An Introduction to Clinical LOINC Stanley M. Huff, M.D. Intermountain Healthcare [email_address]

Outline for All Tutorials LOINC Introduction and Foundation Documents Assessment Instruments and Survey Instruments Radiology and Imaging

LOINC Introduction and Foundation

Documents

Assessment Instruments and Survey Instruments

Radiology and Imaging

Outline LOINC background and goals LOINC structure and content Clinical LOINC Examples Attachments Context specific hierarchies Collections

LOINC background and goals

LOINC structure and content

Clinical LOINC

Examples

Attachments

Context specific hierarchies

Collections

Important facts LOINC 2.27 (June 2009) contains 55,056 codes 40,302 Lab LOINC codes 10,773 Clinical LOINC codes 1,354 Claims Attachment codes 2,629 Survey codes LOINC is protected by copyright, but is licensed Free for Use Download files and tools from Regenstrief Web Site www.regenstrief.org/loinc/loinc.htm Reference manual, submission database, RELMA RELMA – a tool for mapping local codes to LOINC

LOINC 2.27 (June 2009) contains 55,056 codes

40,302 Lab LOINC codes

10,773 Clinical LOINC codes

1,354 Claims Attachment codes

2,629 Survey codes

LOINC is protected by copyright, but is licensed Free for Use

Download files and tools from Regenstrief Web Site

www.regenstrief.org/loinc/loinc.htm

Reference manual, submission database, RELMA

RELMA – a tool for mapping local codes to LOINC

Coverage Laboratory LOINC All laboratory categories including genetic testing , veterinary medicine testing Clinical LOINC Many routine measures, parts of H+P, EKG, Cardiac echoes, OB ultrasound, Nursing survey instruments, Much more HIPAA attachments (Content managed by HL7) Survey Questions Skilled nursing facility Minimum Data Set (MDS)

Laboratory LOINC

All laboratory categories including genetic testing , veterinary medicine testing

Clinical LOINC

Many routine measures, parts of H+P, EKG, Cardiac echoes, OB ultrasound, Nursing survey instruments, Much more

HIPAA attachments

(Content managed by HL7)

Survey Questions

Skilled nursing facility Minimum Data Set (MDS)

The Messaging Paradigm System A System B Trigger Event Network Order Result

HL7 Result Message (ORU) Segment Data Field MSH|^~&|||||19981105131523||ORU^R01| PID|||100928782^9^M11||Smith^John^J| OBR||||Z0063-0^BP^LN| OBX||CE|8361-4^POSITION^LN||SIT^Sitting| OBX||NM|8479-8^SBP^LN||138|mmHg| Component

OBX: a name-value pair approach A code that identifies the data in OBX-5 (Temp Reading) OBX||NM|11289-6^^LN||38|C^^ISO+|||||F Other data fields include: date of observation, identity of provider giving observation, normal ranges, abnormal flags Status A code that identifies the units of numerical data in OBX-5 A code that identifies the datatype of OBX-5 OBX-5: Data

OBX: with a coded value OBX||CE|883-9^ Blood Group ^LN||58460004^ Group O ^SCT| The code is from SNOMED The code is from LOINC OBX-5: Data A code for Group O A code that identifies the datatype as a coded element A code that identifies the data in OBX-5 (ABO Blood Group)

So we are all using HL7, what is the problem? Site 1: OBX|1|CE| SysBP ^ Systolic BP || 132 ||mmHg| Site 2: OBX|1|CE| SBP ^ Systolic BP || 132 ||mmHg| Site 3: OBX|1|CE| BP ^ Systolic BP || 132/70 ||mmHg| You and I may know that these are similar results, but our computers will not.

Site 1:

OBX|1|CE| SysBP ^ Systolic BP || 132 ||mmHg|

Site 2:

OBX|1|CE| SBP ^ Systolic BP || 132 ||mmHg|

Site 3:

OBX|1|CE| BP ^ Systolic BP || 132/70 ||mmHg|

Site 1: OBX|1|CE| 8479-8 ^ SysBP ^ LN || 132 ||mmHg| Site 2: OBX|1|CE| 8479-8 ^ SBP ^ LN || 132 ||mmHg| Site 3: OBX|1|CE| 8479-8 ^ Systolic BP ^ LN || 132/70 ||mmHg| The Goal Agree on a universal coding system for clinical observations.

