2016 02 25 - LOINC - Documents
-
Upload
daniel-vreeman -
Category
Documents
-
view
225 -
download
0
Transcript of 2016 02 25 - LOINC - Documents
-
7/26/2019 2016 02 25 - LOINC - Documents
1/46
Daniel J. Vreeman, PT, DPT, MScAssociate Research Professor
, Indiana University School of Medicine
Associate Director for Terminology Services, Regenstrief Institute, Inc
@djvreeman
2016
Documents
Clinical LOINC Meeting - Salt Lake City, UT USA
-
7/26/2019 2016 02 25 - LOINC - Documents
2/46
Overview
1. Origins of a Document Ontology
2. HL7/LOINC Model
3. Evaluation and Ongoing Development
4. Future Directions
photo via Vernio77
http://www.flickr.com/photos/verino77/ -
7/26/2019 2016 02 25 - LOINC - Documents
3/46
http://loinc.org/slideshows
http://loinc.org/slideshows -
7/26/2019 2016 02 25 - LOINC - Documents
4/46
Origins of a DocumentOntology
-
7/26/2019 2016 02 25 - LOINC - Documents
5/46
Local systems have idiosyncratic names
need a common, controlled vocabulary
OutpatientPain
Note
Dr.SmithsTues
PainClinic
ChronicPain
Clinic
-
7/26/2019 2016 02 25 - LOINC - Documents
6/46
Document Type Codes
Provide consistent semantics for names of documentsexchanged between systems for any purpose
Frazier P, Rossi-Mori A, Dolin RH, Alschuler L, Huff SM. The creation of an ontology of clinical document names. Stud Health Technol Inform. 2001;84(Pt 1):94-8.
Display Retrieval Organization Templates
-
7/26/2019 2016 02 25 - LOINC - Documents
7/46
What is a Document?a collection of information
photo via striatic
http://www.flickr.com/photos/striatic/ -
7/26/2019 2016 02 25 - LOINC - Documents
8/46photo via karen horton
an information collection
Title
Sections
Sentences
Sentences
Other content
http://www.flickr.com/photos/karenhorton/http://www.flickr.com/photos/karenhorton/http://www.flickr.com/photos/karenhorton/ -
7/26/2019 2016 02 25 - LOINC - Documents
9/46photo via karen horton
Different than a panelenumerated, discrete elements
an information collection
Title
Sections
Sentences
Sentences
Other content
http://www.flickr.com/photos/karenhorton/http://www.flickr.com/photos/karenhorton/http://www.flickr.com/photos/karenhorton/ -
7/26/2019 2016 02 25 - LOINC - Documents
10/46
Clinical Notes
Clinical Note
Aclinicaldocument,producedbycliniciansspontaneouslyorinresponsetoarequestforconsultation.
Clinical Report
Aclinicaldocument,producedinresponsetoanorderforaprocedure.
Formal Document Ontology model and rules
apply to clinical notes, but not (yet) to reports.
-
7/26/2019 2016 02 25 - LOINC - Documents
11/46
ApproachEmpiric analysis of >2000 documentnames
Mayo, 3M/Intermountain, VA in SLC, VA in Nashville
Find the level of granularity that best
meets exchange use case
Photo via Jeffrey Beall
http://www.flickr.com/photos/denverjeffrey/ -
7/26/2019 2016 02 25 - LOINC - Documents
12/46
Ultra-specific local
names Dr. Evils Friday Afternoon Pain
Clinic Note
Commonly understoodelements
Outpatient Pain Clinic Note
-
7/26/2019 2016 02 25 - LOINC - Documents
13/46
Local Codes and Names
Still probably neededCan send both in HL7
Mapping to a standard enables:Interoperability
Aggregation
-
7/26/2019 2016 02 25 - LOINC - Documents
14/46
Document Ontology Model
-
7/26/2019 2016 02 25 - LOINC - Documents
15/46photo via karen horton
Names are based on
expected informationcontent
NOTdocument format
http://www.flickr.com/photos/karenhorton/http://www.flickr.com/photos/karenhorton/http://www.flickr.com/photos/karenhorton/http://www.flickr.com/photos/karenhorton/http://www.flickr.com/photos/karenhorton/http://www.flickr.com/photos/karenhorton/ -
7/26/2019 2016 02 25 - LOINC - Documents
16/46
Names Based on Content
Same LOINC code for
if information content is the same
-
7/26/2019 2016 02 25 - LOINC - Documents
17/46
Not Part of the Name
Author nameLocation of service
Date of service
Status (e.g. signed, unsigned)
Security/privacy flags (e.g. protected)
Updates or amendments to a document
-
7/26/2019 2016 02 25 - LOINC - Documents
18/46
Assume that these other
important attributes wouldbe sent in different fields of
the message (e.g. metadata)
-
7/26/2019 2016 02 25 - LOINC - Documents
19/46
Domainofthecontentinthedocumente.g. Cardiology, Pediatric Cardiology, Physical Therapy
Subject Matter Domain
Authortraining/professionalclassification(not@subspecialty)e.g. Physician, Nurse, Case Manager, Therapist, Patient
Role
ModestextensionofCMSsdefinition(notequivalenttolocation)e.g. Hospital, Outpatient, Emergency Department
Setting
Serviceoractivityprovidedtopatiente.g. Consultation, History and Physical, Discharge Summary
Type of Service
Generalstructureofthedocumente.g. Note, Letter, Consent
Kind of Document
-
7/26/2019 2016 02 25 - LOINC - Documents
20/46
Rules for
constructing
namesphoto via Robert S Donovan
http://www.flickr.com/photos/booleansplit/ -
7/26/2019 2016 02 25 - LOINC - Documents
21/46
1. Enumerated List
Documentnamesareconstructedfromenumeratedlists of values for each axis.
