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 Using	  RELMA	  	     Or…In	  Search	  of	  the	  Missing	  LOINC	  Laboratory	  LOINC	  Meeting	  –	  December	  2010	  ...
Acknowledgements	  •  RELMA	  Development	  Team	       •    John	  Hook,	  Karen	  Ahmad,	  Mark	  Fisher,	  Craig	  Kelk...
What	  will	  we	  cover	  today?	  •    Overview	  of	  LOINC	  •    Reviewing	  new	  RELMA	  features!	  •    Installin...
Why	  are	  we	  doing	  this?	            Goals	  of	  Health	  Information	  Standards	  •  Interoperability	  –	  the	 ...
Levels	  of	  Interoperability	  •  Basic	  –	  allows	  data	  to	  be	  exchanged	  between	     computer	  systems	    ...
Comparability	  •  Meaning	  of	  the	  data	  is	  consistent	  when	  shared	     among	  different	  parJes	      •    E...
Potential	  Uses	  of	  Health	  Data	  are	  Constrained	  by	  Data	  Quality	  Factors	   •  Data	  quality	  issues	  ...
The	  Problem	  “In	  aFempJng	  to	  arrive	  at	  the	  truth,	  I	  have	  applied	     everywhere	  for	  informaJon,	...
Test	  comparisons	                                   What	  you	  see	  in	  the	  order	  list                          ...
Why	  LOINC?	   “Within	  one	  laboratory,	  local	  jargon	  terms	        may	  be	  used	  which	  are	  usually	  wel...
LOINC®	  101	       ©2010 Regenstrief Institute and James Case
Anatomy	  of	  a	  LOINC	  Term	         5193-­‐8:Hepatitis	  B	  virus	  surface	  Ab:ACnc:Pt:Ser:Qn:EIA	               5...
What	  is	  NOT	  part	  of	  a	  LOINC	  Name?	  •  The	  instrument	  used	  in	  tesJng	  •  Specific	  details	  about	...
Component/Analyte	  The	  substance	  or	  enJty	  that	  is	  measured,	              evaluated,	  or	  observed         ...
Component/Analyte	  Structure	            Analyte	  Name^Challenge^Adjustments	  •  Formal	  name	  of	  Analyte	  (e.g.	 ...
Property	                                  the	  most	  difficult	  LOINC	  axis	  The	  characterisJc	  or	  aFribute	  of	...
Property	                                 the	  most	  difficult	  LOINC	  axis	           Combine	  Major	  Categories	  wi...
Common	  Issues	  with	  LOINC	  Properties	                         FracJon	  (proporJon)	  vs.	  RaJo	                  ...
Timing*	  The	  interval	  of	  Jme	  over	  which	  the	  observaJon	  or	                     measurement	  was	  made  ...
System	  The	  system	  (context)	  or	  specimen	  type	  upon	  which	                   the	  observaJon	  was	  made. ...
Scale	  •  Qn	  -­‐	  quanJtaJve	  	       •    ConJnuous	  numeric	  (real,	  integer,	  raJo)	       •    OpJonal	  oper...
Scale	  (Special)	  •  OrdQn	  –	  Ordinal	  or	  QuanJtaJve	      •    Primarily	  used	  for	  anJmicrobial	  observaJon...
Method	  •  Methods	  only	  needed	  if	  interpretaJon	  affected	      •    Different	  normal	  ranges	      •    Test	 ...
Mapping	  Terms	  to	  LOINC	                          Things	  to	  Remember	  •  The	  thing	  ordered	  is	  not	  alwa...
What	  is	  in	  LOINC?	                         Content	  •  Term	  structures	  •  SubmiFed	  units,	  Example	  UCUM	  ...
RELMA®	  Regenstrief	  LOINC	  Mapping	  Assistant	                  ©2010 Regenstrief Institute and James Case
Purpose	  of	  Tutorial	  •    “Eliminate”	  need	  to	  read	  the	  User’s	  Manual	  •    Become	  familiar	  with	  RE...
RELMA	  Functions	  •    Manual	  and	  automated	  mapping	  assistant	  •    Same	  free	  use	  as	  LOINC	  (see	  lic...
New	  in	  This	  Version	  (Rel.	  5.0)	                                                  	  •  Search	  uses	  Lucene	  ...
New	  in	  This	  Version	  (Rel.	  5.0)	                                                 	  •  Part	  index	  -­‐	  Engli...
New	  in	  This	  Version	  (Rel.	  5.0)	                                                  	  •  ToolJps	  displayed	  for...
New	  in	  This	  Version	  (Rel.	  5.0)	                                                 	  •  When	  proposing	  new	  L...
New	  in	  Previous	  Version	  (Rel.	  4.5)                         	       Released	  after	  last	  LOINC	  meeting	  –...
LOINC	  Web	  Site	      ©2010 Regenstrief Institute and James Case
What’s	  available	  to	  download?	  •  RELMA	  -­‐	  mapping	  and	  browsing	  tool	          •    HL7	  message	  conv...
RELMA	  Highlights	  •  Browseable	  hierarchies	  of	  LOINC	  parts	  •  Display	  search	  results	  in	  tree	  view	 ...
RELMA	  Mapping	  Window	  	                         Search	  Logic	  For	  a	  given	  test:	  •  User	  can	  select	  L...
RELMA	  Logic	  Not	  	  →	  	  #<word	  A>	  Or 	  →	  	  	  	  <word	  A>	  	  |	  	  <word	  B	  >	  And	  →	  	  	  	 ...
Additional	  RELMA	  Features	  	  •  User	  Specified	  Search	  Limits	  	  •  Selectable	  trees	  for:	     •  Class	  ...
Installing RELMA®      ©2010 Regenstrief Institute and James Case
Installation	  Steps	  •  Make	  sure	  you	  have	  enough	  free	  disk	  space!	       •    2Gb	  is	  recommended	  • ...
File	  Locations	  •  Database	  and	  Ancillary	  Files	     •    Windows	  XP	  =	  C:Documents	  and	  SeMngsAll	  User...
Running RELMA®    Version 5.0    ©2010 Regenstrief Institute and James Case
Copyright	  Screen	        ©2010 Regenstrief Institute and James Case
Main	  Menu/Welcome	  Screen	                             Click	  File,	  Set	  Preferred	                                ...
Select	  Linguistic	  Variant(s)	              ©2010 Regenstrief Institute and James Case
LOINC	  Terms	  with	  Spanish	  Linguistic	  Variant	                                                                    ...
Setting	  User	  Preferences	              ©2010 Regenstrief Institute and James Case
Set	  User	  Preferences	                                               Select	  User	  Preferences     	                 ...
Set	  User	  Preference	  Dialog	                                                 New	  File	  Locations:        	        ...
User	  Map	  Screen	  Preferences	                                              Click	  Map	  Screen	  Tab	               ...
Importing	  Local	  Terms	  into	  RELMA  	          ©2010 Regenstrief Institute and James Case
4	  Ways	  to	  Load	  LMOF	  Files	  •  Direct	  entry	  into	  LMOF	  from	  within	  RELMA	  (painful)	      •    Handy...
Constructing	  a	  Local	  Dataset	  Create	  extract	  of	  your	  test	  catalog	  with:	     •    BaFery/Panel	  Code	 ...
Creating	  Delimited	  ASCII	  File	  •  RELMA	  can’t	  parse	  free	  text	      •    Need	  to	  create	  separate	  fie...
Entering	  New	  Local	  Terms	                                   	         into	  RELMA   	              ©2010 Regenstrie...
Manual	  Enter/Edit	  	                                    View/Add/Edit	  Local	  Terms	        ©2010 Regenstrief Institu...
Edit	  Term	  Dialog	                                                                          EditAddDelete	  Terms 	    ...
Export	  Local	  Term	  File	  Delimiters	  supported:         	   Tab,	  comma,	  bar	  (|)                            	 ...