Site 1:

OBX|1|CE| 8479-8 ^ SysBP ^ LN || 132 ||mmHg|

Site 2:

OBX|1|CE| 8479-8 ^ SBP ^ LN || 132 ||mmHg|

Site 3:

OBX|1|CE| 8479-8 ^ Systolic BP ^ LN || 132/70 ||mmHg|

How terminologies fit into the model LOINC – attributes/observables SNOMED CT – findings/values (mostly) and observables (some) First Data Bank - values RxNORM - values

LOINC – attributes/observables

SNOMED CT – findings/values (mostly) and observables (some)

First Data Bank - values

RxNORM - values

Focus of LOINC Value for ‘Observation Identifier’ (Seq. #3) of OBX Or the name of the observation in other standards, such as ASTM or DICOM Individual result names first, then panels Panels are built based on the tests they contain Panels can contain other panels Name should facilitate automated or manual matching (fully specified) Create local labels as needed Standard LOINC short names One common identifier for tests that are ‘clinically’ the same

Value for ‘Observation Identifier’ (Seq. #3) of OBX

Or the name of the observation in other standards, such as ASTM or DICOM

Individual result names first, then panels

Panels are built based on the tests they contain

Panels can contain other panels

Name should facilitate automated or manual matching (fully specified)

Create local labels as needed

Standard LOINC short names

One common identifier for tests that are ‘clinically’ the same

Brief History of LOINC Logical Observation Identifier Names and Codes Organized by Clement McDonald, 1994 Supported by Regenstrief Institute and NLM Create a universal language for observation identifiers Laboratory observations were created first Creation of clinical observations began in 1996

Logical Observation Identifier Names and Codes

Organized by Clement McDonald, 1994

Supported by Regenstrief Institute and NLM

Create a universal language for observation identifiers

Laboratory observations were created first

Creation of clinical observations began in 1996

Approach Collect result names and descriptions IHC, VA, Regenstrief, Mayo Clinic, 3M, Vendors Formulate a model to represent the individual pieces of information in the name Avoid strategies that lead to “combinatorial explosion” Create “fully specified names” Adjust model as needed Do any distinct entities have the same name? Do any entities that are the same have different names? Repeat the process until no more adjustments are needed

Collect result names and descriptions

IHC, VA, Regenstrief, Mayo Clinic, 3M, Vendors

Formulate a model to represent the individual pieces of information in the name

Avoid strategies that lead to “combinatorial explosion”

Create “fully specified names”

Adjust model as needed

Do any distinct entities have the same name?

Do any entities that are the same have different names?

Repeat the process until no more adjustments are needed

LOINC makes names for things in use We do not make all possible permutations that the six axes would allow (no blind cross products) We try to only make names and codes for things that are real (exist in someone’s system) We do make names that allow both atomic (post coordinated) and molecular (pre coordinated) styles Some people wish we would be more prescriptive Name everything, let others dictate usage We do object to violations of the HL7 model No names that include post coordinated fields from other parts of the HL7 message (status, priority, user role)

We do not make all possible permutations that the six axes would allow (no blind cross products)

We try to only make names and codes for things that are real (exist in someone’s system)

We do make names that allow both atomic (post coordinated) and molecular (pre coordinated) styles

Some people wish we would be more prescriptive

Name everything, let others dictate usage

We do object to violations of the HL7 model

No names that include post coordinated fields from other parts of the HL7 message (status, priority, user role)

Two LOINC committees Laboratory LOINC Clem McDonald, Chair All aspects of tests/measurements done on specimens Chemistry, Hematology, Microbiology, Histology, Cytology, etc. Clinical LOINC Stan Huff, Chair All aspects of tests/measurements on a patient Vital signs, Hemodynamic measurements, Physical findings, Radiology, Ultrasound, etc. Both committees meet at least 2-3 times each year

Laboratory LOINC

Clem McDonald, Chair

All aspects of tests/measurements done on specimens

Chemistry, Hematology, Microbiology, Histology, Cytology, etc.

