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2009 12 17 - LOINC and RELMA Introduction - CDC Vocab Team
 

2009 12 17 - LOINC and RELMA Introduction - CDC Vocab Team

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  • The Regenstrief Institute has over 30 years of experience aggregating, storing, and processing electronic health information. The original Regenstrief Medical Record system developed in the early 70’s now forms the core of a community and state-wide health information exchange called the INPC. Currently, more than 100 different source systems contribute data to the INPC, including data from all 5 major health systems in Indianapolis. A fundamental challenge for us and others who integrate data within and among systems is that local systems have idiosyncratic ways of identifying similar concepts. In response to this challenge, Regenstrief investigators pioneered the development of LOINC, a universal code system for laboratory and other clinical observations. When local system terms are mapped to a common vocabulary like LOINC, LOINC can serve as the lingua franca for information exchange, as it does in our network. As we continue integrating sources into the INPC and distributing their content throughout the network, we hope to combat the common problem of important clinical results like lab tests and radiology being unavailable when and where they are needed.
  • In response to this challenge, Regenstrief investigators pioneered the development of LOINC, a universal code system for laboratory and other clinical observations. When local system terms are mapped to LOINC, LOINC can serve as the lingua franca for information exchange, as it does in our network. As these sources are integrated and their content distributed throughout the network, we hope to combat the common problem that clinical data are often unavailable when and where they are needed.
  • Total PHQ-9 Score of 11 = Moderate Depression
  • Total PHQ-9 Score of 11 = Moderate Depression
  • Highlight Code from rest of name Normal results vary, but in general are: Male: 13.8 to 17.2 gm/dL Female: 12.1 to 15.1 gm/dL
  • 2001-2004:Slope = 600 2004-2007:Slope = 2200
  • LOINC Axes What a Challenge Is.
  • co
  • Example properties: mass rate (MRAT) – g/24h, substance rate (SRAT) – mol/24h
  • SPM (specimen) segment of HL7

2009 12 17 - LOINC and RELMA Introduction - CDC Vocab Team 2009 12 17 - LOINC and RELMA Introduction - CDC Vocab Team Presentation Transcript

  • CDC  Vocabulary  Team  Meeting     LOINC®  and  RELMA®   Introduction  and  Tutorial   12.17.2009   Daniel  J.  Vreeman,  PT,  DPT,  MSc   Assistant  Research  Professor   Indiana  University  School  of  Medicine   Associate  Director  of  Terminology  Services  and  Research  Scientist     Regenstrief  Institute,  Inc   http://loinc.org/slideshows   Copyright  ©  2009  
  • Overview   •  Origins  of  LOINC   –  Background,  Growth,  and  Participation   •  Successes   –  International   –  US   •  LOINC  101   –  Naming  conventions   –  Microbiology   –  Panels,  Forms,  Surveys   •  RELMA   –  Basic  searching  and  mapping   –  Hierarchies   •  Discussion  
  • Origins  of  LOINC   The  Lingua  Franca  of  Clinical   Observation  Exchange  
  • Introduction   •  Regenstrief’s  35-­‐year  history   •  The  Indiana  Network  for  Patient  Care     –  A  working  HIE  for  ~15  years   –  More  than  100  sources   –  Regenstrief:  3rd  party  convener   •  Local  systems  use  idiosyncratic  codes   •  Vocabulary  standards   –  LOINC  ®    -­‐  universal  code  system  for  clinical  observations   –  The  lingua  franca  of  information  exchange   •  Laboratory  and  Radiology  results*     –  Often  unavailable  at  the  time  of  a  clinical  visit  (6%,  4%)   –  Often  located  outside  of  their  clinical  system   *Smith  CP,  Araya-­‐Guerra  R,  Bublitz  C,  et  al.  Missing  clinical  information  during  primary  care  visits.  JAMA.  2005;293(5):565-­‐571  
  • From  whence  comes  LOINC?   • LOINC®   –  Logical  Observation  Identihiers  Names  and  Codes   –  A  universal  code  system  for  laboratory  and  other   clinical  observations   –  The  lingua  franca  of  information  exchange  for   clinical  observations   McDonald  CJ,  Huff  SM,  Suico  JG,  et  al.  LOINC,  a  universal  standard  for  identifying  laboratory  observations:  a  5-­‐year  update.  Clin  Chem.  2003;49(4):624-­‐633.  