Add	  Local	  Term	  MICRO!BUBPLAG!BUBONIC PLAGUE – RRT PCR!           Click	  to	  Add	  to	  Current	                   ...
Search	  Local	  Term	  File	  Calcium                          Enter	  Keyword	  from	  any	                             ...
Print	  Preview	  Local	  Term	  File	                 ©2010 Regenstrief Institute and James Case
Steps	  to	  Import	  Local	  Terms	  1.  Click	  Import Local Terms	  BuFon	  from	  Main	  Menu	  	  	      a) File>Impo...
Example	  Tab-­‐Delimited	  File	              ©2010 Regenstrief Institute and James Case
Importing	  Local	  Files	                                    Select	  Import	  Local	  Terms	                            ...
Navigate	  to	  File	  Location	                                         Select	  File	  iles	  stored	  ipen             ...
Open	  File	  in	  RELMA	                                                  Name	  your	  working	  set.	  	               ...
Open	  File	  in	  RELMA	          ©2010 Regenstrief Institute and James Case
Fields	  Segregated	                                                     Assign LMOF Attribute                            ...
Ready	  to	  Import	  Minimum	  assignments	                                                                    Now	  you	...
Post-­‐Processing	  of	  Local	  File	  •  A]er	  import,	  RELMA	  Searches	  for	  terms	     (words)	  that	  it	  does...
Local	  Term	  File	  Options	             ©2010 Regenstrief Institute and James Case
Change	  Local	  Term	  File	                                         Select	  the	  Working	  Set                        ...
Alternative	  Pragmatic	  Way	  •  Use	  large	  set	  of	  HL7	  messages	  •  AutomaJcally	  make	  dataset	  of:	      ...
Generate	  Local	  term	  jile	  from	  HL7	  messages	  	                                                    Select	  Imp...
Select	  File	  to	  Import	                                                        Select	  HL7	  File	           ©2010 R...
Specify	  HL7	  File	  Name	  and	  Sample	  Size	  Name	  the	  Local	  Term	   File	  (working	  set)  	                ...
HL7	  Messages	  Data	  Statistics	               ©2010 Regenstrief Institute and James Case
New	  Terms	  added	  to	  LMOF	  Click	  on	  “Edit	  Term”	  to	  see	            Sample	  Data    	                    ...
Sample	  Results	  for	  Observation	                                                              New	  Test	  Code	     ...
Lenny	  L’OINC	  says:	   “Load	  the	  Sample	  Files	     Into	  RELMA	  now!”	      •  Import	  the	  two	  sample	  fil...
Cleaning	  your	  data	         ©2010 Regenstrief Institute and James Case
Preparing	  your	  Data	  for	  Mapping	  •  Improve	  mapping	  success	  by:	     •  Expanding	  abbreviaJons	     •  St...
RELMA	  Cleaning	  Tools	                                                       Use	  this	  tool	  to	  edit	            ...
Review	  Unknown	  Local	  Terms	               May	  Re-­‐Scan	  File	  for	                Unknown	  Terms            	 ...
Replace	  Local	  Terms	       Assign	  LMOF	  Attribute     Replacement Options	     	             ©2010 Regenstrief Inst...
RELMA	  Cleaning	  Tools	                                                  Use	  this	  tool	  to	  make	                 ...
Term	  Substitution	  Save	  this	  global	  substitution	    for	  only	  this	  working	  set                           ...
Lenny	  L’OINC	  says:	       “Begin	  to	  clean	  your	           data	  now!”	      •  Using	  the	  OBR	  or	  OBX	  s...
Searching	  for	  LOINC	  Terms	              ©2010 Regenstrief Institute and James Case
Simplijied	  Search	                                                               	                                      ...
Search	  Window	  Enter	  Search	     Terms	  	                          New	  Feature!                         Limit	  to...
New	  RELMA	  Helpjile	         ©2010 Regenstrief Institute and James Case
Context	  Menu	  Right	  click	  to	  bring	   up	  context	  menu      	                                      ©2010 Regen...
Mapping	  Local	  Terms	           ©2010 Regenstrief Institute and James Case
Mapping	  Local	  Terms	  •  Select	  your	  Working	  Set	  to	  Map	       File>Select Local Term File to Process    • •...
Standard	  Mapping	  Window	  Features	  •  Customizable	  grid	  •  View	  details	  of	  LOINC	  term	  •  Sort	  by	  c...
Mapping	  Screen	  	                 View	  or	  edit	  local	  term	                  Enter	  local	  term	  number	  Qui...
Conjigure	  Grid	                                    Select	  elements	  to	  display	                                    ...
Quick	  choice	  buttons	   Viewing	  LOINC	  term	  detail	                                     	                 ©2010 R...
View	  Local	  Term	  Details	                                      Select	  level	  of	  detail	  to	                    ...
Select	  detail	  display	  level                                              	  Select	  level	  of	  detail	  to	      ...
Standard	  Mapping	  Screen	  Begin	  a	  search 	  (or	  hit	  “enter”) 	                                ©2010 Regenstrie...
Initial	  Mapping	  Results	                                                         EEK!	  	  What’ll	  I                ...
Initial	  Mapping	  Results	  Use	  term	     Number	  of	  LOINC	                                     Battery	  terms	  c...
Revised	  Mapping	  Results	    Match	  units	                                                   Number	  of	    selected	...
Re-­‐revised	  Mapping	  Results	                                                                         Number	  of	    ...
Standard	  Mapping	  Screen	                              CANINE DISTEMPER VIRUS IFEnter	  keywords	  here	               ...
Ad	  hoc	  term	  search	         ©2010 Regenstrief Institute and James Case
Standard	  Mapping	  Screen	          Navigate	  through	           the	  local	  terms	            ©2010 Regenstrief Inst...
Tabbed	  Access	  to	  Functions	          Navigate	  to	  Functions	           from	  Mapping	  Page  	                  ...
Tree	  View	    ©2010 Regenstrief Institute and James Case
Tree	  View	  •  Results	  displayed	  hierarchically	      •    Defined	  by	  the	  mulJ-­‐axial	  hierarchy	  in	  searc...
Tree	  View	     Can	  map	  to	  terms	                                                  Cannot	  map	  to	     with	  LO...
Assigning	  a	  LOINC	  Map	                                            Click	  “Map”	  Button	                           ...
Adding	  Mapping	  Comments	  Check with Frank in Chemistry        If	  comments	        option	  is	  selected,	         ...
Assigning	  a	  LOINC	  Map	      LOINC	  Term	       Assigned   	               ©2010 Regenstrief Institute and James Case
View	  LOINC	  Term	  Details	                                                                                        View...
LOINC	  Term	  Details	                                                           Can	  scroll	  down	  a	  single	       ...
View	  Panel	  Children	  Select	  View	  Panel	  Children	      from	  context	  menu     	                              ...
Panel	  Children	     ©2010 Regenstrief Institute and James Case
Conjigure	  Export	  Options	                              Output	  Options	                                              ...
Excel	  Export	  Format                        	         ©2010 Regenstrief Institute and James Case
More	  on	  Searching	  	   Mapping	  Screen    	         ©2010 Regenstrief Institute and James Case
Using	  Wildcards	  in	  Searches	  •  Substring	  search	  supported	  by	  default	      •    “Gluc”	  yields	  any	  te...
Other	  Search	  Qualijiers	  •  “#”	  represents	  the	  “NOT”	  operator	      •    #GLUCOSE	  –	  terms	  without	  the...
Search	  Qualijiers	                      	                        Detailed	  help	  available	    Includes	  Glucuronidas...
Combining	  Search	  Terms	                   Exclude	  Glucosidase	                                       Reduced	  numbe...
Limiting	  Searches	        ©2010 Regenstrief Institute and James Case
Setting	  Search	  Limits	  •  Narrows	  search	  to	  specific	  subset	  of	  LOINC	  terms	  •  Reduces	  number	  of	  ...