Clinical LOINC

Stan Huff, Chair

All aspects of tests/measurements on a patient

Vital signs, Hemodynamic measurements, Physical findings, Radiology, Ultrasound, etc.

Both committees meet at least 2-3 times each year

Current and Former Clinical LOINC Members James Barthel , Dean Bidgood, Bruce Bray, Bill Francis, Alan Golichowski, Daniel Vreeman, Karl Hammermeister, Anders Thurin, Barry Gordon, Warren Williams, James Campbell, Jim Cimino, Sue Bakken, Pat Wilson, Stan Huff, Doug Martin, Clem McDonald, Dan Pollock, Angelo Rossi Mori, Susan Matney, Jeff Suico, Wayne Tracy, Pavla Frazier, Pat Wilson, Lee Min Lau, Shawn Shakib, Bill Karitis, Thomas White, Steven Steindel, Elizabeth King, Loren Stevenson, Sundak Ganesan, Ted Klein, Vivian Auld

James Barthel , Dean Bidgood, Bruce Bray, Bill Francis, Alan Golichowski, Daniel Vreeman, Karl Hammermeister, Anders Thurin, Barry Gordon, Warren Williams, James Campbell, Jim Cimino, Sue Bakken, Pat Wilson, Stan Huff, Doug Martin, Clem McDonald, Dan Pollock, Angelo Rossi Mori, Susan Matney, Jeff Suico, Wayne Tracy, Pavla Frazier, Pat Wilson, Lee Min Lau, Shawn Shakib, Bill Karitis, Thomas White, Steven Steindel, Elizabeth King, Loren Stevenson, Sundak Ganesan, Ted Klein, Vivian Auld

Clinical LOINC Subject Areas Vital Signs Hemodynamics Fluid Intake/Output Body Measurements Operative Notes Emergency Department Respiratory Therapy Documents (collections) Standard survey instruments EKG (ECG) Cardiac Ultrasound Obstetrical Ultrasound Discharge Summary History & Physical Pathology Findings Colonoscopy/Endoscopy Radiology reports Clinical Documents Tumor Registry

Vital Signs

Hemodynamics

Fluid Intake/Output

Body Measurements

Operative Notes

Emergency Department

Respiratory Therapy

Documents (collections)

Standard survey instruments

EKG (ECG)

Cardiac Ultrasound

Obstetrical Ultrasound

Discharge Summary

History & Physical

Pathology Findings

Colonoscopy/Endoscopy

Radiology reports

Clinical Documents

Tumor Registry

LOINC Mascot

Outline LOINC background and goals LOINC structure and content Clinical LOINC Examples Attachments Context specific hierarchies Collections

LOINC background and goals

LOINC structure and content

Clinical LOINC

Examples

Attachments

Context specific hierarchies

Collections

LOINC codes are created systematically using a six axis model General Form of Clinical LOINC Names <component> : <property> : <timing> : <system> : <scale> : <method> The first 5 parts are mandatory, but method is optional. Subparts of the six axes are created as needed in specific subject areas. 8331-1 Body Temperature :TEMP :PT :MOUTH :QN

LOINC codes are created systematically using a six axis model

Summary of the six primary axes (clinical) Component Ejection fraction, heart beats, cardiac output, circumference Kind of property Angle, area, length, mass, pressure, temperature Timing Point in time, study minimum, maximum in 8 hours System Head of fetus, tricuspid valve, ventilator setting Scale Quantitative, ordinal, nominal (coded), narrative Method Stated, measured, estimated, ultrasound, spirometry

Component

Ejection fraction, heart beats, cardiac output, circumference

Kind of property

Angle, area, length, mass, pressure, temperature

Timing

Point in time, study minimum, maximum in 8 hours

System

Head of fetus, tricuspid valve, ventilator setting

Scale

Quantitative, ordinal, nominal (coded), narrative

Method

Stated, measured, estimated, ultrasound, spirometry

Component The substance or entity that is measured, evaluated, or observed. RR INTERVAL ORIFICE (OF A HEART VALVE) EJECTION FRACTION HEART BEATS BREATHS CARDIAC OUTPUT SEGMENTAL WALL MOTION PROSTHETIC VALVE TYPE FLUID INTAKE

The substance or entity that is measured,

evaluated, or observed.

