Public Laboratory LOINC Workshop and Committee Meeting




 Overview and Introduction to LOINC
        a universal catalog...
Overview
•  Origins of LOINC
  –  Background, growth, and participation
•  The LOINC Community
  –  Growth and adoption su...
Origins of LOINC
The lingua franca of clinical observation exchange
Introduction
•  Regenstrief’s 35-year history
•  Indiana Network for Patient Care
   –    A working HIE for 15 years
   – ...
Indiana Network for Patient Care
LOINC Background
•  Logical Observation Identifiers Names and Codes
•  Organized by Regenstrief Institute in 1994
  –  Ong...
LOINC’s General Role
•  If an observation is a question, and the
   observation value an answer:
   –  LOINC provides code...
Indiana Network for Patient Care
   HL7 v.2.X Message
MSH|^~&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay|||||||||||||||
...
Laboratory LOINC
 Chemistry                      Allergy Testing
 Urinalysis                     Blood Bank
 Toxicology   ...
Clinical LOINC
 Vital Signs                       EKG
 Hemodynamic Measurements          Cardiac Ultrasound
 Fluid Intake/...
The LOINC Community
Open, Nimble, Pragmatic
A Highly ‘Open Source’ Model
•  LOINC (the database) and RELMA (the
   mapping program) are available freely
   worldwide ...
LOINC codes over time by release
70,000
          LOINC Codes
          Lab Codes
60,000


                               ...
loinc.org members
8000	
  

7000	
  

6000	
  

5000	
  

4000	
  

3000	
  
              10 new members per day
2000	
  ...
7255+ users in 131 countries
Downloads:   ~1100/month
http://loinc.org/websearch   (alpha)
~ 87 Organizations Listed
International Adoption
Submissions, Translations, Implementations
Submissions 2009 05 to 2010 04




    Since 2003 organizations
            43 … 125+ organizations
Translation Efforts
Existing Translations
•  Spanish
   –  BiTAC (Spain); 39,000 terms
   –  Conceptum Medical Terminology Center; 38,000 term...
Existing Translations
•  German
  –  DIMDI; Companion website, Users’ Guide
•  Estonian
  –  Estonian LOINC working group ...
In-progress Translations
•  French: Assistance Publique-Paris Hospitals
   PMID: 18999107
•  Estonian: University of Tartu...
French!
Large-scale Implementations
•  SIGA Saúde project- São Paulo city, Brazil
  –  25+ million lab tests per year
•  Canada (w...
Large-scale Implementations
•  Assistance publique - Hôpitaux de Paris
  –  44 hospitals, largest system in Europe
•  Span...
US Adoption
A few key highlights
Consolidated Health Informatics
•  CHI Goal:
  –  Adopting interoperability standards for all federal
     health agencies...
Other Key US Adoptions
•  HITSP
  –  C80: vital signs, lab results, lab orders, genetic results, other results
  –  C83: P...
Other Key US Adoptions
•  HL7 – many implementation guides, CDA, etc
•  HIPAA Claims Attachments
•  Many Regional HIEs
  –...
EHR “Meaningful Use”
•  Health Information Technology for Economic
   and Clinical Health Act (HITECH Act) in ARRA
•  CMS ...
2010 06 07 - LOINC Introduction
2010 06 07 - LOINC Introduction
2010 06 07 - LOINC Introduction
2010 06 07 - LOINC Introduction
2010 06 07 - LOINC Introduction
2010 06 07 - LOINC Introduction
2010 06 07 - LOINC Introduction
2010 06 07 - LOINC Introduction
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2010 06 07 - LOINC Introduction

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2010 06 07 - LOINC Introduction

  1. 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. 2. Overview •  Origins of LOINC –  Background, growth, and participation •  The LOINC Community –  Growth and adoption successes
  3. 3. Origins of LOINC The lingua franca of clinical observation exchange
  4. 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. 5. Indiana Network for Patient Care
  6. 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. 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. 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. 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. 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. 11. The LOINC Community Open, Nimble, Pragmatic
  12. 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. 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. 14. loinc.org members 8000   7000   6000   5000   4000   3000   10 new members per day 2000   300+ new members per month 1000   0  
  15. 15. 7255+ users in 131 countries
  16. 16. Downloads: ~1100/month
  17. 17. http://loinc.org/websearch (alpha)
  18. 18. ~ 87 Organizations Listed
  19. 19. International Adoption Submissions, Translations, Implementations
  20. 20. Submissions 2009 05 to 2010 04 Since 2003 organizations 43 … 125+ organizations
  21. 21. Translation Efforts
  22. 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. 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. 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. 25. French!
  26. 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. 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. 28. US Adoption A few key highlights
  29. 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. 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. 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. 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
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