  • Indiana Network for Patient Care HL7 v.2.X Message MSH|^~&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay||||||||||||||| PID|||$patientId$||$patientName$|||||||||||||||||||| PV1|||||||$attendingDoctor$||$consultingDoctor$|||||||| OBR|1|||CBC^CBC/Auto Diff^HSPA^57021-8^CBC W Auto Diff^LN||$reqDate||||||||| OBX|2|ST|WBC^WBC^HSP_A^26464-8^Leukocytes [#/volume] in Blood^LN||10.8|K/MM3|||||F| OBX|3|ST|RBC^RBC^HSP_A^26453-1^Erythrocytes [#/volume] in Blood^LN||4.82|MIL/MM3|||||F| OBX|4|ST|HGB^HGB^HSP_A^718-7^Hemoglobin [Mass/volume] in Blood^LN||15.7|GM/DL|||||F| OBX|5|CE|HCT^HCT^HSP_A^20570-8^Hematocrit [Volume Fraction] of Blood^LN||45|%|||||||F| A A
  • Indiana Network for Patient Care HL7 v.2.X Message MSH|^~&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay||||||||||||||| PID|||$patientId$||$patientName$|||||||||||||||||||| PV1|||||||$attendingDoctor$||$consultingDoctor$|||||||| OBR|1|||44249-1^PHQ-9 Quick Depression Assessment Pnl^LN||$requestDate||||||||| OBX|1|ST|44250-9^Little interest or pleasure in doing things:Find:Pt:^Patient:Ord:Reported.PHQ-9^LN| 1|3^More than half the days^Pfizer^LA6570-1^More than half the days^LN||||||||||||| OBX|2|ST|44255-8^Feeling down, depressed, or hopeless^LN|1|2^Several days^Pfizer^LA6569-3^Several days^LN||||||||||||| … OBX|10|ST|44261-6^PHQ-9 Total Score^LN|1|11||||||||||||| A A
  • LOINC  Purpose   To  facilitate  the  exchange  and  pooling  of  results  for  clinical   care,  outcomes  management,  and  research   •  Specihically,  to  provide  a  universal  ID  for   the  OBX-­‐3  hield  in  HL7  ORU  messages   •  LOINC  codes  “questions”,  not  answers   – Orders/Panels  (OBR-­‐4)   – Questions  (OBX-­‐3)   – NOT  Values  (OBX-­‐5)   • Numbers,  organisms  (E.  coli)   McDonald  CJ,  Huff  SM,  Suico  JG,  et  al.  LOINC,  a  universal  standard  for  identifying  laboratory  observations:  a  5-­‐year  update.  Clin  Chem.  2003;49(4):624-­‐633.  
