2009 06 15 - LOINC Workshop

Using RELMA
Or…In Search of the Missing LOINC

Laboratory LOINC Meeting – June 2009

James T. Case MS, DVM, PhD
Professor, Clinical Diagnostic Informatics
California Animal Health and Food Safety
Laboratory
University of California, Davis

©2009 Regenstrief Institute and James Case

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


What will we cover today?
• Why we are doing this!
• Overview of LOINC
• 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


Why are we doing this?
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
accessibility, completeness, accuracy and
precision (and more)


Levels of Interoperability
• Basic – allows messages to be exchanged
between computer systems
• Word processing documents, text messages
• 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
What you see in the order list

Lab A Lab B
Test Name:Lyme Disease Serology Test Name:Lyme Disease Antibody
Measures:B. burgdorferi Ab IgG Measures:B. burgdorferi Ab IgM
Method: ELISA Method: Immune blot
Scale: quantitative Scale: qualitative
e.g.: Titer 1:40 e.g.: Positive

LOINC Code = 5062-5 LOINC Code = 6321-4


LOINC ® 101


Anatomy of a LOINC Term
5193-8:Hepatitis B virus surface Ab:ACnc:Pt:Ser:Qn:EIA

5193-8 LOINC Code

Hepatitis B virus surface Ab Component
ACnc Property Measured
Pt Timing

Ser System
Qn Scale

EIA Method

There are six major LOINC axes

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 OBR or 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


Component/Analyte Structure
AnalyteName^Challenge^Adjustments
• 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


Property
the most difficult LOINC axis

The characteristic or attribute of the analyte that is
measured, evaluated, or observed
Major Categories
• 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 most difficult LOINC axis

Combine Major Categories with Subtypes for Full Property

• 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”


Common Issues with LOINC Properties
Fraction (proportion) vs. Ratio
a/a+b vs. a/b
• Fraction = Part/whole
• Number fraction (NFr): % Eosinophils
• Substance fraction (SFr): % HGB which is A2
• Ratio = Measures multiple analytes from the same
system (specimen)
• 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 – e.g. ratio of actual to control values
• RlTm – e.g. time©2009 Regenstrief Institute and Jamesnormal control
from actual and Case

Timing*
The interval of time over which the observation or
measurement was made
• Pt - at a point in time
• 12H - a twelve hour collection
• 24H - a twenty four hour collection

*non-Pt timings are usually associated with Rate Property


System
The system (context) or specimen type upon which
the observation was made.
• Ser - Serum • Gast – Gastric fluid/contents
• Bld - Whole blood (RBC) • Food – Food or feedstuff
• Ur- Urine • Tiss – Tissue
• BldA - Arterial blood • XXX – To be specified in
• Liver - Liver another part of the message
• Flu – Body Fluid, unspecified

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.

Scale
• Qn - quantitative
• Continuous numeric (real, integer, ratio)
• Optional operator (>, , , <)
• When assay detection limits are exceeded
• 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 (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 – TreponemapallidumAb
• Urinalysis – lots of different things
• The question (what am I measuring? e.g. Glucose) is
not the answer (e.g. 90 mg/dl)
• 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: Screen shots from version 3.24(early
release)


New in This Version (Rel. 3.25)
• RELMA being converted to Microsoft's .NET
technology.
• Uses Microsoft Windows Installer
• Supports the display of "context specific
hierarchies."
• Users can create their own hierarchies of
LOINC codes and share them between users.
• "Long Common Name" available
• Stores and displays the test and battery
code systems when importing from
delimited files.

• Stores the Notes and Comments (NTE)
segment data in the LMOF3.MDB (beta)
• Allows export of the LOINC database
version to a delimited file
• LOINC Intelligent Mapper allows time limit
for processing local terms.
• May specify only unmapped terms
• "Configure Grid“ - enhanced capability to
change order, column widths, and visibility
of search results.

• Mapping screen "Lookup Term by #“ allows
searching of LOINCs and LOINC Parts by any
combination of spaces and commas.
• "Custom Export" allows inclusion/exclusion
of a header row.