RR INTERVAL

ORIFICE (OF A HEART VALVE)

EJECTION FRACTION

HEART BEATS

BREATHS

CARDIAC OUTPUT

SEGMENTAL WALL MOTION

PROSTHETIC VALVE TYPE

FLUID INTAKE

Subtypes – period as a separator CAPACITY.VITAL.FORCED GRADIENT.MAX (as across a valve) INTERNAL DIAMETER.MINOR AXIS.SYSTOLE BIRTHS.TERM GLASGOW SCORE.VERBAL R' WAVE AMPLITUDE.LEAD II ST SEGMENT AXIS.HORIZONTAL PLANE PHYSICAL FINDINGS.SENSATION CALORIE INTAKE.TOTAL TIDAL VOLUME MAX.SETTING

CAPACITY.VITAL.FORCED

GRADIENT.MAX (as across a valve)

INTERNAL DIAMETER.MINOR AXIS.SYSTOLE

BIRTHS.TERM

GLASGOW SCORE.VERBAL

R' WAVE AMPLITUDE.LEAD II

ST SEGMENT AXIS.HORIZONTAL PLANE

PHYSICAL FINDINGS.SENSATION

CALORIE INTAKE.TOTAL

TIDAL VOLUME MAX.SETTING

Challenge/Pre condition - ^ as a separator FLUID OUTPUT.URINE ^ POST VOID FRACTIONAL COLLAPSE ^ INSPIRATION BREATHS ^ AT MAX VOLUNTARY VENTILATION RR INTERVAL ^ AT TRICUSPID FLOW MEASUREMENT GAS FLOW.MIN ^ PRE THERAPY FLOW ^ AT 25-75% OF FORCED EXPIRATION INTRAVASCULAR DIASTOLIC ^ STANDING NEONATAL APGAR ^ 5M POST BIRTH MULTISECTION ^ WITH ANESTHESIA BODY WEIGHT ^ WITH CLOTHES

FLUID OUTPUT.URINE ^ POST VOID

FRACTIONAL COLLAPSE ^ INSPIRATION

BREATHS ^ AT MAX VOLUNTARY VENTILATION

RR INTERVAL ^ AT TRICUSPID FLOW MEASUREMENT

GAS FLOW.MIN ^ PRE THERAPY

FLOW ^ AT 25-75% OF FORCED EXPIRATION

INTRAVASCULAR DIASTOLIC ^ STANDING

NEONATAL APGAR ^ 5M POST BIRTH

MULTISECTION ^ WITH ANESTHESIA

BODY WEIGHT ^ WITH CLOTHES

Adjustments - ^ ^ as a separator DIFFUSION CAPACITY.CARBON MONOXIDE ^ ^ ADJUSTED FOR HEMOGLOBIN DIFFUSION CAPACITY ^ ^ ADJUSTED TO BODY CONDITIONS

DIFFUSION CAPACITY.CARBON MONOXIDE ^ ^ ADJUSTED FOR HEMOGLOBIN

DIFFUSION CAPACITY ^ ^ ADJUSTED TO BODY CONDITIONS

Kind of Property TYPE – selection of subtype (nominal items) PRID – presence or identified (nominal items) TIME – duration of time COLOR – color ANGLE – degrees of arch APER – appearance AREA - area ELPOT – voltage LEN – length MASS – mass MRAT – mass rate (gm/hr) PRES – pressure TEMP – temperature FCN – function (of a body part or system) The characteristic or attribute of the component that is measured, evaluated, or observed.