  • LOINC’s  General  Role   •  If  an  observation  is  a  question,  and  the  observation   value  an  answer:   –  LOINC  provides  codes  for  the  questions  {OBR-­4,  OBX-­3}   –  Other  systems  (eg  SNOMED)  provide  codes  for  the  answers   What  is  my  patient’s  hemoglobin  level?   718-­‐7:Hemoglobin:MCnc:Pt:Bld:Qn   How  fast  does  my  patient  usually  walk?   41959-­‐8:Walking  speed:Vel:1W^mean:^Patient:Qn:Calculated  
  • LOINC  Background   •  Organized  by  Regenstrief  Institute  in  1994   –  Ongoing  support  from  NLM  and  Regenstrief   –  Guided  by  the  LOINC  Committee  (Lab  +  Clinical)   •  Covers  domain  of  Clinical  Observations   –  Laboratory  observations  (since  1995)   –  Clinical  observations  (since  1996)   •  LOINC  development  is  a  highly  ‘open  source’  model   –  Open,  nimble,  pragmatic   –  LOINC  and  RELMA  program  are  freely  available   –  Much  work  is  done  by  volunteers   –  Additions  to  the  database  are  end-­‐user  driven  
  • LOINC  Submissions  2003-­2008   67  Organizations,  13  Countries  
  • Laboratory  LOINC    Chemistry    Allergy  Testing    Urinalysis    Blood  Bank    Toxicology    Cell  Markers    Hematology    Skin  Tests    Microbiology    Coagulation    Antibiotic  Susceptibilities    Cytology    Immunology/Serology    HLA  Antigens    Molecular  Genetics    Surgical  Pathology    Cell  Counts  
  • Clinical  LOINC    Vital  Signs    EKG    Hemodynamic  Measurements    Cardiac  Ultrasound    Fluid  Intake/Output    Obstetrical  Ultrasound    Body  Measurements    Discharge  Summary    Emergency  Department  Variables      History  and  Physical    Respiratory  Therapy    Pathology  Findings    Tumor  Registry    Colonoscopy/Endoscopy    Patient  Assessment  Instruments    Clinical  Documents    Ophthalmology  Measurements    Document  Sections    Radiology  Reports    Patient  Assessment  Instruments  
  • Slope = 2200 Slope = 600
  • http://loinc.org  
  • Downloads:    875/month  
  • ~  80  Organizations  Listed  
  • Current  Initiatives/ Successes   International  and  US  Adoption  
  • International  Adoption  
  • International  Adoption   •  Brazil  –  SIGA  Saúde  lab  integration  project  in  São  Paulo  city   •  Canada  –  Adopted  by  Canada  Health  Infoway,  incorporated   into  many  efforts,  e.g.  the  eCHN  network  (province-­‐wide)   •  China  –Lab  interoperability  prohile  with  gov’t,  academic,   hospital,  and  vendor  participation   •  France  -­‐  Assistance  Publique-­‐Paris  Hospitals  (AP-­‐HP)   •  Germany  –  DIMI  produces  a  companion  LOINC  website   •  Korea  –  Support  from  Korean  Ministry  for  Health,  Welfare,   and  Family  Affairs   •  The  Netherlands  –  Dutch  National  Institute  for  ICT  in   Healthcare  has  2  mapping  efforts  underway  
  • International  Adoption   •  Spain  –  Extensive  use  in  HIE  efforts  by  BiTAC  and  others,   Red  Agrolab  network  (49  labs)  for  food  safety/animal  health   •  Mexico  –  Mexican  Institute  of  Social  Security  uses  in  more   than  850  medical  services   •  Taiwan  –  Adoption  supported  by  Department  of  Health   since  2004,  large  mapping  project  between  National  Health   Insurance  (NHI)  codes  and  LOINC   •  Europe-­wide  –  being  used  in  European  Patients  Smart  Open   Services  (epSOS)  project    
  • Translations   •  Spanish,  French,  Simplihied  Chinese,   German,  Korean,  Estonian,  Portuguese,   Italian   •  More  coming:  Catalan,  Dutch,  Russian,   Ukrainian   •  See  http://loinc.org/international  
  • Active  Translation  Efforts   16  Countries  
  • US  Adoption     a  few  recent  highlights
  • Consolidated  Health  Informatics  Initiative   •  CHI  Goal:   –  Adopting  interoperability  standards  to  enable  all  agencies   in  the  federal  health  enterprise  to  “speak  the  same   language”   •  Adopted  LOINC  as  standard   –  Laboratory  results  names  (2003)   –  Laboratory  test  order  names  (2006)   –  Medications:  Structured  Product  Labeling  Sections  (2006)   –  Federally-­‐required  assessments  with  functioning  and   disability  content  (2007)  
