20080609 Loinc Workshop

Using RELMA Or… In Search of the Missing LOINC © 2007 Regenstrief Institute & James Case James T. Case MS, DVM, PhD Professor, Clinical Diagnostic Informatics California Animal Health and Food Safety Laboratory University of California, Davis Laboratory LOINC Meeting – June 2008

Acknowledgements
RELMA Development Team
John Hook, Mark Fisher, Ryan Phillips, Karen Ahmad, and more!
Kathy Mercer
Clem McDonald
Dan Vreeman
The Lab LOINC Committee
Funding Support
NLM, Regenstrief Institute, NCI, CDC
© 2007 Regenstrief Institute & James Case

What will we cover today?
Installing RELMA
Setting personal preferences
Loading a Local Observation File (LMOF)
Preparing LMOF for Mapping
Review of Map Screen Functions
Setting Search Limits
Mapping Local Terms to LOINC
Viewing LOINC Term Details
Proposing/Submitting New LOINC Terms
Exporting/Printing Mapped Terms
Mapping your own LMOF data

Goals of Health Information Standards
Interoperability – the ability to exchange information between organizations
Comparability – the ability to ascertain the equivalence of data from different sources
Data Quality – the measurement of completeness, accuracy and precision

Levels of Interoperability
Basic – allows messages to be exchanged between computer systems
Word processing documents, spreadsheets
Functional – describes the standard syntax (format) of the message
Document templates, forms, data structures
Message standards
Semantic – requires use of standard vocabularies within the message

Comparability
Meaning of the data is consistent when shared among different parties
Common terminology required
Should work in the background
Not just words
Codes – uniquely identifies terms
Classification – groups related terms
Vocabulary – specialized, precise terms that remove ambiguity

Potential Uses of Health Data are Constrained by Data Quality Factors
Data quality issues
Different for client communications vs. analysis
Often constrained by external forces
E.g. criteria for diagnosis often differs from the criteria for reporting
Unidirectional effect of data consolidation
Detailed -> General
General -> Detailed

The Problem
“ In attempting to arrive at the truth, I have applied everywhere for information, but in scarcely an instance have I been able to obtain hospital records fit for any purpose of comparison. If they could be obtained, they would enable us to decide many other questions… They would show [subscribers] how their money was being spent [and] what amount of good was really being done with it…”
Florence Nightingale - Notes on a Hospital, 1873

Why LOINC?
“ Within one laboratory, local jargon terms may be used which are usually well understood between colleagues, but would not be sufficiently widely known for communication with the outside world.”
U. Forsum et al., Pure Appl. Chem 72:555-745, 2000 Properties and Units in the Clinical Laboratory Sciences Part VII. Properties and Units in Clinical Microbiology

Test comparisons
Lab A
Test Name: Lyme Disease Serology
Measures: B. burgdorferi Ab IgG
Method: ELISA
Scale: quantitative
e.g.: Titer 1:40
Lab B
Test Name: Lyme Disease Antibody
Measures: B. burgdorferi Ab IgM
Method: Immune blot
Scale: qualitative
e.g.: Positive
LOINC Code = 5062-5 LOINC Code = 6321-4 What you see in the order list

LOINC ® 101

Anatomy of a LOINC Term 5193-8 LOINC Code Hepatitis B virus surface Ab ACnc Pt Ser Qn EIA Component Property Measured Timing System Scale Method There are six major LOINC axes 5193-8:Hepatitis B virus surface Ab:ACnc:Pt:Ser:Qn:EIA

What is NOT part of a LOINC Name?
The instrument used in testing
Specific details about the specimen
Priority (e.g. STAT)
Where testing was done
Who did the test
Test interpretation
Anything that is not an intrinsic part of the name of the result
Other things that are carried in;
The OBX segment
An HL7 Version 3 Observation Object