General	  Search	  Constraints	  •  Controls	  features	  including:	      •      Limit	  to	  LOINC	  terms	  compaJble	 ...
Setting	  Search	  Limits	  Click	  Hierarchy	  &	  Search	             Limits	  Tab	                                     ...
Setting	  search	  limits	  Can	  also	  set	  most	  of	  them	  by	  toggling	  buFons	                  at	  the	  boFo...
Search	  Constraints	                                                                           Attribute	  trees	        ...
Terms	  Consistent	  with	  Units	                                      Only	  terms	  consistent	                        ...
Setting	  Search	  Limits	                                              Specimen	                                         ...
Terms	  Consistent	  with	  Specimen	  	                                                               CSF                ...
Terms	  Consistent	  with	  Specimen	  	  Only	  CSF	  Terms	   are	  returned   	                             ©2010 Regen...
Setting	  Search	  Limits	  Methodless	  Terms	           Override	  Methodless	  Terms	     Restriction  	               ...
Limit	  to	  Methodless	  Terms	              ©2010 Regenstrief Institute and James Case
Limit	  to	  Methodless	  Terms	  Only	  Methodless	   Terms	  Appear 	                           ©2010 Regenstrief Instit...
More	  on	  Methodless	  Terms	  •  Some	  LOINC	  categories	  do	  not	  have	     methodless	  terms	  •  Checking	  me...
Methodless	  Only	  Unchecked	                  All	  terms	  returned	              ©2010 Regenstrief Institute and James...
Methodless	  Only	  Checked	                                                     Only	  Methodless	                       ...
Conditional	  Methodless	                                        More	  terms	                                         ret...
Setting	  Search	  Limits	                       Limit	  to	  Lab	  Tests	  Only	                                         ...
Setting	  Search	  Limits	                  Limit	  to	  lab	  tests	  that	  comprise	                      99.8%	  of	  ...
Setting	  Search	  Limits	                    Limit	  Number	  of	  Words	  in	  the	                        Component	  A...
Limit	  Number	  of	  Component	  Words	                                                               Without	  Limit	  A...
Limit	  Number	  of	  Component	  Words	                            Restriction	  appears	  on	                           ...
Setting	  Search	  Limits	            Include	  Trial,	  Deprecated	  or	           Discouraged	  LOINC	  Codes	  with	   ...
Include	  Deprecated	  LOINC	  Terms	                                                    -­‐ You	  cannot	  map	  to	     ...
Favor	  Property	  Restriction	   Favor	  one	  type	  of	  property	  over	  others      	                               ...
Order/Observation	  Restriction	  Order	  or	  Observation	       preference      	                                   ©201...
LOINC	  Hierarchies	  –	  Class	  Tree	                  Three	  top-­‐level	                     branches      	         ...
Before	  Class	  Restriction	                                                         Most	  terms	  have	  class	        ...
Search	  Trees	  CHAL                                 Restrict	  eligible	  tests	                                     to	...
Following	  Class	  Restriction	  Only	  Non-­‐Challenge	   Chemistry	  tests	          returned  	                       ...
Improvements	  to	  Trees	             Continued	  reorganization	  to	                 provide	  a	  Specimen	           ...
Improved	  Hierarchy	  for	  Component	             Click	  on	  details	  for	  more	              information	  about	  ...
Details	  Screen	  LOINC	  Part                                 	             ©2010 Regenstrief Institute and James Case
Show	  Associated	  LOINCs	            ©2010 Regenstrief Institute and James Case
Details	  Screen	  LOINC	  Term	                                               Detailed	  Information	  on	               ...
Tree	  Export	  Tools	  Export	  according	  to	    Conjiguration	  	    Conjigure	  Export	  Format	                     ...
Tree	  Export	  Conjiguration	             ©2010 Regenstrief Institute and James Case
RELMA	  -­‐	  Tree	  Features	  •  All	  trees	  operate	  the	  same	  way	  •  Shows	  terms	  spelled	  out	  •  Can	  ...
LOINC	  Part	  Search	  •  Same	  look	  as	  term	  search	  •  Uses	  “Google-­‐like”	  query	  language	     •    Extre...
Navigating	  through	  the	     Mapping	  Process    	           ©2010 Regenstrief Institute and James Case
LOINC	  Mapping	  Tactics	  •  Limit	  effort	  to	  one	  lab	  secJon	  at	  a	  Jme	  and	     focus	  experJse	  •  Che...
Vreeman	  DJ,	  Finnell	  JT,	  Overhage	  JM.	  A	  Rationale	  for	  Parsimonious	  Laboratory	  Term	               Map...
More	  LOINC	  Mapping	  Tactics	  •  Try	  using	  method-­‐less	  terms	  first	      •    Specific	  methods	  can	  be	 ...
Common	  Mapping	  Issues	  •  Locally	  Defined	  Test	  Name	  Ambiguity	       •    Reuse	  of	  local	  test	  code	  •...
Using	  your	  Mapped	  Terms	  •  Print	  results	  of	  LOINC	  Mapping	  •  Export	  to	  File	                        ...
Conjigure	  Export	  Format                            	  Context	  Sensitive	  Export	       Conjiguration	     	        ...
LMOF	  Export	  Conjiguration	  Select	  Export	  Format	                            	                                    ...
Print	  Mapped	  Terms	  from	  View/Add/                     Edit	  Menu  	                                              ...
Formatted	  Report	  Output                                	  Click	  Print	  button	  to	  output	           formatted	  ...
Custom	  Export	  Conjiguration	          Select	  the	  Format	  you	  wish	                      to	  Export  	         ...
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Picking	  the	  Intelligent	  Mapper	                                 Begin	  by	  jinding	  qualifying	                  ...
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Panels,	  Forms	  and	  Survey	  Review	                                                  Review	  Panels,	  Forms	  and	 ...
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 Access	  Context-­‐Specijic	  Hierarchies                                 Select	  Context	  Specijic	                   ...
Select	  Directory	       ©2010 Regenstrief Institute and James Case
Context	  Specijic	  Hierarchies	                                                      Locally	  dejined	                 ...
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Search	  Hints	  and	  Tips	  •  	  Keywords	  with	  zero	  frequency	  are	  ignored	      •    May	  need	  to	  rephra...
Proposing	  New	  LOINC	  Terms	              ©2010 Regenstrief Institute and James Case
Proposing	  New	  Terms	  •  Make	  sure	  the	  term	  is	  really	  needed	      •    Think	  of	  other	  names	  for	 ...
Propose	  new	  LOINC	  terms	                                                          Select	  Propose	  a	             ...
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Click	  double	  arrow	                        New!	  	  Roll	  up	                        minor	  parts!       	  ©2010 R...
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Review	  Proposed	  Terms	                                                        Choose	  whether	  to	                  ...
Submitting	  New	  Terms	  •  Must	  supply	  name,	  organizaJon,	  phone	     and	  email	  of	  submiFer	  •  Must	  se...
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Using	  LOINC	  and	  SNOMED	             Together	             ©2010 Regenstrief Institute and James Case
Where	  do	  LOINC	  and	  SNOMED	  Fit?	  Remember:	   •  LOINC	  represents	  the	  quesJon:	      •    Is	  there	  any...