RELMA Functions
• Manual and automated mapping assistant
• Same free use as LOINC (see license)
• Comes with the LOINC files and indexes
• Initially developed in Visual Basic, being
migrated to MS .NET.
• 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


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

RELMA Search logic
For a given test:
• User can select LOINC records containing:
• A set of words connected by ANDs or Ors
• Additional keyed in words
• A particular category of test (e.g. microbiology)
• 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 Logic

Not #<word A>
Or <word A> | <word B >
And <word B><word A>


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 500Mb 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®
Version 3.25


Copyright Screen

© 2006 Regenstrief Institute & James Case

Main Menu/Welcome Screen

Click File, Set Preferred
Language


Select Linguistic Variant(s)


LOINC Terms with Spanish Linguistic Variant

Spanish!


Welcome Screen


Setting User Preferences


Set User Preferences

Select User Preferences
From the File Menu


Set User Preference Dialog
User Name or Initials

File Locations

Startup Screen Preference

RELMA Color Scheme


RELMA Color Schemes
Predefined Schemes

Customize Colors

Create, Save, Delete
custom color schemes


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)
• Handy for individual entries/edits
• 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
• Pulls data from OBR and OBX segments
• Stores NTE segment data (new)


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


Manual Enter/Edit
View/Add/Edit Local Terms


Edit Term Dialog
Add New Test

Text alignment option
Custom Export Format

Print Preview List


Add Local Term Form

MICRO

BUBPLAG
BUBONIC PLAGUE – RRT PCR

Click to Add to Current
Working File


Print Preview Local Term File


Text Alignment
Truncated vs. Wrapped

Truncated terms end
with ellipsis


Custom Export Options

Output Options

NEW! May include
column headers


Exported as Excel File


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


Example Tab-Delimited File


Importing Local Files
Select Import Local Terms


Open File in RELMA

Name your working set.
RELMA allows multiple sets in
LMOF database

Select your delimiter

Import Button


Open File in RELMA


Fields Segregated

Assign LMOF Attribute


Ready to Import

Minimum assignments

Now you can click this
button!

Alternative Pragmatic 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)


HL7 Messages Data Statistics


New Terms added to LMOF
New Battery Code

Click on “Edit Test to see
Sample Data


Sample Results for Observation
New Test Code

Sample Values from
Messages


Lenny L’OINC says:
“Load the Sample Files
Into RELMA now!”

• 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

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
version
• 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


Replace Local Terms

Assign LMOF Attribute
ReplacementOptions


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
• Customizable grid (New!)
• 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

Expanded quick select
button list

Custom Grid Configuration


Configure Grid

Reorder grid elements

Select elements to display

Reset Default Configuration

Choose LOINC for template

Visually resize elements

View Local Term Details


Standard Mapping Screen

Begin a
search


Initial Mapping Results

EEK! What’ll
I do?!

Click to
show words
used in
search


Initial Mapping Results

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


Revised Mapping Results

Match units Number of
selected by matching
default records found


Re-revised Mapping Results

Number of
matching
Match units
records found
unselected



Clear all
input fields


Cleared Mapping Screen

CANINE DISTEMPER VIRUS IF

Enter keywords here


Ad hoc term search



Show entire local
term file

Navigate through
the local terms


Show all terms

Displays printed
Brings up edit local report format
term window


Code System
Column Added
(Rel. 3.25)


Additional Search Screen Options

Navigate to viewed
screens
View Mode:
Grid (default) or
Tree (new)


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


Tree View

Can map to terms Cannot map to
with LOINC Codes terms
representing
LOINC parts


Assigning a LOINC Map

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

Adding Mapping Comments

Check with Frank in Chemistry

If comments
option is selected,
prompt appears


Assigning a LOINC Map

LOINC Term
Assigned

View LOINC Term Details

View details for a
specific LOINC Term

Right clicking on a LOINC
term brings up a Task Menu

LOINC Term Details

Can scroll down a single
formatted page

Can scroll through
Change to expanded returned subset of
details view terms

Change text size


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)



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
Attribute trees

Local Unit Constraint:
Now defaults to “ON”

Predefined, general search
constraints


Terms Consistent with Units

Only terms consistent
with mmol/L appear



Specimen
constraints


Terms Consistent with Specimen

CSF

Enter default
Specimen


Terms Consistent with Specimen

Only CSF Terms are
returned



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

Differ in one or
more components


Conditional Methodless
More terms
returned

No methodless
term; all shown



Limit to Lab Tests Only
(No Clinical LOINC Terms)



