2014 06 04 - LOINC Introduction - Brief

8/12/2019 2014 06 04 - LOINC Introduction - Brief

http://slidepdf.com/reader/full/2014-06-04-loinc-introduction-brief 1/198

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

© [email protected]

Laboratory LOINC Workshop - Indianapolis, IN

mailto:[email protected]



loinc.org/slideshows



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



Origins of LOINCThe lingua franca of clinical observation exchange



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/


http://slidepdf.com/reader/full/2014-06-04-loinc-introduction-brief 7/198photo 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/


http://slidepdf.com/reader/full/2014-06-04-loinc-introduction-brief 8/198photo via beckstei

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



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



More than Meets the Eye

photo via chadlewis

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



Fundamental challenge:

Local systems have different ways of

identifying the same concept.


http://slidepdf.com/reader/full/2014-06-04-loinc-introduction-brief 14/198photo via pfarrell95

Only way to corral the

infinite indiosyncracies is

with standards

http://www.flickr.com/photos/65005341@N03/



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/



Logical

Observation

Identifiers

Names and

CodesA universal code system that facilitates exchange,

pooling, and processing of results



Established in 1994 byRegenstrief Institute.

Vocabulary standard forobservation identifiers.



Similar name, different meaning…

photo via Caption Time

i i i i

http://captiontime.tumblr.com/



Similar name, different meaning…

meerkat meerkat mere cat meerkat

photo via Caption Time

http://captiontime.tumblr.com/



MEASUREMENTS US

“ R ”

photo via puuikibeach

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



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



What is my patient’s

hemoglobin level?718-7:Hemoglobin:MCnc:Pt:Bld:Qn



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/




di k f i C



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






HL7 v2.x Message

I di N k f P i C






HL7 v2.x Message

I di N t k f P ti t C






HL7 v2.x Message






LocalCode^LocalName^CodeSystem^LOINCcode^LOINCname^CodeSystem


HL7 v2.x Message








HL7 v2.x Message




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






element

This code isfrom LOINC

Code identifying thisobservation

(what are these results?Conditions identified by

newborn screening )






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 )



photo via eye of einstein

A brief aside about terminology…

http://www.flickr.com/photos/35188692@N00/466404658/sizes/o/in/photostream/

http://www.flickr.com/photos/35188692@N00/466404658/sizes/o/in/photostream/



LOINC Terminology



LOINC Terminology

LOINC (noun)



LOINC Terminology

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



LOINC Terminology


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



LOINC Terminology



LOINCification (noun)



LOINC Terminology




SNOMED Terminology



LOINC Terminology




SNOMED Terminology

SNOMED (noun)



LOINC Terminology




SNOMED Terminology

SNOMED (noun)

SNOMEDicated???



photo via Ludovic Hirlimann

Different standards for differentparts of the elephant.

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





We now return to your

regularly scheduledprogram…

photo via x-ray delta one

http://www.flickr.com/photos/x-ray_delta_one



Laboratory LOINC



Clinical LOINC



Laboratory LOINC Committee Chair:

Clem McDonald, MD

Clinical LOINC Committee Chair:

Stan Huff, MD



LOINC CollectionsPanels, forms, surveys, and other patientassessments

photo via LuzA

Standardized Assessments and Collections

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



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.



The LOINC ApproachOpen. Nimble. Pragmatic.

Open Development



Open Development

Worldwide distribution at no cost

New terms from end-users

Welcome all comers Committees are volunteers

Open Development



Open Development




Open Development



Open Development




It’s free, but invaluable

R i f I i



Regenstrief Institute

Steward

Developer of content

Developer of tools

Developer of community

Distributor

Voice

F di S



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



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




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


y

Slope = 600





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


y

Slope = 600

Slope = 2200




Lots Cooking…Always more lab tests

Genetic reporting

Lots of survey instruments, forms, and assessments

More radiology reportsStructured document titles

…

photo via liber

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



32,000+ users in 162 countries



32,000 users in 162 countries

loinc.org registered users



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




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




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


Doubled in 19 months!