  • US  Federal  Agencies   •  NLM   –  Source  vocabulary  in  UMLS   –  Principal  funder  of  LOINC  development   •  VA  (Standards  and  Terminology  Service)   –  VistA  Lab  interfaces  to/from:   •  VA,  DoD,  Commercial  References  labs   •  Clinical  laboratory  automated  instruments   •  Clinical  decision  support  systems   •  Health  data  repositories/data  warehouse   – Document  Title  Ontology  
  • US  Federal  Agencies   •  DoD   –  Incorporated  into  Composite  Health  Care  System,  used  by   100+  systems  supporting  500+  hospitals  and  clinics   –  Mappings  to  LOINC  support  the  Global  Laboratory   Information  Transfer  Project  for  lab  orders/results   between  DoD,  VA,  and  commercial  labs   •  IHS   –  After  pilot  project,  now  embarking  on  ~250  facility   mapping  process   •  NCI  –  caBIG   –  Lab  portion  of  LOINC  adopted  as  caBIG  vocab  standard  
  • US  Federal  Agencies   •  CDC  (why  we’re  talking!)  –  Many  projects  underway   in  various  stages   –  Notihiable  condition  mapping   –  NHANES   –  Data  elements  in  CTSE  position  statements   –  National  immunization  program   –  CDA  IG  for  Case  Reporting   –  Inhluenza  program   –  Lab  response  network-­‐C,  -­‐B   –  NHSN   –  DEEDs  –  Release  1.0  and  1.1  
  • Other  Key  US  Adoptions   •  ARRA  “Meaningful  Use”   •  HITSP   –  C80:  vital  signs,  lab  results,  lab  orders,  genetic  results,  other  results   –  IS92:  newborn  screening   •  eLINCS   –  Standard  for  results  delivery  from  LIS  to  an  EHR   •  NAACCR   –  Volumes  II    (Data  Standards/Dictionary)  and  V  (Path  Lab  e-­‐Reporting)   •  CDISC   –  Pharmaceutical  research  specs   •  NCQA/HEDIS   –  Used  90%  of  health  plans  to  measure  quality  
  • Other  Key  US  Adoptions   •  HL7  –  many  implementation  guides,  CDA,  etc   •  HIPAA  Claims  Attachments   •  Many  Regional  HIEs   –  Indiana  Network  for  Patient  Care   –  Maine  Health  InfoNet   –  Florida  Health  Information  Network   –  Vermont  Information  Technology  Leaders   •  Many  large  care  delivery  organizations   –  Intermountain  Healthcare   –  Kaiser  Permanente  
  • LOINC  101  
  • The  LOINC  Distribution   •  Free  worldwide!   –  Copyrighted,  but  open  terms  of  use   –  Releases  ~2x/year  (June  and  December)   •  LOINC,  RELMA,  or  LOINC+RELMA   –  LOINC  Table  as  ascii  text  or  .mdb   –  RELMA   •  Easy  searching  of  LOINC   •  Helps  map  local  terms  to  LOINC   •  LOINC  Accessory  Files   –  LOINC  Panels  and  Forms   –  LOINC  Multiaxial  Hierarchy   –  LOINC  Context-­‐specihic  Hierarchy  Template  
  • 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   •  Specihic  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   -­‐  Inhluenza  A  Virus  antigen   -­‐  Cytomegalovirus  Virus  antibody   -­‐  Lipids.Total   5193-­‐8:Hepatitis  B  virus  surface  Ab:ACnc:Pt:Ser:Qn:EIA  
  • Component/Analyte  Structure   Analyte Name^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.ionized   •  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 •  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”   5193-­‐8:Hepatitis  B  virus  surface  Ab:ACnc:Pt:Ser:Qn:EIA  
  • 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 Ratio Property
  • System   The system (context) or specimen type upon which the observation was made. •  Ser  -­‐  Serum   •  Gast  –  Gastric  hluid/contents   •  Bld  -­‐  Whole  blood  (RBC)   •  Food  –  Food  or  feedstuff   •  Ur-­‐  Urine   •  Tiss  –  Tissue   •  BldA  -­‐  Arterial  blood   •  XXX  –  To  be  specihied  in   •  Liver  -­‐  Liver   another  part  of  the  message     •  Flu  –  Body  Fluid,  unspecihied   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)  
  • Method   •  Methods  only  needed  if  interpretation   affected   •  Different  normal  ranges   •  Test  Sensitivity   •  Listed  only  at  the  generic  level   •  Agglutination   •  Immunoassay   •  Probe  with  target  amplihication  