Limit to lab tests that comprise
99.8% of INPC volume



Limit Number of Words in the
Component Attribute


Limit Number of Component Words

Without Limit Applied:
711 terms returned


Limit Number of Component Words
Restriction appears on
Toggle Bar
(cannot toggle off)

With Limit Applied:
63 terms returned



Include Deprecated
LOINC Codes with
Returned Terms


Include Deprecated LOINC Terms

You cannot map to
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
All other components
being equal MCnc
only will be displayed


Order/Observation Restriction

Order or Observation
preference


LOINC Hierarchies – Class Tree

Three top-level
branches Tree Navigation
Buttons


Before Class Restriction

Many terms have class
of “CHAL”

Large number of
candidate terms


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

Send Tree data to aExcel
Exporttree data as email
Save tree data to file


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


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


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


Print Mapped Terms from
View/Add/Edit Menu

Click Print button to Preview
Must highlight terms to be
output
printed


Formatted Report Output

Click Print button to output
formatted report


Export Mapped Terms

Click Custom Export to select
exported fields


Custom Export Configuration


Excel™ Export


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

Begin by finding qualifying
candidates based on local
file attributes


Intelligent Mapper Start Screen

New Feature!
Max search time per local
term


Intelligent Mapper - Mapping Screen


Exporting Mapped Terms

Export Terms to
Delimited File


Export Terms Dialog

Select Term Set

Select Delimiter

Check Fields you
wish to export

Output File

Mapped terms
include LOINC code


Other RELMA®

Features


Panels, Forms and Survey Review

Review Panels, Forms and
Surveys


Government Forms

Component LOINC
terms

Form Name


Laboratory panels

Expand category to
see panels

Double-click
panel name to see
components


Expanded Panel Detail


Expanded Clinical Panel


Clinical Panels

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


Context Specific Hierarchies
• New Feature for Rel. 3.25
• Allows local definition of LOINC code
hierarchies
• Template data base is provided with
RELMA
• CONTEXT_SPECIFIC_HIERARCHY_TEMPLATE.mdb
• Does not support .accdb format
• Hierarchies can be displayed (only) in
RELMA
• Codes and terms may come from multiple
code systems ©2009 Regenstrief Institute and James Case

Access Context-Specific Hierarchies

Select Context Specific
Hierarchies


Context Specific Hierarchies

Change schema using
the File Menu


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

Create new term,
save current term
or Exit form
Navigate through
proposed terms Required fields


Preview Proposed Terms

Review your new
terms


Preview Proposed Terms

Choose whether to
send or postpone

X

X
X

X

All proposed terms
fully editable


Use Existing Terms as Template

Click the Propose
Term button

Select your closest
match


Use Existing Terms as Template

All required
components filled in


Using LOINC and SNOMED
Together


Where do LOINC and SNOMED Fit?
Remember:
• 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)


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
A code that
identifies the
data type in
The code is The code is
OBX-5 as a
from LOINC from SNOMED
coded element

OBX||CE|6609-2^Listeria ID^LN||36094007^L. monocytogenes^SCT

OBX-3:A code that
identifies the data in OBX-5: Data
OBX-5 A code for L.
(Listeria culture) monocytogenes


HL7 2.5 Example (ER-7 format)
MSH|^~&| LABGL1|| DMCRES|| 199812300100|| ORU^ R01|
LABGL1199510221838581| P| 2.3||| NE| NE

First Order OBR
PID||| 6910828^ Y^ C8|| Newman^ Alfred^ E|| 19720812| M|| W| 25 Centscheap Ave^^
(Culture and ID)
Whatmeworry^ UT^ 85201^^ P||( 555) 777- 6666|( 444) 677- 7777|| M|| 773789090
First Result Value
(SNOMED)
OBR|| 110801^ LABGL| 387209373^ DMCRES|634-6^Bacteria XXX Aerobe Cult
Second Order OBR
^LN||| 199812292128||||||||Stool| IN2973^ Schadow^ Gunther^^^^ MD^
UPIN|||||||||||||||| CA20837^ Spinosa^ John^^^^ MD^ UPIN (Susceptibility)

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
Second Result(s)
First Result First Result Description
Panel^ LN||| 199812300934||||||||Bacterial isolate| IN2973^ Schadow^
OBXs
Gunther^^^^ OBX (LOINC)
(Culture and ID)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


Q and A Session


Exercise
Map your own data


2009 06 15 - LOINC Workshop

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2009 06 15 - LOINC Workshop