2010 12 06 - LOINC Workshop
2010 12 06 - LOINC Workshop
2010 12 06 - LOINC Workshop
2010 12 06 - LOINC Workshop
2010 12 06 - LOINC Workshop
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Transcript of "2010 12 06 - LOINC Workshop"

  1. 1.  Using  RELMA     Or…In  Search  of  the  Missing  LOINC  Laboratory  LOINC  Meeting  –  December  2010   James  T.  Case  MS,  DVM,  PhD   Health  Program  Specialist,  SNOMED  CT   National  Library  of  Medicine   ©2010 Regenstrief Institute and James Case
  2. 2. Acknowledgements  •  RELMA  Development  Team   •  John  Hook,  Karen  Ahmad,  Mark  Fisher,  Craig  Kelker  •  Dan  Vreeman  •  Clem  McDonald  •  Kathy  Mercer  •  The  Lab  LOINC  CommiFee  •  Funding  Support   •  NLM,  Regenstrief  InsJtute,  NCI,  CDC   ©2010 Regenstrief Institute and James Case
  3. 3. What  will  we  cover  today?  •  Overview  of  LOINC  •  Reviewing  new  RELMA  features!  •  Installing  RELMA  •  SeMng  personal  preferences  •  Loading  a  Local  ObservaJon  File  (LMOF)  •  Searching  for  a  LOINC  Term  •  Preparing  LMOF  for  Mapping  •  Review  of  Map  Screen  FuncJons  •  SeMng  Search  Limits  •  Mapping  Local  Terms  to  LOINC  •  Viewing  LOINC  Term  Details  •  Proposing/SubmiMng  New  LOINC  Terms  •  ExporJng/PrinJng  Mapped  Terms  •  Mapping  your  own  LMOF  data     ©2010 Regenstrief Institute and James Case
  4. 4. Why  are  we  doing  this?   Goals  of  Health  Information  Standards  •  Interoperability  –  the  ability  to  exchange   informaJon  between  organizaJons  •  Comparability  –  the  ability  to  ascertain  the   equivalence  of  data  from  different  sources  •  Data  Quality  –  the  measurement  of   accessibility,  completeness,  accuracy  and   precision  (and  more)   ©2010 Regenstrief Institute and James Case
  5. 5. Levels  of  Interoperability  •  Basic  –  allows  data  to  be  exchanged  between   computer  systems   •  Word  processing  documents,  text  messages    •  Func7onal  –  describes  the  standard  syntax   (format)  of  the  data   •  Document  templates,  forms,  data  structures   •  Message  standards  •  Seman7c  –  requires  use  of  standard   vocabularies  within  the  data   ©2010 Regenstrief Institute and James Case
  6. 6. Comparability  •  Meaning  of  the  data  is  consistent  when  shared   among  different  parJes   •  Erysipelas  –  Human  skin  disease;  Streptococcus  Grp  A   •  Erysipelas  –  Animal  SepJcemia/dermaJJs;  Erysipelothrix   rhusiopathiae  •  Common  terminology  required   •  Should  work  in  the  background  •  Not  just  words   •  Codes  –  uniquely  idenJfies  terms   •  Vocabulary  –  specialized,  precise  terms  that  remove   ambiguity   •  ClassificaJon  –  groups  related  terms   ©2010 Regenstrief Institute and James Case
  7. 7. Potential  Uses  of  Health  Data  are  Constrained  by  Data  Quality  Factors   •  Data  quality  issues   •  Different  for  client  communicaJons  vs.  analysis   •  O]en  constrained  by  external  forces   •  E.g.  criteria  for  diagnosis  o]en  differs  from  the  criteria   for  reporJng   •  UnidirecJonal  effect  of  data  consolidaJon   •  Detailed   General   •  General      Detailed   ©2010 Regenstrief Institute and James Case
  8. 8. The  Problem  “In  aFempJng  to  arrive  at  the  truth,  I  have  applied   everywhere  for  informaJon,  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  quesJons…  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   ©2010 Regenstrief Institute and James Case
  9. 9. Test  comparisons   What  you  see  in  the  order  list  Lab  A   Lab  B  Test  Name:  Lyme  Disease  Serology   Test  Name:  Lyme  Disease  An7body  Measures:  B.  burgdorferi  Ab  IgG   Measures:  B.  burgdorferi  Ab  IgM  Method:  ELISA   Method:  Immune  blot  Scale:  quan7ta7ve   Scale:  qualita7ve  e.g.:  Titer  1:40   e.g.:  Posi7ve  LOINC  Code  =  5062-­‐5   LOINC  Code  =  6321-­‐4   ©2010 Regenstrief Institute and James Case
  10. 10. 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   communicaJon  with  the  outside  world.”        U.  Forsum  et  al.,  Pure  Appl.  Chem  72:555-­‐745,  2000  Proper3es  and  Units  in  the  Clinical   Laboratory  Sciences  Part  VII.    Proper3es  and  Units  in  Clinical  Microbiology   ©2010 Regenstrief Institute and James Case
  11. 11. LOINC®  101   ©2010 Regenstrief Institute and James Case
  12. 12. Anatomy  of  a  LOINC  Term   5193-­‐8:Hepatitis  B  virus  surface  Ab:ACnc:Pt:Ser:Qn:EIA   5193-­‐8   LOINC  Code  Hepa77s  B  virus  surface  Ab   Component   ACnc   Property  Measured   Pt   Timing   Ser   System   Qn   Scale   EIA   Method   There  are  six  major  LOINC  axes   ©2010 Regenstrief Institute and James Case
  13. 13. What  is  NOT  part  of  a  LOINC  Name?  •  The  instrument  used  in  tesJng  •  Specific  details  about  the  specimen  •  Priority  (e.g.  STAT)  •  Where  tesJng  was  done  •  Who  did  the  test  •  Test  interpretaJon  •  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  ObservaJon  Object   ©2010 Regenstrief Institute and James Case
  14. 14. Component/Analyte  The  substance  or  enJty  that  is  measured,   evaluated,  or  observed   -­‐  Sodium   -­‐  Glucose   -­‐  Brucella  sp.  organism   -­‐  Influenza  A  Virus  anJgen   -­‐  Cytomegalovirus  Virus  anJbody   -­‐  Lipids.Total   5193-­‐8:Hepatitis  B  virus  surface  Ab:ACnc:Pt:Ser:Qn:EIA   ©2010 Regenstrief Institute and James Case
  15. 15. 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.Free  •  Challenge  -­‐  e.g,  1H  post  100  gm  Glucose  PO   •  Two  subparts  separated  by  “post”   •  <Jme  delay>  post  <challenge  type>  •  Adjustments/correcJons   •  E.g.  Adjusted  to  pH  7.4   ©2010 Regenstrief Institute and James Case
  16. 16. Property   the  most  difficult  LOINC  axis  The  characterisJc  or  aFribute  of  the  analyte  that  is   measured,  evaluated,  or  observed  Major  Categories  •  Mass:  ObservaJons  reported  with  mass  (milligrams,  grams,  etc.)   in  the  numerator  of  their  units  of  measure  •  Substance:  ObservaJons  reported  with  moles  or  milliequivalents   in  the  numerator  of  their  units  of  measure  •  Cataly7c  ac7vity:  ObservaJons  that  report  enzymaJc  acJvity    •  Arbitrary:  Results  that  report  arbitrary  units  in  the  numerator  of   their  units  of  measure  •  Number:  Counts   5193-­‐8:Hepatitis  B  virus  surface  Ab:ACnc:Pt:Ser:Qn:EIA ©2010 Regenstrief Institute and James Case  
  17. 17. Property   the  most  difficult  LOINC  axis   Combine  Major  Categories  with  Subtypes  for  Full  Property  •  MCnc  –  mass  concentraJon  (mass/unit  vol)  •  MCnt  –  mass  content  (mass/unit  mass)  •  NCnc  –  number  concentraJon  (number/unit  vol)  •  TmStp  –  Jme  •  CCnc  –  catalyJc  concentraJon  (acJvity)  •  Prid  –  presence  or  idenJty  •  Imp  –  impression/interpretaJon  •  Find  –  subjecJve  or  objecJve  observaJon  •  Type  –  “Kind-­‐of”   5193-­‐8:Hepatitis  B  virus  surface  Ab:ACnc:Pt:Ser:Qn:EIA ©2010 Regenstrief Institute and James Case  
