7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 1/169

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

, Indiana University School of Medicine

Associate Director for Terminology Services, Regenstrief Institute, Inc

@djvreeman

© 2015

An Introduction to LOINC

Laboratory LOINC Workshop - Indianapolis, IN USA

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 2/169

Acknowledgements

LOINC Development TeamClem McDonald, Jami Deckard, David Baorto, Katy Holck,Swapna Abhyankar, Theresa Pritchard, Sara Armson

RELMA Development TeamJohn Hook, Shahid Khokhar

LOINC Committee

Supporters 

NLM, Regenstrief Institute, Regenstrief Foundation, APTA,RSNA, the LOINC Premium Members and Donors

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 3/169

Overview

1. Origins and purpose of LOINC

2. The LOINC way

3. LOINC in action today

4. Overview of implementation resources

photo via Vernio77

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 4/169

Origins of LOINC

McDonald et al. Canopy Computing: using the Web in Clinical Practice.  JAMA

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

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 5/169

Informatics Pioneers

40 years of EMR work

Indiana Network for Patient Care

Regenstrief serves as neutral 3rd party

convener

Most comprehensive and longest tenured Health Information Exchange (HIE) in USA 

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 6/169

Informatics Pioneers

40 years of EMR work

Indiana Network for Patient Care

Regenstrief serves as neutral 3rd party

convener

Most comprehensive and longest tenured Health Information Exchange (HIE) in USA 

Crash Test Dummies

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 7/169photo via noshaMcDonald et al. Canopy Computing: using the Web in Clinical Practice.  JAMA. 1998;280(15):1325-1329.

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 8/169photo via noshaMcDonald et al. Canopy Computing: using the Web in Clinical Practice.  JAMA. 1998;280(15):1325-1329.

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 9/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 10/169

Forrey AW, McDonald CJ, et al. Logical observation identifier names and codes (LOINC) database: a public use set of codes and names for electronicreporting of clinical laboratory test results. Clin Chem. 1996 Jan;42(1):81-90. PubMed PMID: 8565239.

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 11/169photo via chadlewis

More than Meets the Eye

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 12/169

Fundamental challenges: 

Local systems have different ways of

identifying the same concept.

Things that look alike aren’t the same.

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 13/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 14/169

Forrey AW, McDonald CJ, et al. Logical observation identifier names and codes (LOINC) database: a public use set of codes and names for electronicreporting of clinical laboratory test results. Clin Chem. 1996 Jan;42(1):81-90. PubMed PMID: 8565239.

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 15/169

Logical 

Observation 

IdentifiersNames and

CodesA universal code system that facilitates exchange,

pooling, and processing of clinical data.

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 16/169

A non-profit research organization in Indianapolis, USA

Established LOINC in 1994

Overall steward and owner of LOINC

Develops and licenses LOINC to promote widespread global

adoption

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 17/169

LOINC is a universal code

system for tests, measurements,

and observations.

LOINC makes health data more

fluid and understandable todifferent computer systems.

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 18/169

LOINC is like a bar code for

test data…

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 19/169

photo via puuikibeach

WE DOMEASUREMENTS

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 20/169

Laboratory LOINC

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 21/169

Top 10 Lab Domain Overview

Microbiology  10,700

Chemistry 9,700

Drug/Toxicology 7,500

Allergy 3,800Chemistry - Challenge 3,700

Serology 2,400

Hematology 2,100Antibiotic Susceptibilities 1,700

Cell Markers 1,300

Molecular Pathology1,700

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 22/169

Clinical LOINC

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 23/169

If an observation is a question

and the observation value isan answer…

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 24/169

LOINC provides codes for questions 

 Where needed, other vocabularies

provide codes for answers 

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 25/169

Does my patient have HIV?48345-3:HIV 1+O+2 Ab [Presence] in Serum or Plasma

Is my HIV patient’s immune

system responding well to ART?24467-3:CD3+CD4+ (T4 helper) cells [#/volume] in Blood

photo via nihgov

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 26/169

How fast does mypatient usually walk?41959-8:Walking speed:Vel:1W^mean:^Patient:Qn:Calculated

photo via Ed Yourdon

di k f i

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 27/169

Indiana Network for Patient Care

HL7 v2.x Message

I di N k f P i C

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 28/169

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|

Indiana Network for Patient Care

HL7 v2.x Message

I di N k f P i C

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 29/169

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|

Indiana Network for Patient Care

HL7 v2.x Message

I di N k f P i C

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 30/169

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|

Indiana Network for Patient Care

HL7 v2.x Message

I di N t k f P ti t C

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 31/169

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

Indiana Network for Patient Care

HL7 v2.x Message

I di N t k f P ti t C

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 32/169

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

Indiana Network for Patient Care

HL7 v2.x Message

I di N t k f P ti t C

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 33/169

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

Indiana Network for Patient Care

HL7 v2.x Message

I di N t k f P ti t C

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 34/169

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

Indiana Network for Patient Care

HL7 v2.x Message

I di N t k f P ti t C

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 35/169

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

Indiana Network for Patient Care

HL7 v2.x Message

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 36/169

Codes for individual observations

Leukocytes [#/volume] in Blood by Automated countErythrocytes [#/volume] in Blood by Automated count