TYPE – selection of subtype (nominal items)

PRID – presence or identified (nominal items)

TIME – duration of time

COLOR – color

ANGLE – degrees of arch

APER – appearance

AREA - area

ELPOT – voltage

LEN – length

MASS – mass

MRAT – mass rate (gm/hr)

PRES – pressure

TEMP – temperature

FCN – function (of a body part or system)

Timing PT - at a point in time STDY^MIN – minimum over the period of a study 24H - a twenty four hour shift 10H^MEAN – mean value for a ten hour period 8H^MAX – maximum value in an eight hour period The interval of time over which the observation or measurement was made.

PT - at a point in time

STDY^MIN – minimum over the period of a study

24H - a twenty four hour shift

10H^MEAN – mean value for a ten hour period

8H^MAX – maximum value in an eight hour period

System YOLK SAC^FETUS UPPER GI TRACT TRICUSPID VALVE^PATIENT TRICUSPID VALVE^FETUS SYNOVIAL SPACE HEART.VENTRICLE.RIGHT VENTILATOR ARTERIAL SYSTEM BLADDER EYE.LEFT The system (context) or body part about which the observation was made.

YOLK SAC^FETUS

UPPER GI TRACT

TRICUSPID VALVE^PATIENT

TRICUSPID VALVE^FETUS

SYNOVIAL SPACE

HEART.VENTRICLE.RIGHT

VENTILATOR

ARTERIAL SYSTEM

BLADDER

EYE.LEFT

Patient, Control, or Donor (as part of system) CONTROL PATIENT DONOR BABY FETUS Non-patient values for this axis should be used with care, or combinatorial explosion could result

CONTROL

PATIENT

DONOR

BABY

FETUS

Scale QN - quantitative 4, 7.4, 1:8 ORD - ordinal, the answers can be ranked +/-, 1+, 2+, 3+ …. mild, moderate, severe NOM - nominal, answers are unranked Stool appearance Chest tube type NAR - answer is a paragraph of text

QN - quantitative

4, 7.4, 1:8

ORD - ordinal, the answers can be ranked

+/-, 1+, 2+, 3+ ….

mild, moderate, severe

NOM - nominal, answers are unranked

Stool appearance

Chest tube type

NAR - answer is a paragraph of text

Method STATED – reported verbally MEASURED – actually observed CALCULATED – numeric calculation US – ultrasound EKG – electrocardiogram ESTIMATED – an educated guess at the real value HELIUM REBREATHING – helium rebreathing SPIROMETRY – spirometry MANUAL – done by hand AUTOMATED – used an instrument Procedure used to make the measurement or observation. Only used when it makes an important distinction in sensitivity or specificity.

STATED – reported verbally

MEASURED – actually observed

CALCULATED – numeric calculation

US – ultrasound

EKG – electrocardiogram

ESTIMATED – an educated guess at the real value

HELIUM REBREATHING – helium rebreathing

SPIROMETRY – spirometry

MANUAL – done by hand

AUTOMATED – used an instrument

Putting it all together Code Component Prop TIME System Scale Method 8302-2 BODY HGHT LEN PT ^PATIENT QN 3140-1 BODY SURF AREA PT ^PATIENT QN DERIVED 8331-1 BODY TEMP TEMP PT MOUTH QN 8319-6 BODY TEMP TEMP 12H^MIN XXX QN 8629-8 Q WAVE DPT ELPOT PT HEART QN EKG 8632-2 QRS AXIS ANGLE PT HEART QN EKG 8642-1 PUPIL DIA LEN PT EYE.RIGHT QN AUTO 21611-9 AGE TIME PT ^PATIENT QN EST 21612-7 AGE TIME PT ^PATIENT QN REPORT 19867-1 CAPACITY.VITAL VOL PT RESP SYS QN 9279-1 BREATHS NRAT PT RESP SYS QN 11882-8 GENDER FIND PT ^FETUS NOM US