  18. 18. Common  Issues  with  LOINC  Properties   FracJon  (proporJon)  vs.  RaJo   a/a+b  vs.  a/b   •  FracJon  =  Part/whole   •  Number  fracJon  (NFr):    %  Eosinophils   •  Substance  fracJon  (SFr):  %  HGB  which  is  A2   •  RaJo  =  Measures  mulJple  analytes  from  the  same   system  (specimen)   •  Mass  concentraJon  raJo  -­‐  MCrto   •  e.g.,  BUN/Creat  in  urine  specimen   •  Substance  raJo-­‐SCrto   •  Urea/CreaJnine  expressed  as  mmol/L  (SI  units)   •  RelaJve  RaJo  =  Measures  from  different  systems   •  RelRto  –  mulJple  of  the  median   •  RlTm  –  Jme  from  actual  Institute and ormal  control   ©2010 Regenstrief and  n James Case
  19. 19. Timing*  The  interval  of  Jme  over  which  the  observaJon  or   measurement  was  made  •  Pt  -­‐  at  a  point  in  Jme  •  12H  -­‐  a  twelve  hour  collecJon  •  24H  -­‐  a  twenty  four  hour  collecJon   *non-­‐Pt  Jmings  are  usually  associated  with  RaJo  Property   ©2010 Regenstrief Institute and James Case
  20. 20. System  The  system  (context)  or  specimen  type  upon  which   the  observaJon  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,  “paJent”  is  the   default.  Used  to  indicated  blood  product  unit  (BPU),  a  bone   marrow  donor,  or  a  fetus.   ©2010 Regenstrief Institute and James Case
  21. 21. Scale  •  Qn  -­‐  quanJtaJve     •  ConJnuous  numeric  (real,  integer,  raJo)   •  OpJonal  operator  (>,  ≥,  ≤,  <)   •  When  assay  detecJon  limits  are  exceeded  •  Ord  -­‐  ordinal     •  a  ranked  set  of  possible  values  (1+,  2+,  3+)  •  Nom  -­‐  nominal     •  an  unranked  collecJon  of  possible  values   •  a    taxonomy  (e.g  list  of  bacteria)  •  Nar  -­‐  narraJve     •  free  text  narraJve  (e.g.,  visit  note)   ©2010 Regenstrief Institute and James Case
  22. 22. Scale  (Special)  •  OrdQn  –  Ordinal  or  QuanJtaJve   •  Primarily  used  for  anJmicrobial  observaJons  e.g.   MIC  reported  as  resistant,  intermediate,  suscepJble   or  as  the  mm  diameter  of  the  inhibiJon  zone   •  Use  is  discouraged  •  MulJ  –  structured  text  “globs”   •  e.g.  chromatography  output   •  Use  is  discouraged  •  Doc  –  Clinical  documents  •  Set  –  Clinical  aFachments  (headers)   ©2010 Regenstrief Institute and James Case
  23. 23. Method  •  Methods  only  needed  if  interpretaJon  affected   •  Different  normal  ranges   •  Test  SensiJvity/Specificity  •  Listed  only  at  the  generic  level   •  AggluJnaJon   •  Immunoassay   •  Probe  with  target  amplificaJon   ©2010 Regenstrief Institute and James Case
  24. 24. Mapping  Terms  to  LOINC   Things  to  Remember  •  The  thing  ordered  is  not  always  the  thing  measured:   •  Blood  Culture  –  live  organism(s)  idenJfied   •  VDRL  –  Treponema  pallidum  Ab   •  Urinalysis  –  lots  of  different  things  •  The  quesJon  (what  am  I  measuring?  e.g.  Glucose)  is   not  the  answer  (e.g.  90  mg/dl)   •  You  are  mapping  the  quesJon,  not  the  answer!  •  You  must  know  the  specifics  of  the  component  being   tested  for  (what  is  this  test  actually  measuring?)   ©2010 Regenstrief Institute and James Case
  25. 25. What  is  in  LOINC?   Content  •  Term  structures  •  SubmiFed  units,  Example  UCUM  units   •  aiming  toward  preferred  units  sorJng  •  Synonyms  •  Answer  lists  for  categorical    variables   (Some)  •  Text  descripJons  –  links  to  info  sources   about  individual  tests     •  Panel  structures   •  Foreign  language  translaJons     ©2010 Regenstrief Institute and James Case
  26. 26. RELMA®  Regenstrief  LOINC  Mapping  Assistant   ©2010 Regenstrief Institute and James Case
  27. 27. Purpose  of  Tutorial  •  “Eliminate”  need  to  read  the  User’s  Manual  •  Become  familiar  with  RELMA  features  •  Provide  some  insight  into  mapping  Jps/pi}alls  •  Help  begin  the  mapping  process  for  your   insJtuJon   ©2010 Regenstrief Institute and James Case
  28. 28. RELMA  Functions  •  Manual  and  automated  mapping  assistant  •  Same  free  use  as  LOINC  (see  license)  •  Comes  with  the  LOINC  files  and  indexes  •  Now  migrated  to  MS  .NET  environment.  •  RELMA  tools  transform  local  words  in  local  file   •  User  creates  file  of  local  term/name  and  codes  •  Assigns  LOINC  term  to  local  test/baFery  code  •  Context  sensiJve  hierarchies  for  local  use.   ©2010 Regenstrief Institute and James Case
  29. 29. New  in  This  Version  (Rel.  5.0)    •  Search  uses  Lucene  engine  -­‐  FAST  •  Associated  images  displayed  on  detail  page   •  Requires  acJve  internet  connecJon.        •  New  integrated  help  system  (F1  or          )   •  Limited  to  “Mapping  Screen”,  "Part  Search"   and  "LOINC  Simple  Search"  screens  •  CD-­‐ROM  distribuJon  will  no  longer  contain   the  HL7  Lint  program.       •  SJll  available  for  download  from  website.  •  InstallaJon  auto-­‐start  (no  menu  screen)           ©2010 Regenstrief Institute and James Case
  30. 30. New  in  This  Version  (Rel.  5.0)    •  Part  index  -­‐  English  language  automaJcally   installed.    •  Microso]  Data  Access  Components  (MDAC)   2.8  no  longer  installed.  •  Minimum  supported  OS:  Windows  XP  SP3.   •  Older  OS  users  noJfied  on  installaJon.  •  The  .NET  Framework  version  increased  to   version  4.0.       •  Users  will  be  prompted  to  restart  their   computer  if  not  installed   ©2010 Regenstrief Institute and James Case
  31. 31. New  in  This  Version  (Rel.  5.0)    •  ToolJps  displayed  for  deprecated,   discouraged,  and  trial  LOINCs.  •  Search  result  sort  preferences  may  be  set  in   User  Preferences  dialog.  •  Intelligent  Mapper  is  20X+  faster.     •  Default  prefers  common  tests.  Common  tests   will  appear  first  in  the  results.   •  Tries  to  detect  specimen(s)  in  the  OBR/OBX   descripJon  or  uses  rules  to  determine.   •  Tries  to  detect  method(s)  in  the  OBR  when   different  from  the  OBX  descripJon.   •  Specialized  for  Lab  LOINCs.   ©2010 Regenstrief Institute and James Case
  32. 32. New  in  This  Version  (Rel.  5.0)    •  When  proposing  new  LOINC  term,  if  Scale  =   ORD,  you  are  prompted  for  an  answer  list.  •  Search  using  LOINC  numbers  on  simple  search   and  mapping  screens.  Semicolon  (;)  now   represents  OR‘  (e.g.  2857-­‐1;  14120-­‐0)          •  Display  of  all  mappings  for  deprecated  and   discouraged  LOINCs  (details  screen).  •  Increased  performance  enhancements  for  HL7   import.          •  New  fields  to  the  “Propose  a  LOINC”  screen   related  to  new  terms.   ©2010 Regenstrief Institute and James Case