Hematocrit [Volume Fraction] of Blood by Automated count

and collections of observations

CBC W Auto Differential panel - Blood

Vital signs, weight and height panel

PHQ-9 quick depression assessment panel

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 37/169

OBX||CE|600-7^Bacteria Bld Cult^LN||56415008^Klebsiella pneumoniae^SCT

Result with a Coded Value

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 38/169

OBX||CE|600-7^Bacteria Bld Cult^LN||56415008^Klebsiella pneumoniae^SCT

Result with a Coded Value

Data type of result

(OBX-5) is a coded

element

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 39/169

OBX||CE|600-7^Bacteria Bld Cult^LN||56415008^Klebsiella pneumoniae^SCT

Result with a Coded Value

This code is from

LOINC

Code identifying this

observation

(what are these results?

Bacteria identified by

Blood Culture )

Data type of result

(OBX-5) is a coded

element

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 40/169

OBX||CE|600-7^Bacteria Bld Cult^LN||56415008^Klebsiella pneumoniae^SCT

Result with a Coded Value

This code is from

LOINC

Code identifying this

observation

(what are these results?

Bacteria identified by

Blood Culture )

Data type of result

(OBX-5) is a coded

element

This code is from

SNOMED

Code identifying the result

(K. pneumoniae)

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 41/169

LOINC fits well withother data standards

photo via Temari 09

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 42/169

The LOINC WayOpen. Nimble. Pragmatic.

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 43/169

Development Approach

Worldwide distribution at no cost 

New terms requested by end-users 

Welcome all comers Committees are volunteers

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 44/169

Development Approach

Worldwide distribution at no cost 

New terms requested by end-users 

Welcome all comers Committees are volunteers

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 45/169

Development Approach

Worldwide distribution at no cost 

New terms requested by end-users 

Welcome all comers Committees are volunteers

It’s free, but invaluable 

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 46/169

Financial Support

Many sourcesAHCPR, ASPE, CDC, CHCF, CMS, Hartford Foundation, IN

CTSA, Regenstrief Foundation*, Regenstrief Institute,

NCRR, NIBIB*, NLM*, LOINC User Community**active now

Today, the U.S. National Library of Medicine

(NLM) accounts for about 2/3 of our funding.

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 47/169

Major releases

twice per year

(June and December)

photo via striatic

LOINC C d O Ti b R l

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 48/169

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000LOINC Codes

Only Lab LOINC Codes

LOINC Codes Over Time by Release

laboratory terms only

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 49/169

76,000 codes…haven’tyou finished yet?

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 50/169

Lots Cooking…Always more lab tests

Genetic testing

Patient reported outcomes

Translational research data

Document titles

Radiology reportsphoto via liber

photo via liber

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 51/169

Deckard J, McDonald CJ, Vreeman DJ. Supporting interoperability of genetic data with LOINC. J Am Med Inform Assoc. 2015 Feb 5. PMID: 25656513.

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 52/169

Legal Stuffhttp://loinc.org/terms-of-use

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 53/169

photo via 917press

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 54/169

Just kidding.

Copyright is a good thing for

standards. 

It’s the licensing part that issometimes interesting.

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 55/169

No cost

Worldwide

In perpetuity

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 56/169

Use

Copy

Distribute

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 57/169

Any purpose:

commercial

non-commercial

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 58/169

Encourages

translation into

other languages

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 59/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 60/169

That would defeat

the purpose of

having a standard!

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 61/169

LOINC in action today

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 62/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 63/169

photo via iboy_daniel

Data standards are like telephones. 

They require a critical mass of usersbefore they become useful.

~ Clem McDonald, MD (1998)

“  

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 64/169

Our vision is for

LOINC to be

integrated into every  clinical information

system that shares oraggregates data.

41,000+ registered users in 170 countries

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 65/169

41,000+ registered users in 170 countries

loinc.org registered users

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 66/169

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

g g

loinc.org registered users

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 67/169

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

g g

6,000 new users per year

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 68/169

 Translations into 18 variants of 12 languages

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 69/169

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.