Component/Analyte The substance or entity that is measured, evaluated, or observed
- Sodium
- Glucose
- Brucella sp. organism
- Influenza A Virus antigen
Cytomegalovirus Virus antibody
Lipids.Total
5193-8: Hepatitis B virus surface Ab :ACnc:Pt:Ser:Qn:EIA

Component/Analyte Structure
Formal name of Analyte (e.g. Calcium)
Must specify any “subanalyte”
e.g. Coronavirus Ag
May have a subclass – separated by “.”
e.g. Calcium.Free
Challenge - e.g, 1H post 100 gm Glucose PO
Two subparts separated by “post”
<time delay> post <challenge type>
Adjustments/corrections
E.g. Adjusted to pH 7.4
Analyte Name^Challenge^Adjustments

Mass: Observations reported with mass (milligrams, grams, etc.) in the numerator of their units of measure
Substance: Observations reported with moles or milliequivalents in the numerator of their units of measure
Catalytic activity: Observations that report enzymatic activity
Arbitrary: Results that report arbitrary units in the numerator of their units of measure
Number: Counts
Property* The characteristic or attribute of the analyte that is measured, evaluated, or observed the most difficult LOINC axis Major Categories 5193-8:Hepatitis B virus surface Ab: ACnc :Pt:Ser:Qn:EIA

MCnc – mass concentration (mass/unit vol)
MCnt – mass content (mass/unit mass)
NCnc – number concentration (number/unit vol)
TmStp – time
CCnc – catalytic concentration (activity)
Prid – presence or identity
Imp – impression/interpretation
Find – subjective or objective observation
Type – “Kind-of”
Property* the most difficult LOINC axis Combine Major Categories with Subtypes for Full Property 5193-8:Hepatitis B virus surface Ab: ACnc :Pt:Ser:Qn:EIA

Common Issues with LOINC Properties
Fraction = Part/whole
Number fraction (NFr): % Eosinophils
Substance fraction (SFr): % HGB which is A2
Ratio = Measures from the same system
Mass concentration ratio - MCrto
e.g., BUN/Creat in urine specimen
Substance ratio-SCrto
Urea/Creatinine expressed as mmol/L (SI units)
Relative Ratio = Measures from different systems
RelRto – multiple of the median
RlTm – time from actual and normal control
Fraction (proportion) vs. Ratio a/a+b vs. a/b

Pt - at a point in time
12H - a twelve hour collection
24H - a twenty four hour collection
Timing* *non-Pt timings are usually associated with Ratio Property The interval of time over which the observation or measurement was made

System The system (context) or specimen type upon which the observation was made. Super System Second subpart (^). When not included, “patient” is the default. Used to indicated blood product unit (BPU), a bone marrow donor, or a fetus.

Qn - quantitative
Continuous numeric (real, integer, ratio)
Optional operator (>,  ,  , <)
Ord - ordinal
a ranked set of possible values (1+, 2+, 3+)
Nom - nominal
an unranked collection of possible values
a taxonomy (e.g list of bacteria)
Nar - narrative
free text narrative (e.g., visit note)
Scale

Scale (Special)
OrdQn – Ordinal or Quantitative
Primarily used for antimicrobial observations e.g. MIC reported as resistant, intermediate, susceptible or as the mm diameter of the inhibition zone
Use is discouraged
Multi – structured text “globs”
e.g. chromatography output
Use is discouraged
Doc – Clinical documents
Set – Clinical attachments (headers)

Method
Methods only needed if interpretation affected
Different normal ranges
Test Sensitivity
Listed only at the generic level
Agglutination
Immunoassay
Probe with target amplification

Mapping Terms to LOINC Things to Remember
The thing ordered is not always the thing measured:
Blood Culture – live organism(s) identified
VDRL – Treponema pallidum Ab
Urinalysis – lots of different things
The question (what am I measuring?) is not the answer (e.g. Pos)
You are mapping the question, not the answer!
You must know the specifics of the component being tested for (what is this test actually measuring?)