  33. 33. New  in  Previous  Version  (Rel.  4.5)   Released  after  last  LOINC  meeting  –  June  2010  •  RequesJng  a  LOINC  now  two  funcJons   •  "Propose  a  new  LOINC"  (empty  form)   •  "Propose  a  LOINC  based  on  selected  term”  •  Separate  restricJons  for  trial,  discouraged,   and  deprecated  LOINCs.   •  Default  -­‐  include  trial  LOINCs;  exclude   discouraged  and  deprecated  LOINCs.  •  Right-­‐click  “Sort  Grid”  acJon  now  a  tabular   display.  •  "Custom  Export"  seMngs  persist  between   RELMA  sessions.   ©2010 Regenstrief Institute and James Case
  34. 34. LOINC  Web  Site   ©2010 Regenstrief Institute and James Case
  35. 35. What’s  available  to  download?  •  RELMA  -­‐  mapping  and  browsing  tool   •  HL7  message  converter-­‐  Makes  a  database   suitable  for  mapping   •  HL7  lint  (finds  bad  messages)  •  LOINC  database  and  spreadsheets    •  LOINC  User  guide;  RELMA  User  Guide  •  Tools  to  assist  language  translaJons  by  part  •  Tools  for  building  databases  to  map  from   HL7  messages       ©2010 Regenstrief Institute and James Case 35
  36. 36. RELMA  Highlights  •  Browseable  hierarchies  of  LOINC  parts  •  Display  search  results  in  tree  view  •  Enhanced  “details”  view  of  terms/parts   •  References   •  DescripJons   •  Sample  units  •  Empirically-­‐derived  common  test  list  •  Special  features  for  panels/forms  •  Enhanced  export/copy-­‐paste  opJons   ©2010 Regenstrief Institute and James Case
  37. 37. RELMA  Mapping  Window     Search  Logic  For  a  given  test:  •  User  can  select  LOINC  records  containing:   •  A  set  of  words  connected  by  ANDs  or    Ors   •  AddiJonal  keyed  in  words   •  A  parJcular  category  of  test  (e.g.  microbiology)   •  Wild  cards  of  ?  and  *     •  Selected  classes,  systems,  components,     •  Any  intersecJon  of  the  above  Notes:   RELMA  assumes  exact  match  on  word  unless  user  adds   terminal  “*”  to  indicate  wild  card.   ©2010 Regenstrief Institute and James Case
  38. 38. RELMA  Logic  Not    →    #<word  A>  Or  →        <word  A>    |    <word  B  >  And  →        <word  B>  <word  A>   ©2010 Regenstrief Institute and James Case
  39. 39. Additional  RELMA  Features    •  User  Specified  Search  Limits    •  Selectable  trees  for:   •  Class   •  MulJaxial  (component/system)   •  System  (specimen)   •  Component   •  Method   ©2010 Regenstrief Institute and James Case
  40. 40. Installing RELMA® ©2010 Regenstrief Institute and James Case
  41. 41. Installation  Steps  •  Make  sure  you  have  enough  free  disk  space!   •  2Gb  is  recommended  •  From  CD  -­‐  Start  –  Run  –  <drive>:RELMASetup  •  Specify  installaJon  directory   •  Life  will  be  easier  if  you  accept  the  default  •  Two  database  files  installed   •  RELMA.MDB  –  LOINC  Terms  Database   •  LMOF3.MDB  –  Local  Master  ObservaJon  File  •  Two  sample  files  included    •  Run  from  Start  –  (All)  Programs  –  Regenstrief  –  RELMA   ©2010 Regenstrief Institute and James Case
  42. 42. File  Locations  •  Database  and  Ancillary  Files   •  Windows  XP  =  C:Documents  and  SeMngsAll  Users DocumentsRELMA   •  Windows  Vista  =  C:UsersPublicDocumentsRELMA   •  Windows  7  =  C:UsersPublicDocumentsRELMA  •  Sample  files   •  Windows  XP  =  C:Documents  and  SeMngsAll  Users DocumentsRELMASamples   •  Windows  Vista  =  C:UsersPublicDocumentsRELMA Samples   •  Windows  7  =  C:UsersPublicDocumentsRELMA Samples   ©2010 Regenstrief Institute and James Case
  43. 43. Running RELMA® Version 5.0 ©2010 Regenstrief Institute and James Case
  44. 44. Copyright  Screen   ©2010 Regenstrief Institute and James Case
  45. 45. Main  Menu/Welcome  Screen   Click  File,  Set  Preferred   Language   ©2010 Regenstrief Institute and James Case
  46. 46. Select  Linguistic  Variant(s)   ©2010 Regenstrief Institute and James Case
  47. 47. LOINC  Terms  with  Spanish  Linguistic  Variant   All  Spanish!   ©2010 Regenstrief Institute and James Case
  48. 48. Setting  User  Preferences   ©2010 Regenstrief Institute and James Case
  49. 49. Set  User  Preferences   Select  User  Preferences   From  the  File  Menu   ...or  from  Welcome  Screen   ©2010 Regenstrief Institute and James Case
  50. 50. Set  User  Preference  Dialog   New  File  Locations:   (See  prior  slide  for  location)   Startup  Screen  Preference   ©2010 Regenstrief Institute and James Case
  51. 51. User  Map  Screen  Preferences   Click  Map  Screen  Tab   Include/Exclude  Battery   Terms   Add  comments  on  Mappings   ©2010 Regenstrief Institute and James Case
  52. 52. Importing  Local  Terms  into  RELMA   ©2010 Regenstrief Institute and James Case
  53. 53. 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   ©2010 Regenstrief Institute and James Case
  54. 54. Constructing  a  Local  Dataset  Create  extract  of  your  test  catalog  with:   •  BaFery/Panel  Code   •  BaFery/Panel  DescripJon  or  Name   •  *Local  Code     •  *Test  DescripJon  or  Name   •  Include  Method  if  Important   •  Units   •  Example  Values   •  Laboratory  SecJon   ©2010 Regenstrief Institute and James Case
  55. 55. 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  •  Fields  can  be  in  any  order  •  Minimum  required  fields     •  Local  Code   •  Local  DescripJon   •  Units  (highly  recommended)   ©2010 Regenstrief Institute and James Case
  56. 56. Entering  New  Local  Terms     into  RELMA   ©2010 Regenstrief Institute and James Case
  57. 57. Manual  Enter/Edit     View/Add/Edit  Local  Terms   ©2010 Regenstrief Institute and James Case
  58. 58. Edit  Term  Dialog   EditAddDelete  Terms   Export  Terms   Search  Terms  by  Keyword  Text  alignment  option   Print  Preview  List   ©2010 Regenstrief Institute and James Case
  59. 59. Export  Local  Term  File  Delimiters  supported:   Tab,  comma,  bar  (|)   ©2010 Regenstrief Institute and James Case
  60. 60. Add  Local  Term  MICRO!BUBPLAG!BUBONIC PLAGUE – RRT PCR! Click  to  Add  to  Current   Working  File   ©2010 Regenstrief Institute and James Case
  61. 61. Search  Local  Term  File  Calcium Enter  Keyword  from  any   Return  to  Full  List   Field   ©2010 Regenstrief Institute and James Case
  62. 62. Print  Preview  Local  Term  File   ©2010 Regenstrief Institute and James Case
  63. 63. Steps  to  Import  Local  Terms  1.  Click  Import Local Terms  BuFon  from  Main  Menu       a) File>Import Local Terms from Delimited File  2.  Locate  your  local  terms  text  file   a)  E.g.  WinXP  Sample  files  loaded  into  C:Documents  and   SeMngsAll  UsersShared  DocumentsRELMA  3.  Name  your  Working  Set   a)  LMOF  database  can  contain  mulJple  work  sets  4.  Define  default  secJon  (OpJonal)  5.  IdenJfy  file  delimiter    6.  Assign  fields  to  LMOF  aFributes   a)  Ignore  fields  you  don’t  need   b)  Combine  fields  if  needed  7.  Check  “Case-­‐sensiJve”  if  needed  8.  Click  Import.   ©2010 Regenstrief Institute and James Case
  64. 64. Example  Tab-­‐Delimited  File   ©2010 Regenstrief Institute and James Case