-
7/26/2019 2016 02 25 - LOINC - Documents
22/46
2. Document + One Other
NamesneedtospecifyaKind of Documentvalueandatleastone of the other four axes.
Component
Property
Find
System
Scale
Doc
Method
.
-
7/26/2019 2016 02 25 - LOINC - Documents
23/46
3. Combinations
Combinationsfromwithinanaxisare allowedwheretheyarereasonable(SMD,Service).
Only a few examples currently:
Assessment+Plan note
Treatment plan+summary note
Hematology+Medical oncology
-
7/26/2019 2016 02 25 - LOINC - Documents
24/46
Example LOINC Names
Component Prop Time System Scale Method
Group counseling note Find Pt Hospital Doc {Author Type}
History and physical note Find Pt {Setting} Doc {Author Type}
Initial evaluation note Find Pt {Setting} Doc Physician
Note Find Pt Outpatient Doc Diabetology
Note Find Pt {Setting} Doc Mental health
{Curly Braces} notation:sendthatcontentasaseparateiteminthemessage(fieldorsegment).
-
7/26/2019 2016 02 25 - LOINC - Documents
25/46
Find All the Terms
In the LOINC database (and RELMA),all of the terms conforming to the
rules of the ontology are placed in
the DOC.ONTOLOGYclass.
Before LOINC version 2.50, they were (non-intuatively) inthe class DOC.CLINRPT
-
7/26/2019 2016 02 25 - LOINC - Documents
26/46
LOINC Terms for Sharing Ontology Values
Pro Tip:findthemwiththissearch
http://search.loinc.org/search.zul?query=LOINC+Document+Ontology
http://search.loinc.org/search.zul?query=LOINC+Document+Ontology -
7/26/2019 2016 02 25 - LOINC - Documents
27/46
LOINC Accessory FilesSpecial representations of LOINC content
-
7/26/2019 2016 02 25 - LOINC - Documents
28/46
Accessory Files
LOINC Panels and Forms FileAn export of key panels, survey instruments, and forms in a detailed data structure.
LOINC Document Ontology FileSpecial file for the detailed naming conventions for clinical document titles.
LOINC Multiaxial Hierarchy FileHierarchical organization of LOINC terms based on their axes.
LOINC/IEEE Medical Device Code Mapping FileLinkages between LOINC terms and content from IEEE EMB/11073 standard.
LOINC/RSNA Radiology Playbook FileSpecial file for the detailed naming conventions for radiology procedure titles.
LOINC/SNOMED CT Expression Association and Map SetsDraft status (Technology Preview) file containing a) mappings between LOINC parts and
SNOMED CT concepts and b) SNOMED CT expressions linked to LOINC codes.
-
7/26/2019 2016 02 25 - LOINC - Documents
29/46
Accessory Files
LOINC Panels and Forms FileAn export of key panels, survey instruments, and forms in a detailed data structure.
LOINC Document Ontology FileSpecial file for the detailed naming conventions for clinical document titles.
LOINC Multiaxial Hierarchy FileHierarchical organization of LOINC terms based on their axes.
LOINC/IEEE Medical Device Code Mapping FileLinkages between LOINC terms and content from IEEE EMB/11073 standard.
LOINC/RSNA Radiology Playbook FileSpecial file for the detailed naming conventions for radiology procedure titles.