  • LOINC  “Parts”   •  Pieces  of  a  LOINC  term  name  are  called   “parts”  and  are  given  an  “LP*”  code   – E.g  “LP14635-­‐4”  is  Glucose   •  LOINC  parts  are  used  for  synonymy,   building  hierarchies,  algorithmically   creating  alternate  names,  and  attaching   descriptions  
  • Hierarchies   •  LOINC  ‘class’  attribute   •  Trees  constructed  for  the  parts  that   make  up  the  system,  component,   method  axes  (in  RELMA)   •  Multi-­‐axial  hierarchy   – Component  |  System   – Available  as  separate  download  
  • Microbiology  Basics   An  inherently  complex  result  structure   Local  HIE  experience:  very  challenging,  systems  don’t  follow  HL7  guidelines  
  • LOINC’s  General  Approach   •  Result  Status   –  Not  a  separate  observation  or  part  of  name   –  Send  in  HL7  hield  OBR-­‐25   •  Specimen  Type   –  Send  in  HL7  hield  OBR-­‐15   –  May  also  be  part  of  name   •  Details  of  Specimen  Collection   –  Usually  sent  as  OBX  segments  or  comments   under  culture  results  
  • LOINC’s  General  Approach   •  Culture  growth  descriptions  and   measurement   –  Sent  as  separate  OBX  segments   –  E.g  a  qn  test  of  bacteria  in  a  specimen:   •  564-­‐5:Colony  count:Num:Pt:XXX:Qn:VC   •  Gram  stain  hindings   –  Sent  as  separate  OBX  segments   –  664-­‐3:Microscopic  observation:Prid:Pt:   XXX:Nom:Gram  stain    
  • Organisms  Identihied  in  a  Culture   •  Sent  as  results  in  OBX  segments   –  Coding  organisms  with  SNOMED  is  good   •  Example  name  of  culture  results   –  6463-­‐4:Bacteria  identihied:Prid:Pt:  XXX  Nom:Culture     •  Example  names  of  methods  of  staining   directly  on  a  sample/material   –  664-­‐3:Microscopic  observation:Prid:Pt:   XXX:Nom:Gram  stain    
  • Organisms  Identihied  in  a  Culture   •  Names  for  results  of  staining  procedures  on   organisms  growing  in  culture  –  use  Isolate   as  system   –  613-­‐0:Fungus  identihied:Prid:Pt    Isolate:Nom:Fungal  subtyping     •  Names  for  organism-­‐specihic  cultures   –  557-­‐9:Chlamydia  sp  identihied:Prid:Pt:  Genital:Nom:Organism  specihic  culture  
  • Other  Notes  on  LOINC  Property   •  Presence  or  Identity  (Prid)  with   Nominal  (Nom)  Scale   –  Should  be  used  when  the  value  of  a  test  can   come  from  a  taxonomy  or  spectrum  of  possible   species/subspecies   •  Arbitrary  Concentration  (Acnc)  with   Ordinal  (Ord)  Scale   –  For  when  the  answer  is  positive/negative  or   yes/no  
  • Antimicrobial  Susceptibilities     Class  =  ABXBACT •  Named  with  generic  name  of  drug,  Property  of   susceptibility  (Susc),  and  appropriate  method,  scale   •  Example  E-­‐tests:   •  Special  Scale:  OrdQn   •  Observations  reported  as  resistant,  intermediate,   susceptible,  or  as  mm  diameter  of  inhibition  zone   •  Difhicult  for  some  systems  to  implement  OBX  sub   IDs  and  links  back  to  parent  culture  battery    
  • Panels,  Forms,  and  Patient   Assessment  Instruments  
  • Standard  Panels  in   LOINC  
  • Panels  (Batteries)  in  LOINC   •  Panel  term  linked  to  enumerated  child  elements   –  Child  elements  can  be  panels  themselves  (nesting)   •  Panel  term  names  (under  discussion)   –  Component    often  have  “panel”,  include  authoritative  source   –  Property    typically  “-­‐”  because  child  elements  will  vary   –  Scale    typically  “-­‐”  because  child  elements  will  vary   –  Class    PANEL.*   •  Child  elements  linked  and  identihied  as:   –  Required  (R)    Element  always  reported  with  panel   –  Optional  (O)    Element  may  not  be  reported  depending  on        institutional  policies  or  capabilities   –  Conditional  (C)  Element  is  a  key  hinding  and  thus  should  be        assumed  to  be  negative,  absent,  or  not  present  if        panel  result  does  not  include  data  for  this  element.  