RELMA ® Regenstrief LOINC Mapping Assistant

Purpose of Tutorial
“Eliminate” need to read the User’s Manual
Become familiar with RELMA features
Provide some insight into mapping tips/pitfalls
Help begin the mapping process for your institution
Note: Most screen shots from version 3.24(early release)

New in this Version (rel. 3.24)
Determine which panels have any of or all of a group of LOINCs.
LOINC Details new display type, "Custom Display".
Custom Export - Select columns to send to the Clipboard, Excel, a CSV file, or email program.
Exporting mapped local terms to a delimited file support LOINC parts
Component, Property, Time, System, Scale, and Method of mapped terms.
Row numbers now displayed on restriction trees and multi-axial tree search results.
Grids allow switch between word-wrapped and truncated cell contents.
Truncated cells display an ellipsis (...)

Context menu now has the "Propose a LOINC" action.
When adding or editing a local term, can use the context menu.
When displaying LOINC/Part Details, you can type a LOINC/Part number into the LOINC/Part number box, hit Enter, and RELMA will display that LOINC/Part.
Then, that LOINC/Part is added to the end of the list of displayed LOINCs/Parts.
The Change Submission form now lists the name of the local term file, the number of local terms in the file, the number of mapped terms, the number of unmapped terms, and the percentage of mapped terms.
When RELMA is set to ask for a comment at each mapping, if no comment is supplied the mapping is not performed.

Units from the original submission are included as part of the example units on the LOINC Details.
On the LOINC Details display, externally defined answers are now explicitly shown as externally defined.
Importing HL7 switches to the local term file of the HL7 import.
Switching preferred language from the User Preferences form immediately loads the language.
Support for searching the LOINC database in multiple languages.
The HIPAA HL7 attachments displays have been modifed to display on the "Panels, Forms & Surveys" form.

Manual and automated mapping assistant
Same free use as LOINC (see license)
Comes with the LOINC files and indexes
Developed in Visual Basic (No API)
RELMA tools transform local words in local file
User creates file of local term/name and codes
Assigns LOINC term to local test/battery code
RELMA Functions

Highlights
Browseable Hierarchies
Display search results in tree view
Enhanced “details” view of terms/parts
References
Descriptions
Sample units
Empirically-derived common test list
Special features for panels/forms
Enhanced export/copy-paste options

For a given test, users can select LOINC records containing:
A particular category of test (e.g., microbiology)
Any selected word in the input term
Additional keyed in word(s)
Wild cards of ? and *
Any intersection of the above
RELMA

RELMA Logic
Not  #<word A>
Or  <word A> | <word B >
And  <word B> <word A>

For a given test:
User can select LOINC records containing:
A set of words connected by ANDs or Ors
Wild cards of ? and *
Selected classes, systems, components,
Any intersection of the above
Note:
RELMA assumes exact match on word unless user adds terminal “*” to indicate wild card.
RELMA Search logic

Additional RELMA Features
User Specified Search Limits
Selectable trees for:
Class
System (specimen)
Component
Method

Installing RELMA®

Installation Steps
Make sure you have enough free disk space!
At least 250Mb are needed
From CD
Start – Run – D:RELMASetup
Specify installation directory
Life will be easier if you accept the default
Two database files installed
RELMA.MDB – LOINC Terms Database
LMOF3.MDB – Local Master Observation File
Two sample files copied (C:Program FilesRELMA)
Run from Start – (All) Programs – Regenstrief – RELMA

Running RELMA®

Select Linguistic Variant(s)

LOINC Terms with Spanish Linguistic Variant Spanish!