Code Component Prop TIME System Scale Method

8302-2 BODY HGHT LEN PT ^PATIENT QN

3140-1 BODY SURF AREA PT ^PATIENT QN DERIVED

8331-1 BODY TEMP TEMP PT MOUTH QN

8319-6 BODY TEMP TEMP 12H^MIN XXX QN

8629-8 Q WAVE DPT ELPOT PT HEART QN EKG

8632-2 QRS AXIS ANGLE PT HEART QN EKG

8642-1 PUPIL DIA LEN PT EYE.RIGHT QN AUTO

21611-9 AGE TIME PT ^PATIENT QN EST

21612-7 AGE TIME PT ^PATIENT QN REPORT

19867-1 CAPACITY.VITAL VOL PT RESP SYS QN

9279-1 BREATHS NRAT PT RESP SYS QN

11882-8 GENDER FIND PT ^FETUS NOM US

More complex examples 9273-4 NEONATAL APGAR^ 2M POST BIRTH FCN PT ^PATIENT ORD 9192-6 FLUID OUTPUT.URINE VRAT 24H URINARY TRACT QN 11892-7 GESTATIONAL AGE TIME PT ^FETUS QN US.ESTIMATED FROM AC.HADLOCK84 10105-5 ST SLOPE.LEAD V6 ELPOTRAT PT HEART QN EKG 8431-9 INTRACHAMBER SYSTOLIC PRES PT HEART.VENTRICLE.LEFT.OUTFLOW TRACT QN 8283-4 CIRCUMFERENCE. MAX LEN PT CALF.RIGHT QN

9273-4 NEONATAL APGAR^ 2M POST BIRTH FCN PT ^PATIENT ORD

9192-6 FLUID OUTPUT.URINE VRAT 24H URINARY TRACT QN

11892-7 GESTATIONAL AGE TIME PT ^FETUS QN US.ESTIMATED FROM AC.HADLOCK84

10105-5 ST SLOPE.LEAD V6 ELPOTRAT PT HEART QN EKG

8431-9 INTRACHAMBER SYSTOLIC PRES PT HEART.VENTRICLE.LEFT.OUTFLOW TRACT QN

8283-4 CIRCUMFERENCE. MAX LEN PT CALF.RIGHT QN

Outline LOINC background and goals LOINC structure and content Clinical LOINC Examples Attachments Context specific hierarchies Collections

LOINC background and goals

LOINC structure and content

Clinical LOINC

Examples

Attachments

Context specific hierarchies

Collections

HL7 & the Claims Attachment Recommendation HIPAA Legislation was passed in Aug 1996 Extended debate Different motivations for payers and providers Initial proposal to use X12 messages, HL7 Version 2 messages, LOINC Notice of proposed rule making (NPRM) in Sept 2005 X12 messages HL7 CDA Release 1 standard (probably will now be R2) XML based standard for transmitting documents LOINC codes No final rule yet

HIPAA Legislation was passed in Aug 1996

Extended debate

Different motivations for payers and providers

Initial proposal to use X12 messages, HL7 Version 2 messages, LOINC

Notice of proposed rule making (NPRM) in Sept 2005

X12 messages

HL7 CDA Release 1 standard (probably will now be R2)

XML based standard for transmitting documents

LOINC codes

No final rule yet

Unsolicited Attachment

Request for Additional Information

Organizations & Documents X12 277 Transaction 12748-1 9832-1 X12 275 Transaction HL7 CDA R1 15748-3 7832-8 20118-5 4332-7 12748-1 9832-1 ASC X12 & Subcommittee X12N X12 Trans. Sets 277, 275 TG2 Impl. Guides 277, 275 Health Level Seven HL7 CDA R 1 HL7 Claims Attachments Impl. Guide LOINC Consortium LOINC Codes LOINC Attachment Booklets

Attachment Types Selected for HIPAA Attachment types ultimately selected for development and HIPAA recommendation: Ambulance Emergency Department Rehabilitative Services Lab Results Medications Clinical Notes