  65. 65. Importing  Local  Files   Select  Import  Local  Terms   from  Delimited  File   ©2010 Regenstrief Institute and James Case
  66. 66. Navigate  to  File  Location   Select  File  iles  stored  ipen Sample  j and  Click  O n     RELMA  Directory   ©2010 Regenstrief Institute and James Case
  67. 67. Open  File  in  RELMA   Name  your  working  set.     RELMA  allows  multiple  sets  in   LMOF  database  Select  your  delimiter   Import  Button   ©2010 Regenstrief Institute and James Case
  68. 68. Open  File  in  RELMA   ©2010 Regenstrief Institute and James Case
  69. 69. Fields  Segregated   Assign LMOF Attribute Choose  jield  name   ©2010 Regenstrief Institute and James Case
  70. 70. Ready  to  Import  Minimum  assignments   Now  you  can  click  the   Import  button!   ©2010 Regenstrief Institute and James Case
  71. 71. Post-­‐Processing  of  Local  File  •  A]er  import,  RELMA  Searches  for  terms   (words)  that  it  does  not  recognize  •  Stored  in  a  file  for  future  reconciliaJon   ©2010 Regenstrief Institute and James Case
  72. 72. Local  Term  File  Options   ©2010 Regenstrief Institute and James Case
  73. 73. Change  Local  Term  File   Select  the  Working  Set   ©2010 Regenstrief Institute and James Case
  74. 74. Alternative  Pragmatic  Way  •  Use  large  set  of  HL7  messages  •  AutomaJcally  make  dataset  of:   •  OBR  ID   •  OBR  descripJon   •  OBX  ID   •  OBX  descripJon   •  Sample  of  results    with     •  Real  values   •  Units   •  Abnormal  flags   •  Normal  ranges   ©2010 Regenstrief Institute and James Case
  75. 75. Generate  Local  term  jile  from  HL7  messages     Select  Import  Terms  from   HL7  File   ©2010 Regenstrief Institute and James Case
  76. 76. Select  File  to  Import   Select  HL7  File   ©2010 Regenstrief Institute and James Case
  77. 77. Specify  HL7  File  Name  and  Sample  Size  Name  the  Local  Term   File  (working  set)   Select  the  number  of   sample  values   Select  which  codes  to  store   ©2010 Regenstrief Institute and James Case
  78. 78. HL7  Messages  Data  Statistics   ©2010 Regenstrief Institute and James Case
  79. 79. New  Terms  added  to  LMOF  Click  on  “Edit  Term”  to  see   Sample  Data   New  Battery  Code   ©2010 Regenstrief Institute and James Case
  80. 80. Sample  Results  for  Observation   New  Test  Code   Sample  Values  from   Messages   ©2010 Regenstrief Institute and James Case
  81. 81. Lenny  L’OINC  says:   “Load  the  Sample  Files   Into  RELMA  now!”   •  Import  the  two  sample  files   provided   •  Import_Sample_OBR.txt   •  Contains  baFery  code  and   descripJon   •  Import_Sample_OBX.txt   •  Contains  test  code  and   descripJon   •  Create  2  working  sets   •  Load  your  personal  data  set  ©2010 Regenstrief Institute and James Case
  82. 82. Cleaning  your  data   ©2010 Regenstrief Institute and James Case
  83. 83. Preparing  your  Data  for  Mapping  •  Improve  mapping  success  by:   •  Expanding  abbreviaJons   •  Standardizing  colloquial  terms   •  Ignoring  “administraJve”  terms   •  Standardizing  Jme  references  •  Can  be  done  prior  to  imporJng  •  BeFer  to  use  tools  built  into  RELMA   ©2010 Regenstrief Institute and James Case
  84. 84. RELMA  Cleaning  Tools   Use  this  tool  to  edit   unknown  terms   ©2010 Regenstrief Institute and James Case
  85. 85. Review  Unknown  Local  Terms   May  Re-­‐Scan  File  for   Unknown  Terms   ©2010 Regenstrief Institute and James Case
  86. 86. Replace  Local  Terms   Assign  LMOF  Attribute Replacement Options     ©2010 Regenstrief Institute and James Case
  87. 87. RELMA  Cleaning  Tools   Use  this  tool  to  make   global  substitutions   ©2010 Regenstrief Institute and James Case
  88. 88. Term  Substitution  Save  this  global  substitution   for  only  this  working  set   ©2010 Regenstrief Institute and James Case
  89. 89. Lenny  L’OINC  says:   “Begin  to  clean  your   data  now!”   •  Using  the  OBR  or  OBX  sample   files,  take  15-­‐20  minutes  to   clean  up  these  unrecognized   terms   •  You  may  use  your  own  data  if   you  wish.  ©2010 Regenstrief Institute and James Case
  90. 90. Searching  for  LOINC  Terms   ©2010 Regenstrief Institute and James Case
  91. 91. Simplijied  Search     Only  Tool  ©2010 Regenstrief Institute and James Case
  92. 92. Search  Window  Enter  Search   Terms     New  Feature! Limit  to       Specijic     Help  File Units   Limit  to  Common     Tests   “Common  Tests”   relative  frequency   ©2010 Regenstrief Institute and James Case
  93. 93. New  RELMA  Helpjile   ©2010 Regenstrief Institute and James Case
  94. 94. Context  Menu  Right  click  to  bring   up  context  menu   ©2010 Regenstrief Institute and James Case
  95. 95. Mapping  Local  Terms   ©2010 Regenstrief Institute and James Case
  96. 96. Mapping  Local  Terms  •  Select  your  Working  Set  to  Map   File>Select Local Term File to Process • •  Select  “Map Local Terms to LOINC”  from   Welcome  Screen  •  Select  the  subset  of  terms  to  work  with:   •  All   •  Mapped   •  Unmapped  •  Set  your  Search Limits •  Set Search Limits BuFon   ©2010 Regenstrief Institute and James Case
  97. 97. Standard  Mapping  Window  Features  •  Customizable  grid  •  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   ©2010 Regenstrief Institute and James Case
  98. 98. Mapping  Screen     View  or  edit  local  term   Enter  local  term  number  Quick  select  button  list   Custom  Grid  Conjiguration   ©2010 Regenstrief Institute and James Case
  99. 99. Conjigure  Grid   Select  elements  to  display   Reorder  grid  elements   Visually  resize  elements  Reset  Default  Conjiguration   ©2010 Regenstrief Institute and James Case
  100. 100. Quick  choice  buttons   Viewing  LOINC  term  detail     ©2010 Regenstrief Institute and James Case
  101. 101. View  Local  Term  Details   Select  level  of  detail  to   display   ©2010 Regenstrief Institute and James Case
  102. 102. Select  detail  display  level  Select  level  of  detail  to   display   ©2010 Regenstrief Institute and James Case
  103. 103. Standard  Mapping  Screen  Begin  a  search  (or  hit  “enter”)   ©2010 Regenstrief Institute and James Case
  104. 104. Initial  Mapping  Results   EEK!    What’ll  I   do?!   Click  to  show  words   used  in   search   ©2010 Regenstrief Institute and James Case
  105. 105. Initial  Mapping  Results  Use  term   Number  of  LOINC   Battery  terms  checkbox   terms  containing   included  in   keyword   search   ©2010 Regenstrief Institute and James Case
  106. 106. Revised  Mapping  Results   Match  units   Number  of   selected  by   matching   default   records  found   ©2010 Regenstrief Institute and James Case
  107. 107. Re-­‐revised  Mapping  Results   Number  of   matching   Match  units   records  found   unselected   ©2010 Regenstrief Institute and James Case