Welcome Screen

Setting User Preferences

Select User Preferences From the File Menu Set User Preferences

RELMA Color Schemes Predefined Schemes Create, Save, Delete custom color schemes Customize Colors

User Map Screen Preferences Click Map Screen Tab

Importing Local Terms into RELMA

4 Ways to Load LMOF Files
Direct entry into LMOF from within RELMA (painful)
Create an Access table that mimics the LMOF structure (less painful but tedious)
Appendix A: RELMA Manual
Create a delimited ASCII file from your local test catalog (good choice)
Load directly from HL7 v2.x messages (best? choice)
Pulls data from OBR and OBX segments

Constructing a Local Dataset
Create extract of your test catalog with:
Battery/Panel Code
Battery/Panel Description or Name
Local Code
Test Description or Name
Include Method if Important
Units
Example Values
Laboratory Section

Creating Delimited ASCII File
RELMA can’t parse free text
Need to create separate fields
Can use any of these delimiters
Tab, Semicolon, Comma, Space
Can define your own (“|” character recommended)
Fields can be in any order
Minimum required fields
Local Code
Local Description
Units (highly recommended)

Entering New Local Terms into RELMA

Edit Term Dialog Add New Test Print Preview List Text alignment option Custom Export Format

Add Local Term Form Click to Add to Current Working File MICRO BUBPLAG BUBONIC PLAGUE – RRT PCR

Print Preview Local Term File

Text Alignment Truncated vs. Wrapped Truncated terms end with ellipsis

Custom Export Options Output Options

Exported as Excel File

Steps to Import Local Terms
Click Import Local Terms Button from Main Menu
a) File>Import Local Terms from Delimited File
Locate your local terms text file
Sample file loaded into C:Program FilesRELMA
Name your Working Set
LMOF database can contain multiple work sets
Define default section (Optional)
Identify file delimiter
Assign fields to LMOF attributes
Ignore fields you don’t need
Combine fields if needed
Check “Case-sensitive” if needed
Click Import .

Alternative (best) Way
Use large set of HL7 messages
Automatically make dataset of:
OBR ID
OBR description
OBX ID
OBX description
Sample of results with
Real values
Units
Abnormal flags
Normal ranges

Generate Local term file from HL7 messages Select Import Terms from HL7 File

Select File to Import Select HL7 File

Specify HL7 File Name and Sample Size Name the Local Term File (working set)

New Terms added to LMOF New Battery Code Sample Data

Import the two sample files provided
Import_Sample_OBR.txt
Contains battery code and description
Import_Sample_OBX.txt
Contains test code and description
Create 2 working sets
Lenny L’OINC says: “ Load the Sample Files Into RELMA now!”

Cleaning your data

Preparing your Data for Mapping
Improve mapping success by:
Expanding abbreviations
Standardizing colloquial terms
Ignoring “administrative” terms
Standardizing time references
Can be done prior to importing
Better to use tools built into RELMA

Preparing your Data for Mapping
Find local Words not in LOINC
Tools>Concepts in Local Term File Unknown to RELMA
Creates a list of local terms in your file not found in LOINC
Only needs to be run once per working set
Can be printed or saved as a file
Autosearches LOINC terminology
Global Replace, Interactive Replace, Ignore

RELMA Cleaning Tools Use this tool to find unknown terms

Scanning Local Terms

RELMA Cleaning Tools Use this tool to make global substitutions

Term Substitution Save this global substitution for only this working set

Mapping Local Terms

Mapping Local Terms
Select “ Map Local Terms to LOINC ” from Welcome Screen
Select your Working Set to Map
File>Change Local term File
Select the subset of terms to work with:
All
Mapped
Unmapped
Set your Search Limits
Set Search Limits Button

Standard Mapping Window Features
Resizeable grid
Reorder Grid columns
View details of LOINC term
Sort by column
Click column
Custom Sort
Print or export results grid Spell check squiggly line to signify words not known to RELMA

Mapping Screen View or edit local term

Standard Mapping Screen Begin a search

Initial Mapping Results Click to show words used in search EEK! What’ll I do?!