Attachment types ultimately selected for development and HIPAA recommendation:

Ambulance

Emergency Department

Rehabilitative Services

Lab Results

Medications

Clinical Notes

CDA: Semi- or fully-structured HIPAA Claims Attachments Autoadjudicate Provider Payer Transcription * Scanned Paper or Document Imaging * Level 3 CPR Image + XML Semistructured Structured and coded Specific XML forms *

Outline LOINC background and goals LOINC structure and content Clinical LOINC Examples Attachments Context specific hierarchies Collections

LOINC background and goals

LOINC structure and content

Clinical LOINC

Examples

Attachments

Context specific hierarchies

Collections

Use cases for Context Specific Hierarchies Roll-up in decision support Body weight Body height Blood pressure Basis for queries “ All surgery notes” “ All head x-ray reports” “ All hematology lab results” Control of data access Tabs for document types Radiology (by body region) – Head, neck, chest, abdomen, … (by modality) – X-ray, CT, Ultrasound, Scans, … Documents (by subject) – cardiology, ob-gyn, heme-onc, surgery, internal medicine, … (by setting) – inpatient, ambulatory, home care, SNF, …

Roll-up in decision support

Body weight

Body height

Blood pressure

Basis for queries

“ All surgery notes”

“ All head x-ray reports”

“ All hematology lab results”

Control of data access

Tabs for document types

Radiology

(by body region) – Head, neck, chest, abdomen, …

(by modality) – X-ray, CT, Ultrasound, Scans, …

Documents

(by subject) – cardiology, ob-gyn, heme-onc, surgery, internal medicine, …

(by setting) – inpatient, ambulatory, home care, SNF, …

Consultation Note Example 11488-4 Consultation note Find Pt {Setting} Doc {Provider} 34100-8 Consultation note Find Pt Critical care unit Doc {Provider} 34101-6 Consultation note Find Pt Outpatient Doc {Provider} 34101-6 Consultation note Find Pt Outpatient Doc General medicine 34749-2 Consultation note Find Pt Outpatient Doc Anesthesia 34104-0 Consultation note Find Pt Hospital Doc {Provider} 34102-4 Consultation note Find Pt Hospital Doc Psychiatry NewCD Consultation note Find Pt {Setting} Doc Internal medicine 34764-1 Consultation note Find Pt {Setting} Doc General Medicine 34776-5 Consultation note Find Pt {Setting} Doc Gerontology 34781-5 Consultation note Find Pt {Setting} Doc Infect. Disease 34795-5 Consultation note Find Pt {Setting} Doc Nephrology 34797-1 Consultation note Find Pt {Setting} Doc Neurology

11488-4 Consultation note Find Pt {Setting} Doc {Provider}

34100-8 Consultation note Find Pt Critical care unit Doc {Provider}

34101-6 Consultation note Find Pt Outpatient Doc {Provider}

34101-6 Consultation note Find Pt Outpatient Doc General medicine

34749-2 Consultation note Find Pt Outpatient Doc Anesthesia

34104-0 Consultation note Find Pt Hospital Doc {Provider}

34102-4 Consultation note Find Pt Hospital Doc Psychiatry

NewCD Consultation note Find Pt {Setting} Doc Internal medicine

34764-1 Consultation note Find Pt {Setting} Doc General Medicine

34776-5 Consultation note Find Pt {Setting} Doc Gerontology

34781-5 Consultation note Find Pt {Setting} Doc Infect. Disease

34795-5 Consultation note Find Pt {Setting} Doc Nephrology

34797-1 Consultation note Find Pt {Setting} Doc Neurology

Outline LOINC background and goals LOINC structure and content Clinical LOINC Examples Attachments Context specific hierarchies Collections

LOINC background and goals

LOINC structure and content

Clinical LOINC

Examples

Attachments

Context specific hierarchies

Collections

Issues related to “collections” Two “kinds” of items within LOINC Individual measurements/observations/data elements Collections of measurements/observations/data elements Different codes for orders versus results? Different codes for narrative vs nominal? Medication history – paragraph versus coded list Want to have a single code to get all medication history Two kinds of “collections” but different things Panels (known explicit content) Vital Signs, ABGs, CBC, Chem 7 panel (known explicit content) Documents (vague or abstract content) Operative note, discharge summary, consult Bone marrow exam – text table of discreet data Separate codes for: rtf, Word, pdf, scanned images?