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


Ave growth/mo:

2009 = 2762010 = 307

2011 = 3792012 = 5002013 = 667



Tools forImplementers

photo via Robert S Donovan

loinc.org/downloads

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



loinc.org/downloads



d wnl ad 1400/ nth



loinc.org/get-started



g g

search.loinc.org



g



Alternate Language Search



Everything in Italian!

loinc.org/mailing-lists



N ! N l tloinc.org/mailing-lists



No spam! News + release notices



@LOINC

loinc.org/slideshows



loinc.org/adopters



List your organization. Free!

forum.loinc.org



loinc.org/usage



Wisdom of the HerdCan it help novice LOINCers?

photo via suffolktouristguide.com

http://www.suffolktouristguide.com/



photo via jdhancock

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



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.

http://www.ncbi.nlm.nih.gov/pubmed/23676247



Maxent vs Lucene

Mapping Performance on 3 INPC LabsC 101 d t with b t 80 00 l l t



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



~79% = Not bad!

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

57%



57% of local lab codes would always have

the correct LOINC ranked first byusing a Maxent cutoff of 0.46



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



RELMA®REgenstrief LOINC Mapping Assistant



22 organizations, 5 countries, 102,000 mappings



# of codes and institutions mapped to this LOINC



Click here to see the local codes!



When you’ve got a decent number of mappings,share them back with the community



share them back with the community

When you’ve got a decent number of mappings,share them back with the community



share them back with the community



LOINC PremiumMembership Programmembers.loinc.org



What’s still free?

All the Usual Awesomeness



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.



Donate to LOINC.members.loinc.org/donate



loinc.org/terms-of-use



photo via 917press

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



Just kidding.

Copyright is a good thing for

standards. It’s the licensing part that isinteresting.



No cost

Worldwide

In perpetuity



Use

Copy

Distribute



Any purpose:

commercial

non-commercialphoto via Refracted Moments™

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



CANNOT use anyLicensed Material to

develop or promulgate adifferent standard for

orders or observations.



That would defeat

the purpose ofhaving a standard!



International Adoptionparticipation, translation, implementation

LOINC Submitters



Si 2009 150 i ti

LOINC Translators



22 organizations.

C ntly t n l ti n int 18 i nt f 11 l n



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.





2012 Aug;45(4):667-73. PMID: 22285984.

1st International





2012 Aug;45(4):667-73. PMID: 22285984.

1 International LOINC PhD student




Adopted as National Standard



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



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...



For the last few years the AP-HP has



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.



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.




Members of the Korean National StandardsCommittee have enthusiastically embraced LOINC



Some serious LOINCing in Hong Kong



S t LOINC



Talking about LOINC at the Thai Ministry of

I f t d C t T h l



D C l d LOINC C



US AdoptionA few key highlights

Some Key US Adoptions



All the “big” labs

All health-related federal agencies

Lots of care organizations

HIE’s

Insurance companies

EHR vendors

Instrument manufacturers (nascent)



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.



Stage 12011-2012

Data capture

and sharing

Stage 22014

Advance clinical

processes

Stage 32016

Improved care

outcomes

progressive requirements for data standards



Stage 2starting 2014



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



Use in Quality Measures



LOINC Adopted ForP ti t Ch t i ti



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



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



Everyone loves LOINC



photo via mccaughan

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



Key Lessons for Today

photo via IMLS DCC

http://www.flickr.com/photos/imlsdcc/5637868432/sizes/o/in/photostream/



Not just an I.T. problem

If Murky, Don’t Assume



Units of measure are critical.

Sample results can help identify thecorrect LOINC Scale.

Local experts, package inserts can bevery informative.



photo via Fishking_1

Upstream standardization.

Ask instrument or test kitmanufacturers.

ivdconnectivity.org

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



A journey.

Not a destination.

Ongoing Journey



Plan for updating as your testing

changes (less common), or your localcode identifiers change (more common).

Prioritization



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.



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/



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



n=2852



LOINC Top 2000 Results + LOINC Top 300 Orders +

NCD 1 VSAC Q l t LOINC

In closing...



photo via janeandd

Glad you’re here to at leastget your feet wet

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



photo via gmayster01 on & off ...

get your feet wet...

Jump In!

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



photo via Justin Ornellas

The Race is On!

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

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



Happy LOINCing!photo via ryarwood

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

2014 06 04 - LOINC Introduction - Brief

Documents

Transcript of 2014 06 04 - LOINC Introduction - Brief