Initial Mapping Results Use term checkbox Number of LOINC terms containing keyword Battery terms included in search

Revised Mapping Results Number of matching records found Match units selected by default

Re-revised Mapping Results Number of matching records found Match units unselected

Standard Mapping Screen Clear all input fields

Cleared Mapping Screen Enter keywords here CANINE DISTEMPER VIRUS IF

Ad hoc term search

Standard Mapping Screen Navigate through the local terms Show entire local term file

Show all terms Displays printed report format

Additional Search Screen Options Navigate to viewed screens View Mode: Grid (default) or Tree (new)

Tree View
Replaces “Group” View in prior versions
Still in beta
Results displayed hierarchically
Defined by the multi-axial hierarchy in search restrictions
Map to a term in tree by clicking Map button of double clicking term
Only rows that have LOINC Codes

Tree View Cannot map to these Can map to these

Assigning a LOINC Map Highlight correct term Click “Map” Button (or doubleclick)

Adding Mapping Comments If comments option is selected, prompt appears Check with Frank in Chemistry

Assigning a LOINC Map LOINC Term Assigned

View LOINC Term Details Right clicking on a LOINC term brings up a Task Menu View details for a specific LOINC Term

LOINC Term Details Can scroll through returned subset of terms Change to expanded details view Change text size Can scroll down a single formatted page

Expanded Details View

Using Wildcards in Searches
“*” replaces any number of characters
GLUC*
*COSE
GLU*SE
“?” replaces a single character
GLUCOS?
?LUCOSE
GLUC?SE

Other Search Qualifiers
“ #” represents the “NOT” operator
#GLUCOSE – terms without the Word Glucose
“ |” is the “OR” operator
GLUCOSE | LACTOSE
Can have multiple “OR”s per box
Can Mix OR and NOT and Wildcards

Limiting Searches

Setting Search Limits
Narrows search to specific subset of LOINC terms
Reduces number of candidate terms
Limits can be applied to all components
Component attribute can be further restricted by number of words
Tree structure allows for hierarchical constraints

RELMA - Search Constraints
Controls general search constraints including:
Limit to LOINC terms compatible with submitted units
Force match with any specimen contained in name
Methodless terms only ( now enhanced )
Limit to components with N or fewer words in their name
Pop up search timing statistics after each search
Use carefully or search may not be successful
(Note parallel control switches at bottom of screen)

Setting Search Limits Click Hierarchy & Search Limits Button

Setting search limits
Can also set most of them by toggling buttons at the bottom of the screen
Toggle Buttons

Search Constraints Predefined, general search constraints Attribute trees Local Unit Constraint: Now defaults to “ON”

Terms Consistent with Units Only terms consistent with mmol/L appear

Setting Search Limits Specimen constraints

Terms Consistent with Specimen CSF Enter default Specimen

Terms Consistent with Specimen Only CSF Terms are returned

Setting Search Limits Methodless Terms Restriction Override Methodless Terms Restriction

Limit to Methodless Terms

Limit to Methodless Terms Only Methodless Terms Appear

More on Methodless Terms
Some LOINC categories do not have methodless terms
Checking methodless only will remove these from view on results grid
Checking additional box allows these to be seen

Methodless Only Unchecked All terms returned

Methodless Only Checked Only Methodless terms returned

Conditional Methodless More terms returned

Setting Search Limits Limit to Lab Tests Only (No Clinical LOINC Terms)

Setting Search Limits Limit to lab tests that comprise 99.8% of INPC volume

Setting Search Limits Limit Number of Words in the Component Attribute

Limit Number of Component Words Without Limit Applied: 698 terms returned

Limit Number of Component Words With Limit Applied: 64 terms returned Restriction appears on Toggle Bar (cannot toggle off)

Setting Search Limits Include Deprecated LOINC Codes with Returned Terms

Include Deprecated LOINC Terms Deprecated LOINC Terms appear as Strikethrough Text with a “Do Not” Symbol