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 70/169

Ad d N i l S d d

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 71/169

Australia

Austria

Belgium

Brazil

Canada

CyprusEstonia

Finland

France

Germany

Iceland

India

Italy

Malaysia

Mexico

Mongolia

The Netherlands

New Zealand

Philippines

Portugal

QatarRwanda

Saudi Arabia

Slovakia

Slovenia

Spain

Thailand

Turkey

United States

Adopted as National Standard

L I l t ti

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 72/169

Large Implementations

SIGA Saúde project7+ Provincial systems in Canada

8+ Regional Health Information Exchanges in Spain

ePSOSAssistance publique - Hôpitaux de Paris

Hong Kong Hospital Authority

Philippine Health Insurance CorporationInFSE Project in 5 regions in Italy (LOINC Italia)

M ny

Oth K Ad ti

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 73/169

Other Key Adoptions

Many “big” labsAll health-related federal agencies in USA

Lots of care organizations

Professional societiesHealth information exchange networks

Insurance companies

EHR vendorsInstrument manufacturers (nascent)

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 74/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 75/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 76/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 77/169

Vandenbussche PY, Cormont S, André C, et al. Implementation and management of a biomedical observation dictionary in a large healthcare information sy stem.J Am Med Inform Assoc. 2013 May 1. PMID: 23635601.

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 78/169

Vandenbussche PY, Cormont S, André C, et al. Implementation and management of a biomedical observation dictionary in a large healthcare information sy stem.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.

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 79/169

Vandenbussche PY, Cormont S, André C, et al. Implementation and management of a biomedical observation dictionary in a large healthcare information sy stem.J Am Med Inform Assoc. 2013 May 1. PMID: 23635601.

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 80/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 81/169

Members of the Korean National StandardsCommittee have enthusiastically embraced LOINC 

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 82/169

LOINCing in Hong Kong

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 83/169

Some ad hoc LOINCing

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 84/169

 Talking about LOINC at the Thai Ministry of

Information and Communication Technology

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 85/169

Dr Case leading some LOINCing in Cyprus

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 86/169

Support for LOINC in Ministry of Health Malaysia

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 87/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 88/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 89/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 90/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 91/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 92/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 93/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 94/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 95/169

photo via Fishking_1

Upstream standardization.Ask your IVD vendor which LOINC codesare appropriate for that test.

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 96/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 97/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 98/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 99/169

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

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 100/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 101/169

Use in Quality Measures

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 102/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 103/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 104/169

Find HbA1c in the EHR with LOINC

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 105/169

Find HbA1c in the EHR with LOINC

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 106/169

Meaningful Use Stage 3

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 107/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 108/169

2015 Edition Criteria NOT Adopted

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 109/169

Vital Signs

Image Results

Family Health History—Pedigree

Patient List Creation

Electronic Medication Administration Record

Decision Support—Knowledge Artifact

Decision Support—Service

Incorporate Laboratory Tests and Values/Results

Transmission of Laboratory Test Reports

Accessibility Technology

SOAP Transport and Security Specification and XDR/XDM for Direct MessagingHealthcare Provider Directory—Query Request

Healthcare Provider Directory—Query Response

Electronic Submission of Medical Documentation

2015 Edition Criteria NOT Adopted

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 110/169

Vital Signs

Image Results

Family Health History—Pedigree

Patient List Creation

Electronic Medication Administration Record

Decision Support—Knowledge Artifact

Decision Support—Service

Incorporate Laboratory Tests and Values/Results

Transmission of Laboratory Test Reports

Accessibility Technology

SOAP Transport and Security Specification and XDR/XDM for Direct MessagingHealthcare Provider Directory—Query Request

Healthcare Provider Directory—Query Response

Electronic Submission of Medical Documentation

2015 Edition Criteria Unchanged from 2014C t i d P id O d E t (CPOE) M di ti

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 111/169

Computerized Provider Order Entry (CPOE)—Medications

CPOE—Laboratory

CPOE—Diagnostic Imaging

Drug-Drug, Drug-Allergy Interaction Checks for CPOE

Medication List

Medication Allergy List

Drug-Formulary and Preferred Drug List Checks

Smoking Status

Authentication, Access Control, Authorization

Audit Report(s)

Amendments

Automatic Access Time-Out

Emergency Access

End-User Device Encryption

Accounting of Disclosures

Transmission to Public Health Agencies—Reportable Laboratory Tests and Values/Results

2015 Edition Criteria Unchanged from 2014Computerized Provider Order Entry (CPOE) Medications

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 112/169

Computerized Provider Order Entry (CPOE)—Medications

CPOE—Laboratory

CPOE—Diagnostic Imaging

Drug-Drug, Drug-Allergy Interaction Checks for CPOE

Medication List

Medication Allergy List

Drug-Formulary and Preferred Drug List Checks

Smoking Status

Authentication, Access Control, Authorization

Audit Report(s)

Amendments

Automatic Access Time-Out

Emergency Access

End-User Device Encryption

Accounting of Disclosures

Transmission to Public Health Agencies—Reportable Laboratory Tests and Values/Results

