2013 12 05 - LOINC Introduction - Brief

8/13/2019 2013 12 05 - LOINC Introduction - Brief

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Daniel J. Vreeman, PT, DPT, MScAssistant Research Professor

, Indiana University School of Medicine

Associate Director for Terminology Services

, Regenstrief Institute, Inc

2013

Daniel J. Vreeman, PT, DPT, MScAssistant Research Professor

, Indiana University School of Medicine

Research Scientist

, Regenstrief Institute, Inc

[email protected]

Laboratory LOINC Workshop - Indianapolis, IN

Introduction and Overview
mailto:[email protected]


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


7/203photo 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.
http://www.flickr.com/photos/nosha/


8/203photo via beckstei
http://www.flickr.com/photos/beckstei/6269438822/sizes/o/in/photostream/


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Arboreal Informatics Pioneers

40 years of EMR work

Indiana Network for Patient Care

Regenstrief

the Data Switzerland

Nations most comprehensive and longest tenured HIE


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More than Meets the Eye

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


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Fundamental challenge:Local systems have different ways of

identifying the same concept.


14/203photo via pfarrell95

Only way to corral the

infinite indiosyncracies iswith standards
http://www.flickr.com/photos/65005341@N03/


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A vocabulary standard

would serve as theRosetta Stone.

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


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Logical

ObservationIdentifiers

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 il di i
http://captiontime.tumblr.com/


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Similar name, different meaning

meerkat meerkat mere cat meerkat

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


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MEASUREMENTSUS

R

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


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If an observation is a question and

the observation value is

an answerLOINC provides codes for questionsWhere needed, other vocabulariesprovide codes for answers


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What is my patientshemoglobin level?718-7:Hemoglobin:MCnc:Pt:Bld:Qn


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How fast does my patientusually walk?

41959-8:Walking speed:Vel:1W^mean:^Patient:Qn:Calculated

photo via Ed Yourdon
http://www.flickr.com/photos/yourdon/


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I di N k f P 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|


HL7 v2.x Message

I di N k f P i C


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HL7 v2.x Message

I di N k f P i C


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HL7 v2.x Message

I di N t k f P ti t C


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HL7 v2.x Message



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HL7 v2.x Message



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HL7 v2.x Message



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LocalCode^LocalName^CodeSystem^LOINCcode^LOINCname^CodeSystem


HL7 v2.x Message



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HL7 v2.x Message



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HL7 v2.x Message



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HL7 v2.x Message



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HL7 v2.x Message


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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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Data type of result

(OBX-5) is a coded

element


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Data type of result

(OBX-5) is a coded

element

This code is

from LOINC

Code identifying this

observation

(what are these results?

Conditions identified by

newborn screening )


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Data type of result

(OBX-5) is a coded

element

This code is

from LOINC

Code identifying this

observation

(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

A brief aside aboutterminology
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 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


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


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LOINC Terminology



LOINCification (noun)


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LOINC Terminology




SNOMED Terminology


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LOINC Terminology




SNOMED Terminology

SNOMED (noun)


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LOINC Terminology




SNOMED Terminology

SNOMED (noun)

SNOMEDicated???


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LOINC Terminology




SNOMED Terminology

SNOMED (noun)

SNOMEDicated???


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photo via Ludovic Hirlimann

Different standards for differentparts of the elephant.
http://www.flickr.com/photos/lhirlimann/http://www.flickr.com/photos/lhirlimann/http://www.flickr.com/photos/lhirlimann/


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We now return to your

regularly scheduledprogram

photo via x-ray delta one
http://www.flickr.com/photos/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
http://www.flickr.com/photos/luchilu/


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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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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 comersCommittees are volunteers

Open Development


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Open Development




Open Development


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Open Development




Its free, but invaluable

R i f I i


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Regenstrief Institute

Steward

Developer of content

Developer of tools

Developer of community

DistributorVoice

F di S


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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

LOINC Codes Over Time by Release


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12345678

4/24

/199

5|1

.0

5/24/

1995

|1.0

a

6/23/

1995

|1.0b

6/28/

1995

|1.0

c

7/14/

1995

|1.0

d

9/15/

1995

|1.0

e

12/2

1/19

95|1

.0f

4/28/

1996

|1.0

g

8/29/

1996

|1.0h(

2)

12/3/

1996

|1.0h(

3)

1/8/

1999

7|1

.0i

10/9/1

997

|1.0j-a

5/1/

1998

|1.0k

2/12

/199

9|1

.0l

7/23/

1999

|1.0

m

8/6/1

999

|1.0

ma

2/4/

2000

|1.0

n

6/13/

2000

|1.0

0

1/1/

2001

|2.0

0

1/31/

2001

|2.0

1

7/1/

2001

|2.0

3

1/1/

2002

|2.0

4

2/1/

2002

|2.0

5

2/19/

2002

|2.0

6

8/1/

2002

|2.07

9/1/

2002

|2.0

8

5/1/

2003

|2.0

9

10/1/

2003

|2.1

0

1/1/

2004

|2.1

1

2/1/

2004

|2.1

2

12/1/

2004

|2.1

3

12/1/

2004

|2.1

4

6/1/

2005

|2.1

5

12/1/

2005

|2.1

6

6/1/

2006

|2.17

12/21

/200

6|2.

