp://www.flickr.com/photos/puuikibeach


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If an observation is a question andthe observation value isan answer

LOINC provides codes forquestions

Where needed, othervocabularies provide codes for

answers


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What is my patients

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
http://www.flickr.com/photos/yourdon/http://www.flickr.com/photos/yourdon/http://www.flickr.com/photos/yourdon/


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Indiana Network for Patient Care

HL7 v2.x Message


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Result with a Coded Value

Data type of result

(OBX-5) is a coded

element

This code is

from LOINC

Code identifying thisobservation

(what are these results?

Conditions identified by

newborn screening )

This code is from

SNOMED

Code identifying the result

(Phenylketonuria )


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photo via eye of einstein
http://www.flickr.com/photos/35188692@N00/466404658/sizes/o/in/photostream/http://www.flickr.com/photos/35188692@N00/466404658/sizes/o/in/photostream/http://www.flickr.com/photos/35188692@N00/466404658/sizes/o/in/photostream/http://www.flickr.com/photos/35188692@N00/466404658/sizes/o/in/photostream/http://www.flickr.com/photos/35188692@N00/466404658/sizes/o/in/photostream/


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LOINC (noun)o LOINC, LOINCing, LOINCed (verb)

[Chief, Head, etc] LOINCer (noun)LOINCification (noun)

SNOMED (noun)

SNOMEDicated???

From Standardizing the MDS with LOINC and Vocabulary Matcheshttp://aspe.hhs.gov/daltcp/reports/2007/MDS-LOINC.htm
http://aspe.hhs.gov/daltcp/reports/2007/MDS-LOINC.htmhttp://aspe.hhs.gov/daltcp/reports/2007/MDS-LOINC.htmhttp://aspe.hhs.gov/daltcp/reports/2007/MDS-LOINC.htmhttp://aspe.hhs.gov/daltcp/reports/2007/MDS-LOINC.htmhttp://aspe.hhs.gov/daltcp/reports/2007/MDS-LOINC.htm


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Different standards for differentparts of the elephant.

photo via Ludovic Hirlimann
http://www.flickr.com/photos/lhirlimann/http://www.flickr.com/photos/lhirlimann/http://www.flickr.com/photos/lhirlimann/http://www.flickr.com/photos/lhirlimann/http://www.flickr.com/photos/lhirlimann/http://www.flickr.com/photos/lhirlimann/http://www.flickr.com/photos/lhirlimann/


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photo via x-ray delta one

L b LOINC
http://www.flickr.com/photos/x-ray_delta_onehttp://www.flickr.com/photos/x-ray_delta_onehttp://www.flickr.com/photos/x-ray_delta_one


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Laboratory LOINC

Cli i l LOINC


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Clinical LOINC


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photo via LuzA

St d di d A t d C ll ti
http://www.flickr.com/photos/luchilu/http://www.flickr.com/photos/luchilu/http://www.flickr.com/photos/luchilu/


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Standardized Assessments and Collections

Vreeman DJ, McDonald CJ, Huff SM. Representing patient assessments in LOINC. AMIA Annu Symp Proc. 2010;832-836. PMID: 21347095 .Vreeman DJ, McDonald CJ, Huff SM. LOINC - A Universal Catalog of Individual Clinical Observations and Uniform Representation of Enumerated Collections. Int J Funct Inform

Personal Med. 2010;3(4):273-291.


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Laboratory LOINC Committee Chair:

Clem McDonald, MD

Clinical LOINC Committee Chair:

Stan Huff, MD


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Funding Support

Main current sources are:U.S. National Library of Medicine

Regenstrief Foundation

Prior support from

Several other U.S. federal agencies,

John A. Hartford Foundation


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photo via liber
http://www.flickr.com/photos/liberhttp://www.flickr.com/photos/liberhttp://www.flickr.com/photos/liber


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20 900+ i 150 t i


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20,900+ users in 150 countries

loinc org members


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0

2,000

4,000

6,000

8,000

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16,000

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20,000

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loinc.org members

17 new members per day

520 new members per month

Doubled in 19 months!Mental Tipping Point -

Oh Snap!


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downloads: ~1500/month


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forum loinc org


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forum.loinc.org


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Just kidding.