Two “kinds” of items within LOINC

Individual measurements/observations/data elements

Collections of measurements/observations/data elements

Different codes for orders versus results?

Different codes for narrative vs nominal?

Medication history – paragraph versus coded list

Want to have a single code to get all medication history

Two kinds of “collections” but different things

Panels (known explicit content)

Vital Signs, ABGs, CBC, Chem 7 panel (known explicit content)

Documents (vague or abstract content)

Operative note, discharge summary, consult

Bone marrow exam – text table of discreet data

Separate codes for: rtf, Word, pdf, scanned images?

Proposed stragegy For individual measurements Continue to create codes that distinguish between character identifiers, strings, codes, dates, numbers Create generic parents as needed, relate parent to children using new hierarchies For collections Continue to distinguish panels (explicit list of contained elements) from documents (ill defined or vague contents) For documents, do not make distinct names based on narrative, nominal, pdf, Word, scanned image Use the same codes for orders as for results Just a code for “hematocrit”, no code for “hematocrit order” or “hematocrit result” Use context to complete the meaning

For individual measurements

Continue to create codes that distinguish between character identifiers, strings, codes, dates, numbers

Create generic parents as needed, relate parent to children using new hierarchies

For collections

Continue to distinguish panels (explicit list of contained elements) from documents (ill defined or vague contents)

For documents, do not make distinct names based on narrative, nominal, pdf, Word, scanned image

Use the same codes for orders as for results

Just a code for “hematocrit”, no code for “hematocrit order” or “hematocrit result”

Use context to complete the meaning

Literature References McDonald CJ, Huff SM, etal. LOINC® a universal standard for identifying laboratory observations – a 5-year Update . Clinical Chemistry , 2003 Huff SM, Rocha RA, McDonald CJ, De Moor GJE, etal. Development of the LOINC ® (Logical Observation Identifier Names and Codes) Vocabulary. Journal of American Medical Informatics Association , 1998, 5:276-292. Dolin RH, Huff SM, Rocha RA, Spackman KA, Campbell, KE. Evaluation of a “Lexically Assign, Logically Refine”Strategy for Semi-Automated Integration of Overlapping Terminologies. Journal of American Medical Informatics Association , 1998, 5 : 203-213. Forrey AW, McDonald CJ, DeMoor G, Huff SM , Leavelle D, Leland Fiers DT, Charles L, Griffin B, Stalling F, Tullis A, Hutchins K, Baenziger J. Logical Observation Identifier Names and Codes (LOINC) Database: A public use set of codes and names for electronic reporting of clinical laboratory test results . Clinical Chemistry , 1995.

McDonald CJ, Huff SM, etal. LOINC® a universal standard for identifying laboratory observations – a 5-year Update . Clinical Chemistry , 2003

Huff SM, Rocha RA, McDonald CJ, De Moor GJE, etal. Development of the LOINC ® (Logical Observation Identifier Names and Codes) Vocabulary. Journal of American Medical Informatics Association , 1998, 5:276-292.

Dolin RH, Huff SM, Rocha RA, Spackman KA, Campbell, KE. Evaluation of a “Lexically Assign, Logically Refine”Strategy for Semi-Automated Integration of Overlapping Terminologies. Journal of American Medical Informatics Association , 1998, 5 : 203-213.

Forrey AW, McDonald CJ, DeMoor G, Huff SM , Leavelle D, Leland Fiers DT, Charles L, Griffin B, Stalling F, Tullis A, Hutchins K, Baenziger J. Logical Observation Identifier Names and Codes (LOINC) Database: A public use set of codes and names for electronic reporting of clinical laboratory test results . Clinical Chemistry , 1995.