19

6/21

/200

7|2.

21

12/03

/200

7|2.

22

7/10

/200

8|2.

24

1/10

/200

9|2.

26

07/06

/200

9|2.

27

12/30

/200

9|2.

29

2/26

/201

0|2.

30

6/15

/201

0|2.

32

12/29

/201

0|2.

34

06/30

/201

1|2.

36

12/30

/201

1|2.

38

6/30

/201

2|2.

40

12/30

/201

2|2.

42

06/29

/201

3|2.

44

LOINC Codes

Only Lab LOINC Codes

y

laboratory terms only



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12345678

4/24

/199

5|1

.0

5/24/

1995

|1.0

a

6/23/

1995

|1.0b

6/28/

1995

|1.0

c

7/14/

1995

|1.0

d

9/15/

1995

|1.0

e

12/2

1/19

95|1

.0f

4/28/

1996

|1.0

g

8/29/

1996

|1.0h(

2)

12/3/

1996

|1.0h(

3)

1/8/

1999

7|1

.0i

10/9/1

997

|1.0j-a

5/1/

1998

|1.0k

2/12

/199

9|1

.0l

7/23/

1999

|1.0

m

8/6/1

999

|1.0

ma

2/4/

2000

|1.0

n

6/13/

2000

|1.0

0

1/1/

2001

|2.0

0

1/31/

2001

|2.0

1

7/1/

2001

|2.0

3

1/1/

2002

|2.0

4

2/1/

2002

|2.0

5

2/19/

2002

|2.0

6

8/1/

2002

|2.07

9/1/

2002

|2.0

8

5/1/

2003

|2.0

9

10/1/

2003

|2.1

0

1/1/

2004

|2.1

1

2/1/

2004

|2.1

2

12/1/

2004

|2.1

3

12/1/

2004

|2.1

4

6/1/

2005

|2.1

5

12/1/

2005

|2.1

6

6/1/

2006

|2.17

12/21

/200

6|2.

19

6/21

/200

7|2.

21

12/03

/200

7|2.

22

7/10

/200

8|2.

24

1/10

/200

9|2.

26

07/06

/200

9|2.

27

12/30

/200

9|2.

29

2/26

/201

0|2.

30

6/15

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0|2.

32

12/29

/201

0|2.

34

06/30

/201

1|2.

36

12/30

/201

1|2.

38

6/30

/201

2|2.

40

12/30

/201

2|2.

42

06/29

/201

3|2.

44

LOINC Codes


y

Slope = 600




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12345678

4/24

/199

5|1

.0

5/2

4/19

95|1

.0a

6/23/

1995

|1.0b

6/28/

1995

|1.0

c

7/14/

1995

|1.0

d

9/1

5/19

95|1

.0e

12/2

1/19

95|1

.0f

4/2

8/19

96|1

.0g

8/29/

1996

|1.0h(

2)

12/3/

1996

|1.0h(

3)

1/8/

1999

7|1

.0i

10/9/1

997

|1.0j-a

5/1

/199

8|1

.0k

2/12

/199

9|1

.0l

7/23/

1999

|1.0

m

8/6/1

999

|1.0

ma

2/4/

2000

|1.0

n

6/13/

2000

|1.0

0

1/1/

2001

|2.0

0

1/31/

2001

|2.0

1

7/1/

2001

|2.0

3

1/1/

2002

|2.0

4

2/1/

2002

|2.0

5

2/19/

2002

|2.0

6

8/1/

2002

|2.07

9/1/

2002

|2.0

8

5/1/

2003

|2.0

9

10/1/

2003

|2.1

0

1/1/

2004

|2.1

1

2/1/

2004

|2.1

2

12/1/

2004

|2.1

3

12/1/

2004

|2.1

4

6/1/

2005

|2.1

5

12/1/

2005

|2.1

6

6/1/

2006

|2.17

12/21

/200

6|2.

19

6/21

/200

7|2.

21

12/03

/200

7|2.