LOINC/SNOMED CT Expression Association and Map SetsDraft status (Technology Preview) file containing a) mappings between LOINC parts and
SNOMED CT concepts and b) SNOMED CT expressions linked to LOINC codes.
i h i
-
7/26/2019 2016 02 25 - LOINC - Documents
30/46
Hierarchy in RELMA
-
7/26/2019 2016 02 25 - LOINC - Documents
31/46
Document Ontology File
Links all Document Ontology terms to theirconstituent axis values
Axis values given unique Part identifierscategorized by axis
Download from LOINC site
-
7/26/2019 2016 02 25 - LOINC - Documents
32/46
New (Free) ResourceHL7 Implementation Guide
-
7/26/2019 2016 02 25 - LOINC - Documents
33/46
-
7/26/2019 2016 02 25 - LOINC - Documents
34/46
Evolution + EvaluationWere not done yet
-
7/26/2019 2016 02 25 - LOINC - Documents
35/46
Evolution
Ongoing evaluation and evolutionExceptional contributions from Columbia University and the VA
Major Focus: Expanded original SMD values
with ABMS specialty names and iterativediscussion
More ontology additions from submissions
-
7/26/2019 2016 02 25 - LOINC - Documents
36/46
Development Milestones
2000 06 Document Ontology Task Force
2003 09 First axis values and LOINC codes released
2005 06 Expanded SMD domain
2007 10 Revised axis values approved
2013 06 Special Document Ontology File in releases
2013 12 Major harmonization completed
-
7/26/2019 2016 02 25 - LOINC - Documents
37/46
Iterative Evaluation
Case StudyNYPH-CUMC
-
7/26/2019 2016 02 25 - LOINC - Documents
38/46
1. Expanded CDO is better
2. Many local documents map to 1 LOINC
3. Inter-rater reliability was good
Case Study
SMD Role Setting Type Service Kind of Doc Overall DistinctOriginal
CDO
26.7% 99.9% 99.9% 43.5% 100% 23.4%
(n=894)
7.9%
Expanded
CDO
98.6% 100% 100% 99.9% 99.9% 98.5%
(n=935)
39.1%
98.5%
Hyun S, Shapiro JS, Melton G, Schlegel C, Stetson PD, Johnson SB, Bakken S. Iterative evaluation of the Health Level 7--Logical Observation Identifiers Names and Codes Clinical
Document Ontology for representing clinical document names: a case report. J Am Med Inform Assoc. 2009 May-Jun;16(3):395-9.
-
7/26/2019 2016 02 25 - LOINC - Documents
39/46
Cross-site Mapping Study of DO AxesTerms whose titles specified this axis
SMD Role Setting Type of Service None
West Campus
(n=1644)
67.6% 34.6% 28.9% 59.4% 8.2%
East Campus
(n=1124)
69.1% 56.0% 12.7% 69.0% 7.1%
1. Majority of titles map to at least one axis
2. Sites varied in how they specified titles; createsgranularity issues in cross-site aggregation
Li L, Morrey CP, Baorto D. Cross-mapping clinical notes between hospitals: An application of the LOINC Document Ontology. AMIA Symp Proc; 2011:;777-783.
-
7/26/2019 2016 02 25 - LOINC - Documents
40/46
The LOINC document ontology modelcan provide a robust representation of
clinical documents. This can beexploited to assist in common namingconventions, finding notes by
traversing the axis categories ofSubject, Setting, Role and Type ofService. However, the granularity of
representation can be an issue inmapping across sites.
-
7/26/2019 2016 02 25 - LOINC - Documents
41/46
Other Evaluations
photo via Okko Pyykk
http://www.flickr.com/photos/booleansplit/ -
7/26/2019 2016 02 25 - LOINC - Documents
42/46
Other Evaluations
Dugas M, Thun S, Frankewitsch T, Heitmann KU.LOINC codes for hospital information systems documentsJ Am Med Inform Assoc. 2009 May-Jun;16(3):400-3.
PMID: 19261942.
Hyrinen K, Mykknen J.
Mapping the Finnish National EHR to the LOINC.Stud Health Technol Inform. 2011;165:161-6.
PMID: 21685603.
Reeves RM, FitzHenry F, Brown SH, et al.
Who said it? Establishing professional attribution among authorsof Veterans' Electronic Health Records.
AMIA Annu Symp Proc. 2012;2012:753-62. Epub 2012 Nov 3.PMID: 23304349.
http://www.ncbi.nlm.nih.gov/pubmed/23304349http://www.ncbi.nlm.nih.gov/pubmed/21685603http://www.ncbi.nlm.nih.gov/pubmed/19261942 -
7/26/2019 2016 02 25 - LOINC - Documents
43/46
Still ongoing development
photo via shutterrunner
http://www.flickr.com/photos/shutterrunner/5266319924 -
7/26/2019 2016 02 25 - LOINC - Documents
44/46
The FutureGreat Scott!
-
7/26/2019 2016 02 25 - LOINC - Documents
45/46
Future Directions
More v1 and v2 axis value harmonizationIdentifiers for the axis values
Axis definitions
Computable hierarchyExtension to other Kind of Documents
Empiric analysis of document contents
-
7/26/2019 2016 02 25 - LOINC - Documents
46/46