  • Example  Panel  
  • Clinical  Panels  
  • Example  Panel  
  • Patient  Assessment   Instruments   Iterative  Enhancement  of  the  Panel  Model  
  • Introduction   •  Survey  instruments  have  psychometric  properties   •  Question  meaning  tightly  coupled  with  answers   •  With  experience  in  modeling  instruments  from   various  domains,  we  uncovered  additional   relevant  attributes  to  store   General Aim: LOINC could serve as the “master question file” in this domain
  • What’s  in  the  Master  Question  File?   •  Question  (item)  name/text   –  Exact  question  text,  form-­‐specihic  display  name   •  Data  type   •  Description  and/or  help  text   •  For  numeric  values:  units  of  measure,  range  checks     •  For  categorical  results:  answers  in  an  answer  list   •  Required  item  (Y/N)   •  Cardinality  (more  than  one  answer  allowed)   •  Copyright  and  terms-­‐of-­‐use  notices   •  Skip  logic   •  Consistency/data  integrity  logic   •  …  and  more    
  • Future:  URL  for  value  set  where   appropriate…e.g.  PHIN  VADS  
  • Advantages  of  the  Master  Catalog   •  Single  database  (LOINC)  contains  the  details  about   individual  observations  and  sets   –  In  the  database,  all  forms  (sets)  look  the  same   –  Automatic  standardization   –  Data  collection  and  other  programs  can  be  built  upon  a   common  data  model   •  Can  easily  reuse  observations  (and  attributes)  in   different  forms/sets  
  • Rules  for  Display  of  Items   1.  SURVEY_QUEST_TEXT  (if  populated).  Used  when  item  is  asked  as  a   question.  Sometimes  the  item  has  a  label  and  a  question,  so  we   store  both  as  [label].[question  text]   Pain Presence. Ask resident: “Have you had pain or hurting at any time in the last 7 days?” 2.  DISPLAY_NAME_FOR_FORM  (if  populated).  Provides  an  override   display  linked  to  the  instance  of  the  LOINC  in  a  particular  form.   Allows  for  presentation  variation  that  doesn’t  affect  meaning  and   for  where  the  LOINC  naming  conventions  require  some  difference   b/w  the  item  and  the  LOINC  Component.   Item label = “Body Mass Index (BMI)” LOINC Component = “Body mass index” 3.  COMPONENT.  This  is  the  default  display  
  • Currently  in  LOINC   •  US  Government  Forms   –  CARE,  MDSv2,  MDSv3,  OASIS,  RFC   –  US  Surgeon  General’s  Family  Health  Portrait   •  Geriatric  Depression  Scale   •  HIV  Signs  and  Symptoms  Checklist   •  Home  Health  Care  Classihication   •  howRU   •  OMAHA   •  PHQ  (9  and  2)  
  • Many  Other  Potential  Opportunities   •  Mental  health  instruments   •  Lots  of  other  commonly-­‐used   instruments  (SF-­‐36,  etc)   •  AHRQ  Common  Framework  forms   •  CDC  case  report  forms   •  PhenX  protocols  for  clinical  research   trials  
  • Intellectual  Property  Issues   •  Must  negotiate  separate  agreements  with  each   copyright/IP  holder   •  Many  instruments  are  hiercely  protected   –  Protection  against  change  and  attribution  are   understandable   –  Some  want  royalties   –  Commercial  use  in  LOINC’s  context  is  tricky   •  Even  more  complicated  when  several   instruments  included  in  larger  CMS  ones  (MDS,   CARE,  etc)  