22

7/10

/200

8|2.

24

1/10

/200

9|2.

26

07/06

/200

9|2.

27

12/30

/200

9|2.

29

2/26

/201

0|2.

30

6/15

/201

0|2.

32

12/29

/201

0|2.

34

06/30

/201

1|2.

36

12/30

/201

1|2.

38

6/30

/201

2|2.

40

12/30

/201

2|2.

42

06/29

/201

3|2.

44

LOINC Codes


y

Slope = 600

Slope = 2200




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12345678

4/24

/199

5|1

.0

5/2

4/19

95|1

.0a

6/23/

1995

|1.0b

6/2

8/19

95|1

.0c

7/14/

1995

|1.0

d

9/1

5/19

95|1

.0e

12/2

1/19

95|1

.0f

4/2

8/19

96|1

.0g

8/29/

1996

|1.0h(

2)

12/3/

1996

|1.0h(

3)

1/8/

1999

7|1

.0i

10/9

/199

7|1

.0j-a

5/1

/199

8|1

.0k

2/12

/199

9|1

.0l

7/23/

1999

|1.0

m

8/6/1

999

|1.0

ma

2/4/

2000

|1.0

n

6/13/

2000

|1.0

0

1/1/

2001

|2.0

0

1/31/

2001

|2.0

1

7/1/

2001

|2.0

3

1/1/

2002

|2.0

4

2/1/

2002

|2.0

5

2/19/

2002

|2.0

6

8/1/

2002

|2.07

9/1/

2002

|2.0

8

5/1/

2003

|2.0

9

10/1/

2003

|2.1

0

1/1/

2004

|2.1

1

2/1/

2004

|2.1

2

12/1/

2004

|2.1

3

12/1/

2004

|2.1

4

6/1/

2005

|2.1

5

12/1/

2005

|2.1

6

6/1/

2006

|2.17

12/21

/200

6|2.

19

6/21

/200

7|2.

21

12/03

/200

7|2.

22

7/10

/200

8|2.

24

1/10

/200

9|2.

26

07/06

/200

9|2.

27

12/30

/200

9|2.

29

2/26

/201

0|2.

30

6/15

/201

0|2.

32

12/29

/201

0|2.

34

06/30

/201

1|2.

36

12/30

/201

1|2.

38

6/30

/201

2|2.

40

12/30

/201

2|2.

42

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3|2.

44

LOINC Codes


y

Slope = 600

Slope = 2200

laboratory terms onlynot a lab cliff, just no data available


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Lots CookingAlways more lab testsGenetic reporting

Lots of survey instruments, forms, and assessments

More radiology reportsStructured document titles

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


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27,500+ users in 158 countries


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27,500 users in 158 countries

loinc.org members


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5,000

10,000

15,000

20,000

25,000

6/1/08

12/1/08

6/1/09

12/1/09

6/1/10

12/1/10

6/1/11

12/1/11

6/1/12

12/1/12

6/1/13

g

loinc.org members


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0

5,000

10,000

15,000

20,000

25,000

6/1/08

12/1/08

6/1/09

12/1/09

6/1/10

12/1/10

6/1/11

12/1/11

6/1/12

12/1/12

6/1/13

g

22 new members per day667 new members per month

loinc.org members


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0

5,000

10,000

15,000

20,000

25,000

6/1/08

12/1/08

6/1/09

12/1/09

6/1/10

12/1/10

6/1/11

12/1/11

6/1/12

12/1/12

6/1/13

g


Doubled in 19 months!

loinc.org members


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0

5,000

10,000

15,000

20,000

25,000

6/1/08

12/1/08

6/1/09

12/1/09

6/1/10

12/1/10

6/1/11

12/1/11

6/1/12

12/1/12

6/1/13


Ave growth/mo:

2009 = 2762010 = 307

2011 = 3792012 = 500


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Tools forImplementers

photo via Robert S Donovan

loinc.org/downloads
http://www.flickr.com/photos/booleansplit/


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loinc.org/downloads


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downloads: ~1500/month


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loinc.org/get-started


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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
http://loinc.org/mailing-lists


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N ! N l tloinc.org/mailing-lists
http://loinc.org/mailing-lists


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No spam! News + release notices


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@LOINC


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N t dditi


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Li t y i ti F !


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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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loinc.org/collaboration


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loinc.org/terms-of-use


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photo via 917press
http://www.flickr.com/photos/917press/


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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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Any purpose:

commercial

non-commercialphoto via Refracted Moments
http://www.flickr.com/photos/refractedmoments/


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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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International Adoptionparticipation, translation, implementation

LOINC Submitters


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Si 2009 150 i ti LOINC Translators


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22 organizations.