No standards adopted

2015 Edition Criteria Revised from 2014

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 113/169

Demographics

Problem List

Clinical Decision Support

Family Health History

Patient-Specific Education Resources

Transitions of Care

Clinical Information Reconciliation and

Incorporation

Electronic Prescribing

Data Export

Clinical Quality Measures—Record and

Export

Clinical Quality Measures—Import and

Calculate

Clinical Quality Measures—Report

View, Download, and Transmit to 3rd

Party

Transmission to Immunization RegistriesTransmission to Public Health Agencies—

Syndromic Surveillance

Transmission to Cancer Registries

Automated Numerator Recording

Automated Measure Calculation

Safety-enhanced Design

Quality Management System

Auditable Events and Tamper-Resistance*

Integrity*Secure Messaging*

Direct Project*

Direct Project, Edge Protocol, and XDR/

XDM*

2015 Edition Criteria New Since 2014

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 114/169

Implantable Device List

Social, Psychological, and Behavioral

DataData Segmentation for Privacy—Send

Data Segmentation for Privacy—Receive

Care Plan

Common Clinical Data Set Summary

Record—Create

Common Clinical Data Set Summary

Record—Receive

Clinical Quality Measures—Filter

Trusted Connection

API approach

Auditing Actions on Health Information

Patient Health Information Capture

Transmission to Public Health Agencies

—Electronic Case Reporting

Transmission to Public Health Agencies—Antimicrobial Use and Resistance

Reporting

Transmission to Public Health Agencies

—Health Care Surveys

Consolidated CDA Creation Performance

Application Access—Patient Selection

Application Access—Data Category

Request

Application Access—All Data Request

Accessibility—centered Design

Social, Psychological, and Behavioral Data

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 115/169

, y g ,

Financial resource strain

Education

Stress

DepressionPhysical activity

Alcohol use

Social connection and isolationExposure to violence

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 116/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 117/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 118/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 119/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 120/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 121/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 122/169

Know LOINC? Get Hired!Dec 1, 2015

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 123/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 124/169

Many unexpected

successes along the way

photo via heyyu

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 125/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 126/169

The LOINC DistributionLOINC Table, Accessory Files, and Tools and

Resources for Implementers

loinc.org/downloads

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 127/169

g

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 128/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 129/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 130/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 131/169

LOINC Accessory FilesSpecial representations of LOINC content

Accessory Files

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 132/169

LOINC Panels and Forms FileAn export of key panels, survey instruments, and forms in a

detailed data structure.

LOINC Multiaxial Hierarchy FileHierarchical organization of LOINC terms based on their axes.

Lab terms are organized first by Component, then by System.

LOINC Document Ontology FileSpecial file for the detailed naming conventions for clinical

document titles (e.g. Discharge Summary, Progress Note, etc).

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 133/169

Tools for

Implementers

photo via Robert S Donovan

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 134/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 135/169

search.loinc.org

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 136/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 137/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 138/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 139/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 140/169

Alternate Language Search

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 141/169

Everything in Italian!Alternate Language Search

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 142/169

 Everything in Italian!

forum.loinc.org

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 143/169

loinc.org/usage

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 144/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 145/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 146/169

@LOINC@LOINC

loinc.org/slideshows

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 147/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 148/169

loinc.org/adopters

List your organization. Free!

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 149/169

y g

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 150/169

RELMA®REgenstrief LOINC Mapping Assistant

RELMA Features

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 151/169

Browse LOINC content

Map local terms to LOINC

import/export

translate local words to LOINC-speak

manual/automated mapping

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 152/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 153/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 154/169

22 organizations, 5 countries, 102,000 mappings

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 155/169

Dixon BE, Hook J, Vreeman DJ. Learning From the Crowd in Terminology Mapping: The LOINC Experience. Lab Med. 2015 Spring;46(2):168-74. PMID: 25918199.

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 156/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 157/169

LOINC PremiumMembership Programmembers.loinc.org

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 158/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 159/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 160/169

Share the love.

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 161/169

Donate to LOINC.members.loinc.org/donate 

members.loinc.org/donate 

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 162/169

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 163/169

What’s still free?

All the Usual Awesomeness

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 164/169

LOINC Table

Accessory Files

RELMA Program

Documentation

Web search app (search.loinc.org)

Participation in the LOINC Community

Access to submit new concepts to LOINC

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 165/169

In closing...

photo via janeandd

Glad you’re here to at least

t f t t

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 166/169

photo via gmayster01 on & off ...

get your feet wet...

Jump in!

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 167/169

photo via Justin Ornellas

The Race is On!

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 168/169

Happy LOINCing!photo via ryarwood

7/23/2019 2015 12 02 - LOINC Introduction

http://slidepdf.com/reader/full/2015-12-02-loinc-introduction 169/169