Favor Property Restriction Favor one type of property over others

Order/Observation Restriction Order or Observation preference

LOINC Hierarchies – Class Tree Three top-level branches Tree Navigation Buttons

Before Class Restriction Large number of candidate terms Many terms have class of “CHAL”

Search Trees chal Restrict eligible tests to non-challenge chemistry tests only

Following Class Restriction Only Non-Challenge Chemistry tests returned

Improvements to Trees Continued reorganization to provide a Specimen hierarchy

Improved Hierarchy for Component Show the LOINC Codes associated with these components

Show Associated LOINCs Click on details for more information about the selection

Details Screen

Tree Export Tools Save tree data to a file Export tree data to Excel Send Tree data as email

RELMA - Tree Features
All trees operate the same way
Shows terms spelled out
Can expand and collapse parts or all of tree.
Tree is string searchable
Search can be based on one or more branches of a tree with or without other criteria
Tabs are marked with an asterisk if criteria selected

Navigating through the Mapping Process

Limit effort to one lab section at a time and focus expertise
Chemistry and hematology will be easiest
Consider prioritizing by frequency
LOINC Mapping Tactics

Vreeman DJ, Finnell JT, Overhage JM. A Rationale for Parsimonious Laboratory Term Mapping by Frequency. AMIA Annu Symp Proc . 2007;:771-775.

More LOINC Mapping Tactics
Try using method-less terms first
Specific methods can be transmitted in:
OBX–17 (v2.x), Observation.methodCode (v3.0)
Examine local units or real results to verify correct properties
Properties are rarely distinguishable in tests
You don’t have to do it all at one sitting
Use the “Unmapped” function to return where you left off
With every release - Update previous mappings to identify deprecated terms

Common Mapping Issues
Locally Defined Test Name Ambiguity
Reuse of local test code
“ Analyte-free” Local Test Names
Incongruent Value sets (Scale ambiguity)
Result vs. Interpretation
Available LOINC Terms too Specific
Available LOINC Terms too General
Panel vs. Discrete Test
Common in Microbiology

Using your Mapped Terms
Print results of LOINC Mapping
Export to File

Intelligent Mapper
Run in batch mode to find N- closest terms
Can then use this output to do final mapping
Again units are VERY important
Can pick all limits available to regular mapping
With Radiology can use CPT to help
Intelligent Mapper Radiology References
Vreeman DJ, McDonald CJ. A Comparison of Intelligent Mapper and Document Similarity Scores for Mapping Local Radiology Terms to LOINC. Proc AMIA Symp. 2006;809-813.
Vreeman DJ and McDonald CJ. Automated Mapping of Local Radiology Terms to LOINC. Proc AMIA Symp. 2005;769-773.

Picking the Intelligent Mapper

Intelligent Mapper Start Screen

Intelligent Mapper - Mapping Screen

Exporting Mapped Terms Export Terms to Delimited File

Export Terms Dialog Check Fields you wish to export Select Delimiter

Other RELMA ® Features

Panels, Forms and Survey Review New Menu Function: Review Panels, Forms and Surveys

Government Forms Form Name Component LOINC terms

Laboratory panels Expand category to see panels Double-click panel name to see components

Expanded Panel Detail

Clinical Panels New Feature: Find where a term has been used

LOINC Term Usage 35089-2, 35090-0

LOINC Term Panel Usage

Other Survey Instruments

HIPAA Attachments View Various HIPAA Attachments

HIPPA Attachment Tree

Expanded Attachment Data

Can’t find the term you want?