Copyright is agoodthing for

standards.

Its 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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CANNOTuse anyLicensed Material to

develop or promulgate adifferent standard for

orders or observations.


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That would defeat

the purpose of

having a standard!


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LOINC Submitters


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LOINC Submitters

105 organizations from 15 countries

Since 2009:

LOINC Translators


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LOINC Translators22 organizations


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Adopted as National Standard

AustraliaBrazil

Canada

Cyprus

Estonia

France

Germany

MexicoMongolia

The Netherlands

Rwanda

Thailand

Turkey

United States


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Large Implementations

SIGA Sade projectCanada Health Infoway

ePSOS

Assistance publique - Hpitaux de Paris

BiTAC

Hong Kong Hospital AuthorityPhilippine Health Insurance Corporation

Many re


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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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Some not so serious LOINCing


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This agreement further solidifiesthe wonderful relationship HL7has enjoyed with Regenstrief for

many years.

- Bob Dolin, MDChair of HL7 Board of Directors


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CMS EHR Incentive

Program

a.k.a. Meaningful Use


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A t f LOINC T


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5193-8 LOINC Code

Hepatitis B virus surface Ab

ACncPt

Ser

Qn

EIA

Component

Property MeasuredTiming

System

Scale

Method

There are six major LOINC axes

Anatomy of a LOINC Term


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Component


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Component

Sodium

GlucoseBrucella sp. organismInfluenza A Virus antigenCytomegalovirus antibody

Lipids.total


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Property * the most difficult LOINC axis


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Fully Na ed PropertiesMCnc mass concentration

SCnc substance concentration

MCnt mass content

CCnc catalytic concentration

Prid presence or identity

Imp impression

Type kind of

mg/dL

umol/L

mg/g

U/L

Property the most difficult LOINC axis


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Common Property Issues


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Common Property Issues

Fraction= Part/Whole

NFr: % Eosinophils / leukocytes

SFr: % HGB which is A2

Ratio= multiple analytes fromsamesystem

MCrto: BUN/Creatinine in urine

Relative Ratio= measures from differentsystem

RelRto: Albumin.pericard fld/Albumin.SerPl

Timing


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Timing

Pt

12H24H

point in time

12 hour collection24 hour collection

System


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System

Ser

Ser/Plas

Bld

Ur

Flu

TissXXX

serum

serum or plasma

whole blood

urine

body fluid

tissuespecified elsewhere

photo via AlishaV
http://www.flickr.com/photos/AlishaV/http://www.flickr.com/photos/AlishaV/http://www.flickr.com/photos/AlishaV/


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Scale


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Scale

Qn

Ord

Nom

Nar

Quantitativecontinuous numeric

can have operators

Ordinal

Ranked set (1+, 2+, 3+)Nominal

unranked collection

Taxonomy (e.g. bacteria)

Narrative

photo via puuikibeach

Method
http://www.flickr.com/photos/puuikibeach/http://www.flickr.com/photos/puuikibeach/http://www.flickr.com/photos/puuikibeach/


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Method

Onlyneeded if interpretation affectedDifferent normal ranges

Test sensitivity

Listed at the generic levelAgglutination

Enzyme Immunoassay

Probe with target amplification

St t h B k


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Stretch Break

photo via Rainbirder
http://www.flickr.com/photos/rainbirder/4727814937/sizes/o/in/photostream/http://www.flickr.com/photos/rainbirder/4727814937/sizes/o/in/photostream/http://www.flickr.com/photos/rainbirder/4727814937/sizes/o/in/photostream/


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Mapping might not be rocket

science, but it requires bothexpertiseand effortthat iseasy to underestimate.

Baorto DM, Cimino JJ, Parvin CA, Kahn MG. Combining laboratory data sets from multiple institutions using the logical observation identi!er

names and codes (LOINC). Int J Med Inform.1998 Jul;51(1):29-37.


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Clean water act


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Clean water act

photo via Fishking_1

Upstream data standardization

=downstream bliss

ivdconnectivity.org
http://www.flickr.com/photos/fishking1/5304638016/sizes/o/in/photostream/http://www.flickr.com/photos/fishking1/5304638016/sizes/o/in/photostream/http://www.flickr.com/photos/fishking1/5304638016/sizes/o/in/photostream/


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A journey.

