2010 06 07 - LOINC Introduction
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  • 1. Public Laboratory LOINC Workshop and Committee Meeting Overview and Introduction to LOINC a universal catalog of clinical observations Daniel J. Vreeman, PT, DPT, MSc Assistant Research Professor, Indiana University School of Medicine Associate Director of Terminology Services, Regenstrief Institute, Inc 06.07.2010 Copyright © 2010
  • 2. Overview •  Origins of LOINC –  Background, growth, and participation •  The LOINC Community –  Growth and adoption successes
  • 3. Origins of LOINC The lingua franca of clinical observation exchange
  • 4. Introduction •  Regenstrief’s 35-year history •  Indiana Network for Patient Care –  A working HIE for 15 years –  200+ source systems –  10.5 million patients, 3 billion results –  Regenstrief: 3rd party convener •  A fundamental challenge –  Local systems use idiosyncratic codes •  Vocabulary standards –  Provide the lingua franca of information exchange
  • 5. Indiana Network for Patient Care
  • 6. LOINC Background •  Logical Observation Identifiers Names and Codes •  Organized by Regenstrief Institute in 1994 –  Ongoing support from NLM and Regenstrief •  Covers domain of Clinical Observations –  Laboratory Observations (since 1995) –  Clinical Observations (since 1996) •  A universal code system that facilitates exchange, pooling, and processing of results
  • 7. 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
  • 8. Indiana Network for Patient Care HL7 v.2.X Message MSH|^~&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay||||||||||||||| LocalCode^LocalName^CodeSystem^LOINCcode^LOINCname^CodeSystem PID|||$patientId$||$patientName$|||||||||||||||||||| PV1|||||||$attendingDoctor$||$consultingDoctor$|||||||| OBR|1|||012^CBC/Auto Diff^HSPA^57021-8^CBC W Auto Diff^LN||$reqDate||||||||| OBX|2|ST|123^WBC^HSP_A^26464-8^Leukocytes [#/volume] in Blood^LN||10.8|K/MM3|||||F| OBX|3|ST|234^RBC^HSP_A^26453-1^Erythrocytes [#/volume] in Blood^LN||4.82|MIL/MM3|||||F| OBX|4|ST|345^HGB^HSP_A^718-7^Hemoglobin [Mass/volume] in Blood^LN||15.7|GM/DL|||||F| OBX|5|CE|456^HCT^HSP_A^20570-8^Hematocrit [Volume Fraction] of Blood^LN||45|%|||||||F| A   A  
  • 9. 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
  • 10. 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  Ophthalmology Measurements  Clinical Documents  Patient Assessment Instruments  Document Sections  Radiology Reports
  • 11. The LOINC Community Open, Nimble, Pragmatic
  • 12. A Highly ‘Open Source’ Model •  LOINC (the database) and RELMA (the mapping program) are available freely worldwide for nearly any purpose •  Much work is done by volunteers •  Content additions are end-user driven
  • 13. LOINC codes over time by release 70,000 LOINC Codes Lab Codes 60,000 Slope = 2200 50,000 40,000 Slope = 600 30,000 20,000 Laboratory  terms  only  (estimate)   10,000 data  prior  to  2000  not  available   0
  • 14. loinc.org members 8000   7000   6000   5000   4000   3000   10 new members per day 2000   300+ new members per month 1000   0  
  • 15. 7255+ users in 131 countries
  • 16. Downloads: ~1100/month
  • 17. http://loinc.org/websearch (alpha)
  • 18. ~ 87 Organizations Listed
  • 19. International Adoption Submissions, Translations, Implementations
  • 20. Submissions 2009 05 to 2010 04 Since 2003 organizations 43 … 125+ organizations
  • 21. Translation Efforts
  • 22. Existing Translations •  Spanish –  BiTAC (Spain); 39,000 terms –  Conceptum Medical Terminology Center; 38,000 terms, Users’ Guide –  Mexican Institute of Social Security; Users’ Guide •  French –  Canada Health Infoway; 38,000 terms •  pan Canadian Laboratory Observation Code Database (pCLOCD) –  Société Française d'Informatique de Laboratoires; 4,400 terms •  Simplified Chinese –  Bethune International Peace Hospital; 38,000 terms, Users’ Guide, tutorial •  Korean –  Korean Ministry for Health, Welfare and Family Affairs; 27,000 terms
  • 23. Existing Translations •  German –  DIMDI; Companion website, Users’ Guide •  Estonian –  Estonian LOINC working group of the Estonian Society for Clinical Chemistry; Users’ Guide, Tutorial •  Portuguese –  Brazilian Federal Agency for Health Plans and Insurance, Brazilian Clinical Analysis Society, Brazilian Clinical Pathology Society, and Diagnóstico das Américas (DASA); 2,800 terms •  German, French, Italian, Spanish –  CUMUL (Switzerland); 5000 common terms
  • 24. In-progress Translations •  French: Assistance Publique-Paris Hospitals PMID: 18999107 •  Estonian: University of Tartu; Lab terms •  Dutch: SKML (the Dutch Foundation for Quality Assessment in Medical Laboratories); Lab terms •  Catalan: BiTAC; Lab terms •  Russian: Donetsk National Medical University, corTTex •  German: DIMDI; lab terms •  Italian: HL7 Italia; lab terms •  Greek: Efstratia Kontaxi; Top 300 lab orders
  • 25. French!
  • 26. Large-scale Implementations •  SIGA Saúde project- São Paulo city, Brazil –  25+ million lab tests per year •  Canada (with Canada Health Infoway) –  Electronic Child Health Network (Ontario) •  100+ hospitals, community centers, offices –  Ontario Laboratories Information System •  Phase I: 4 hospitals + 3 reference labs •  European Patients Smart Open Services –  European-wide large pilot of patient summaries and e-prescriptions
  • 27. Large-scale Implementations •  Assistance publique - Hôpitaux de Paris –  44 hospitals, largest system in Europe •  Spanish Adoption –  Red Agrolab •  Network of 49 labs in Spain •  Quality, food safety, and animal health –  Many regional HIE’s via BiTAC •  Hong Kong Hospital Authority –  41 hospitals, 48 specialty clinics, 16 clinical laboratories
  • 28. US Adoption A few key highlights
  • 29. Consolidated Health Informatics •  CHI Goal: –  Adopting interoperability standards for all federal health agencies •  Adopted LOINC as standard –  Laboratory result names (2003) –  Laboratory test order names (2006) –  Meds: structured product labeling sections (2006) –  Federally-required patient assessment instruments with functioning and disability content (2007)
  • 30. Other Key US Adoptions •  HITSP –  C80: vital signs, lab results, lab orders, genetic results, other results –  C83: Patient assessment instruments (sections, questions, answers) –  IS92: newborn screening •  eLINCS –  Messaging 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 by 90% of US health plans to measure quality
  • 31. Other Key US Adoptions •  HL7 – many implementation guides, CDA, etc •  HIPAA Claims Attachments •  Many Regional HIEs –  Maine Health InfoNet –  Florida Health Information Network –  Vermont Information Technology Leaders •  Many large care delivery organizations –  Intermountain Healthcare, Kaiser Permanente •  Insurance Companies –  UnitedHealth Group, Anthem, etc
  • 32. EHR “Meaningful Use” •  Health Information Technology for Economic and Clinical Health Act (HITECH Act) in ARRA •  CMS authorized to give reimbursement incentives for eligible providers/hospitals who become “meaningful users” of certified EHR technology •  LOINC chosen as standard for Lab Results –  Phase I: when received from lab and for patient summaries –  Phase II: LOINC