  • RELMA®   Regenstrief  LOINC  Mapping  Assistant   (some  screen  shots  from  v4.2  that  will  be  out  soon)  
  • RELMA   •  Browse  LOINC   – Restrict  based  on  hierarchies   – Flexible  searching   •  Map  local  codes  to  LOINC   – Start  with  local  codes  from  master  hile  or   HL7  messages   • Include  sample  data,  units,  categories   • Mass  translations   • Propose  new  LOINC  codes  based  on  old  ones   • Export  mapped  terms  
  • Welcome  Screen  
  • Simple  Search  Screen  
  •   Panels,  Forms,  and  Surveys  Browser Clinical  Panels  
  • Mapping  Screen   View  or  edit  local  term   Quick  select  button  list   Custom  Grid  Conhiguration  
  • Standard  Mapping  Screen   Navigate  through   the  local  terms  
  • Standard  Mapping  Screen   Clear  all  input   hields  
  • Tabbed  Access  to  Functions   Navigate  to  Functions  from   Mapping  Page   Switch  between  Grid  and   Tree  Views  
  • Tree  View  
  • Common  Grid  Result  Functions   Right  clicking  on  a  LOINC  term   brings  up  a  Task  Menu  
  • LOINC  Term  Details   Change  to  expanded  or   custom  details  view    
  • Customizing  the  Details  View  
  • Details  View  for  a  Panel  -­‐  Hierarchy  
  • Details  View  for  a  Panel  –  Summary  for  Child  Elements  
  • Conhigure  Export  Options  for  Grid   Output  Options   Include     column  headers   Save  Conhiguration/Export  
  • Excel  Export  Format  
  • Setting  Search  Limits  in  RELMA   •  Narrows  search  to  subsets  of  LOINC  terms   –  Reduces  number  of  candidate  terms   •  Component  attribute  can  be  further  restricted   by  number  of  words   •  Tree  structure  allows  for  hierarchical   constraints  
  • Setting  Search  Limits   Click  Hierarchy  &  Search   Limits  Tab  
  • 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”   Predehined,  general  search   constraints  
  • Component  Hierarchy   Show  the  LOINC  Codes   associated  with  these   Components  
  • Show  Associated  LOINCs   Click  on  details  for  more   information  about  the   selection  
  • Details  Screen  –  LOINC  Part  
  • Discussion  
  • Context-­‐Specihic  Hierarchies   a  generic  model  for  user-­‐dehined  hierarchies  
  • Context  Specihic  Hierarchies   •  Generic  data  model  to  allow  local  dehinition  of   LOINC  code  hierarchies   •  Template  data  base  is  provided  with  RELMA   •  CONTEXT_SPECIFIC_HIERARCHY_TEMPLATE.mdb   •  Or  download  from  LOINC  website   •  Described  in  detail  in  RELMA  User’s  Manual   •  Hierarchies  can  be  displayed  (only)  in  RELMA   •  Codes  may  come  from  multiple  code  systems   •  May  share  community  contributed  hierarchies   on  LOINC  website  and/or  incorporate  into   main  LOINC  distribution  
  •   Access  Context-­‐Specihic  Hierarchies Select  Context  Specihic   Hierarchies  
  • Context  Specihic  Hierarchies