Not a destination.


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Ongoing Journey


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Ongoing Journey

Replace mappings to deprecated

terms with new LOINC releases.

(RELMA can help)

Prioritization


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Prioritization

Local or national policies may helpprioritize mapping subsets.

For example:

common results

+ panel elements

+ public health reportable tests


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Tools forImplementers

photo via Robert S Donovan
http://www.flickr.com/photos/booleansplit/http://www.flickr.com/photos/booleansplit/http://www.flickr.com/photos/booleansplit/


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loinc.org/usage


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search.loinc.orgIf you want to poke aroundstart here!

search.loinc.org


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Search Syntax


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Search Syntax

Google-likeAND, OR, -, +Limit by category (e.g. class:micro)Wildcards (? and *)RELMA uses the same syntax


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Alternate Language Search


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Everything in Italian!


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Helpful Hints


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Helpful Hints

Always look at units (if you have them)append them to your query

exunits:L/L

Properties are tricky for novices

Look at Table 8 in LOINC Users Guide forthe meaning of the abbreviations

(http://loinc.org/downloads/files/LOINCManual.pdf)
http://loinc.org/downloads/files/LOINCManual.pdfhttp://loinc.org/downloads/files/LOINCManual.pdfhttp://loinc.org/downloads/files/LOINCManual.pdf


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Whats it Good For?


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Browse LOINCMap local terms to LOINC

import/export translate local words to LOINC-speak manual/automated mapping

What s it Good For?

Search Window


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Mapping Screen


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navigate through your local term set

hit enter to run a search


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photo via pasukaru76

What Does It Do?
http://www.flickr.com/photos/pasukaru76/4672433373/http://www.flickr.com/photos/pasukaru76/4672433373/http://www.flickr.com/photos/pasukaru76/4672433373/


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Batch processes local term file or runs on-demand for selected local term

Uses wordsand unitsfrom local terms

Produces a ranked list for your review

photo via pasukaru76

Auto Mapper On-Demand
http://www.flickr.com/photos/pasukaru76/4672433373/http://www.flickr.com/photos/pasukaru76/4672433373/http://www.flickr.com/photos/pasukaru76/4672433373/


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breaks ties with rank

Successes/Challenges


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Automapper + CPT is prettyaccurate for radiology terms

Automapper out-performs

Document Similarity Scores inmapping radiology terms

Successes/Challenges

Vreeman DJ and McDonald CJ. Automated mapping of local radiology terms to LOINC. AMIA Annu Symp Proc. 2005;769-773. PMID: 16779144.

Vreeman DJ, McDonald CJ. A comparison of Intelligent Mapper and document similarity scores for mapping local radiology terms to LOINC. AMIA Annu Symp Proc. 2006;809-813.PMID: 17238453.


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The study Im not going to

talk about(because it is under peer review)

Evaluation of a large shared mapping repository as a corpus

for automated mapping tools photo via AndYaDontStop
http://www.flickr.com/photos/thenovys/3743183624/sizes/l/in/photostream/http://www.flickr.com/photos/thenovys/3743183624/sizes/l/in/photostream/http://www.flickr.com/photos/thenovys/3743183624/sizes/l/in/photostream/


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Opportunity 1:Widespread use of RELMA


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Opportunity 2:Existing mappings fromlarge institutions


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Specific Aim 1a. Extend RELMA to benefit from the herdb. Extend RELMA to enhance the community

resource


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27 submissions (~92,000 mappings)


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Now you can just log in with your loinc.org ID


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# of codes and institutions mapped to this LOINC


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photo via Wikipedia

When youve got a decent number of mappings,share them back with the community
http://en.wikipedia.org/wiki/The_Giving_Treehttp://en.wikipedia.org/wiki/The_Giving_Treehttp://en.wikipedia.org/wiki/The_Giving_Tree


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y


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photo via ryarwood
http://www.flickr.com/photos/yarwood/http://www.flickr.com/photos/yarwood/http://www.flickr.com/photos/yarwood/


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2013 02 19 - LOINC - Introduction and Overview

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