Currently translations into 17 variants of 11 languages


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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.
http://www.ncbi.nlm.nih.gov/pubmed/22285984


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1st I t ti l


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1stInternationalLOINC PhD student


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Adopted as National Standard


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p

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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g p

SIGA Sade project7+ Provincial systems in Canada

8+ Regional Health Information Exchanges in Spain

ePSOS

Assistance publique - Hpitaux 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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h l f h h


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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 itstreatment processes, whenever

biology analyses and test results arerequested.


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Vandenbussche PY, Cormont S, Andr 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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The results of our workvalidate the choice made to

develop a local dictionaryaligned with LOINC.


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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 i LOINCi


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Talking about LOINC at the Thai Ministry of

I f ti d C i ti T h l y


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D C l di LOINCi i Cy


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US AdoptionA few key highlights

Some Key US Adoptions


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All the big labsAll health-related federal agencies

Lots of care organizations

HIEs

Insurance companies

EHR vendorsInstrument manufacturers (nascent)


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In USA, major driver ofeHealth standards adoption is

EHR Incentive Programa.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 party2.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 patients6.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 For


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Patient Characteristics

[Non-lab] Diagnostics studies

Patient experience

Family history

Functional statusHealth 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 Measure


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National Committee for Quality Assurance

Diabetes: Hemoglobin A1c

Poor Control

Percentage 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
http://www.flickr.com/photos/mccaughan/3484111996/


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Key Lessonsfor Today

photo via IMLS DCC
http://www.flickr.com/photos/imlsdcc/5637868432/sizes/o/in/photostream/


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N t t I bl

If Murky, Dont 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
http://www.flickr.com/photos/fishking1/5304638016/sizes/o/in/photostream/


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A journey.

Not a destination.

Ongoing Journey


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Plan for updating as yourtesting

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 tests


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Need to be mindful ofSecondary Data Usespublic health reporting | electronic quality measures

photo via pagedooley
http://www.flickr.com/photos/pagedooley/8435953365/sizes/o/in/photostream/


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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 T 129 VSAC Q lit LOINC


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Our newest ideas...

photo via cblue98
http://www.flickr.com/photos/cblue98/7254347346/


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Wisdom of the HerdCan it help novice LOINCers?

photo via suffolktouristguide.com
http://www.suffolktouristguide.com/


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photo via jdhancock
http://www.flickr.com/photos/jdhancock/3540861791


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A corpus-based approach for

automated LOINC mappingMustafa Fidahussein, MD, MS

Daniel J. Vreeman, PT, DPT, MSc


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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 LabsCorpus = 101 code sets with about 80,00 local terms


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Institution 1n=1,099


Institution 3n=838

Maxent Top 1 78.6% (864) 73.5% (1,253) 84.6% (709)

Lucene Top 1 72.6% (798) 66.5% (1,133) 76.6% (642)

Maxent Top 5 90.5% (995) 88.8% (1,514) 94.7% (794)

Lucene Top 5 89.8% (987) 86.0% (1,466) 94.3% (790)

Mapping Performance on 3 INPC Labs

Corpus = 101 code sets with about 80,00 local terms


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Institution 3n=838

Maxent Top 1 78.6% (864) 73.5% (1,253) 84.6% (709)

Lucene Top 1 72.6% (798) 66.5% (1,133) 76.6% (642)

Maxent Top 5 90.5% (995) 88.8% (1,514) 94.7% (794)

Lucene Top 5 89.8% (987) 86.0% (1,466) 94.3% (790)

~79% = Not bad!

57%


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57%of local lab codes would alwayshave

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


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RELMAREgenstrief LOINC Mapping Assistant


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photo via Stig Nygaar
http://www.flickr.com/photos/stignygaard/http://www.flickr.com/photos/stignygaard/http://www.flickr.com/photos/stignygaard/


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27 submissions, 18 organizations, 5 countries92,000 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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Click here to see the local codes!



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Click here to see the local codes!


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When youve got a decent number of mappings,share them back with the community


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In closing...


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photo viajaneandd

Glad youre here to at leastget your feet wet...
http://www.flickr.com/photos/jayneandd/


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photo via gmayster01 on & off ...

get your feet wet...

Jump In!
http://www.flickr.com/photos/10422334@N08/6175595309


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photo via Justin Ornellas

The Race is On!
http://www.flickr.com/photos/ornellas/http://www.flickr.com/photos/ornellas/


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


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2013 12 05 - LOINC Introduction - Brief

Documents

Transcript of 2013 12 05 - LOINC Introduction - Brief