Search Hints and Tips
Keywords with zero frequency are ignored
May need to rephrase – use synonym
Some causes for no returned terms
Too many keywords in search – uncheck some
Limits applied that don’t make sense
E.g. Method-less tests plus Method tree set to EIA
Did not find and revise words not in RELMA
Local units not in RELMA
Units are GREAT discriminators
You may have tests that need to be added to LOINC

Proposing New LOINC Terms

Proposing New Terms
Make sure the term is really needed
Think of other names for the same concept
Avoid detailed methods or localizations
Is the distinction really important?
Supply sufficient annotation to justify the new term
Package inserts, sample reports (email to Regenstrief)
The more the better!
Construct new terms within RELMA
File>Propose a LOINC
Linked to the “trees” to allow browsing
Can review and submit them to LOINC from within RELMA

Propose new LOINC terms Select Propose a LOINC

Propose new LOINC terms Navigate through proposed terms Create new term, save current term or Exit form

Preview Proposed Terms Review your new terms

Preview Proposed Terms All proposed terms fully editable Choose whether to send or postpone X X X X

Use Existing Terms as Template Select your closest match Click the Propose Term button

Use Existing Terms as Template All required components filled in

Using LOINC and SNOMED Together

Where do LOINC and SNOMED Fit?
LOINC represents the question:
Is there any Botulism toxin in my specimen? (33708-9)
Organisms identified in specimen? (634-6)
SNOMED represents the answer:
Negative (SCTID 260385009)
E. coli O157:H7 (SCTID 103429008)
Remember:

Where do LOINC and SNOMED Fit?
In an HL7 message, LOINC may be used:
In OBR-4 (Universal Service Identifier)
In OBX-3 (Observation Identifier
SNOMED may be used:
In OBX-5 (where nominal values are needed)
Almost anyplace else in an HL7 message where coded values are needed

OBX: With a Coded Value OBX||CE|6609-2^Listeria ID^LN||36094007^L. monocytogenes^SCT The code is from SNOMED The code is from LOINC OBX-5: Data A code for L. monocytogenes A code that identifies the data type in OBX-5 as a coded element OBX-3:A code that identifies the data in OBX-5 (Listeria culture)

HL7 2.5 Example (ER-7 format)
MSH|^~&| LABGL1|| DMCRES|| 199812300100|| ORU^ R01| LABGL1199510221838581| P| 2.3||| NE| NE
PID||| 6910828^ Y^ C8|| Newman^ Alfred^ E|| 19720812| M|| W| 25 Centscheap Ave^^
Whatmeworry^ UT^ 85201^^ P||( 555) 777- 6666|( 444) 677- 7777|| M|| 773789090
OBR|| 110801^ LABGL| 387209373^ DMCRES|634-6^Bacteria XXX Aerobe Cult
^LN||| 199812292128||||||||Stool| IN2973^ Schadow^ Gunther^^^^ MD^ UPIN|||||||||||||||| CA20837^ Spinosa^ John^^^^ MD^ UPIN
OBX|| CE| 634-6^Bacteria XXX Aerobe Cult^ LN||50136005^Salmonella typhimurium ^SCT|||||| F||| 199812292128|| CA20837
OBR|| 110801^ LABGL| 387209373^ DMCRES| 29567-9^Bacterial Susceptibility Panel^ LN||| 199812300934||||||||Bacterial isolate| IN2973^ Schadow^ Gunther^^^^ MD^ UPIN||||||||| Salmonella typhimurium ||||||| CA20837^ Spinosa^ John^^^^ MD^ UPIN
OBX|| CE|23631-5^Trimethoprim/Sulfasoxazole^ LN||264841006^Intermediate ^SCT|||||| F||| 199812300934|| CA20837
OBX|| CE|18967-7^Penicillin^LN||30714006^Resistant^SCT|||||| F||| 199812300934|| CA20837
OBX|| CE|18928-2^Gentamicin^ LN||131196009^Susceptible^SCT|||||| F||| 199812300934|| CA20837
First Order OBR (Culture and ID) First Result Value (SNOMED) First Result Description OBX (LOINC) Second Order OBR (Susceptibility)

Q and A Session

Exercise Map your own data

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20080609 Loinc Workshop

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