  108. 108. Standard  Mapping  Screen   CANINE DISTEMPER VIRUS IFEnter  keywords  here   Clear  all   input  jields   ©2010 Regenstrief Institute and James Case
  109. 109. Ad  hoc  term  search   ©2010 Regenstrief Institute and James Case
  110. 110. Standard  Mapping  Screen   Navigate  through   the  local  terms   ©2010 Regenstrief Institute and James Case
  111. 111. Tabbed  Access  to  Functions   Navigate  to  Functions   from  Mapping  Page   Switch  between  Grid  and   Tree  Views   ©2010 Regenstrief Institute and James Case
  112. 112. Tree  View   ©2010 Regenstrief Institute and James Case
  113. 113. Tree  View  •  Results  displayed  hierarchically   •  Defined  by  the  mulJ-­‐axial  hierarchy  in  search   restricJons  (covered  later)  •  Map  to  a  term  in  tree  by  clicking  Map  buFon   or  double  clicking  term   •  Only  rows  that  have  LOINC  Codes   ©2010 Regenstrief Institute and James Case
  114. 114. Tree  View   Can  map  to  terms   Cannot  map  to   with  LOINC  Codes   terms   representing   LOINC  parts  Tree  Navigation   Buttons   ©2010 Regenstrief Institute and James Case
  115. 115. Assigning  a  LOINC  Map   Click  “Map”  Button     (or  doubleclick)   Highlight  correct   term   ©2010 Regenstrief Institute and James Case
  116. 116. Adding  Mapping  Comments  Check with Frank in Chemistry If  comments   option  is  selected,   prompt  appears   ©2010 Regenstrief Institute and James Case
  117. 117. Assigning  a  LOINC  Map   LOINC  Term   Assigned   ©2010 Regenstrief Institute and James Case
  118. 118. View  LOINC  Term  Details   View  details  for  a   specijic  LOINC  Term   Right  clicking  on  a  LOINC  term  brings  up  a  Task  Menu   ©2010 Regenstrief Institute and James Case
  119. 119. 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   ©2010 Regenstrief Institute and James Case
  120. 120. View  Panel  Children  Select  View  Panel  Children   from  context  menu   ©2010 Regenstrief Institute and James Case
  121. 121. Panel  Children   ©2010 Regenstrief Institute and James Case
  122. 122. Conjigure  Export  Options   Output  Options   Include    Save  Conjiguration   column  headers   and/or  Export   ©2010 Regenstrief Institute and James Case
  123. 123. Excel  Export  Format   ©2010 Regenstrief Institute and James Case
  124. 124. More  on  Searching     Mapping  Screen   ©2010 Regenstrief Institute and James Case
  125. 125. Using  Wildcards  in  Searches  •  Substring  search  supported  by  default   •  “Gluc”  yields  any  terms  with  “gluc”  in  the   component/analyte    •  “*”  replaces  any  number  of  characters   •  GLUC*   •  *COSE   •  GLU*SE  •  “?”  replaces  a  single  character   •  GLUCOS?   •  ?LUCOSE   •  GLUC?SE   ©2010 Regenstrief Institute and James Case
  126. 126. Other  Search  Qualijiers  •  “#”  represents  the  “NOT”  operator   •  #GLUCOSE  –  terms  without  the  Word  Glucose  •  “|”  is  the  “OR”  operator   •  GLUCOSE  |  LACTOSE  •  Can  have  mulJple  “OR”s  per  box  •  Can  Mix  OR  and  NOT  and  Wildcards   ©2010 Regenstrief Institute and James Case
  127. 127. Search  Qualijiers     Detailed  help  available   Includes  Glucuronidase,   Glucosidase,   Glucosylceramidase,  etc.   ©2010 Regenstrief Institute and James Case
  128. 128. Combining  Search  Terms   Exclude  Glucosidase   Reduced  number  of  terms   ©2010 Regenstrief Institute and James Case
  129. 129. Limiting  Searches   ©2010 Regenstrief Institute and James Case
  130. 130. Setting  Search  Limits  •  Narrows  search  to  specific  subset  of  LOINC  terms  •  Reduces  number  of  candidate  terms  •  Limits  can  be  applied  to  all  components  •  Component  aFribute  can  be  further  restricted  by   number  of  words  •  Tree  structure  allows  for  hierarchical  constraints   ©2010 Regenstrief Institute and James Case
  131. 131. General  Search  Constraints  •  Controls  features  including:   •  Limit  to  LOINC  terms  compaJble  with  submiFed  units   •  Forced  match  with  any  specimen  contained  in  name   •  Method-­‐less  terms  only     •  Limit  to  components/analytes  with  N  or  fewer  words  in  their   name   •  Pop  up  search  Jming  staJsJcs  a]er  each  search  •  Use  carefully  or  search  may  not  be  successful    (Note  parallel  control  switches  at  boFom  of  screen)     ©2010 Regenstrief Institute and James Case
  132. 132. Setting  Search  Limits  Click  Hierarchy  &  Search   Limits  Tab   ©2010 Regenstrief Institute and James Case
  133. 133. Setting  search  limits  Can  also  set  most  of  them  by  toggling  buFons   at  the  boFom  of  the  screen     Toggle  Buttons   ©2010 Regenstrief Institute and James Case
  134. 134. Search  Constraints   Attribute  trees   Local  Unit  Constraint:   Default  is  “ON”   New!  Type  toggle  boxes  Predejined,  general  search   constraints   ©2010 Regenstrief Institute and James Case
  135. 135. Terms  Consistent  with  Units   Only  terms  consistent   with  mmol/L  appear   ©2010 Regenstrief Institute and James Case
  136. 136. Setting  Search  Limits   Specimen   constraints   ©2010 Regenstrief Institute and James Case
  137. 137. Terms  Consistent  with  Specimen     CSF Enter  default   Specimen   ©2010 Regenstrief Institute and James Case
  138. 138. Terms  Consistent  with  Specimen    Only  CSF  Terms   are  returned   ©2010 Regenstrief Institute and James Case
  139. 139. Setting  Search  Limits  Methodless  Terms   Override  Methodless  Terms   Restriction   Restriction   ©2010 Regenstrief Institute and James Case
  140. 140. Limit  to  Methodless  Terms   ©2010 Regenstrief Institute and James Case
  141. 141. Limit  to  Methodless  Terms  Only  Methodless   Terms  Appear   ©2010 Regenstrief Institute and James Case
  142. 142. More  on  Methodless  Terms  •  Some  LOINC  categories  do  not  have   methodless  terms  •  Checking  methodless  only  will  remove  these   from  view  on  results  grid  •  Checking  addiJonal  box  allows  these  to  be   seen   ©2010 Regenstrief Institute and James Case
  143. 143. Methodless  Only  Unchecked   All  terms  returned   ©2010 Regenstrief Institute and James Case
  144. 144. Methodless  Only  Checked   Only  Methodless   terms  returned   Differ  in  one  or  more  components   ©2010 Regenstrief Institute and James Case
  145. 145. Conditional  Methodless   More  terms   returned  No  methodless  term;  all  shown   ©2010 Regenstrief Institute and James Case
  146. 146. Setting  Search  Limits   Limit  to  Lab  Tests  Only     (No  Clinical  LOINC  Terms)   ©2010 Regenstrief Institute and James Case
  147. 147. Setting  Search  Limits   Limit  to  lab  tests  that  comprise   99.8%  of  INPC  volume   ©2010 Regenstrief Institute and James Case
  148. 148. Setting  Search  Limits   Limit  Number  of  Words  in  the   Component  Attribute   ©2010 Regenstrief Institute and James Case
  149. 149. Limit  Number  of  Component  Words   Without  Limit  Applied:   846  terms  returned   ©2010 Regenstrief Institute and James Case
  150. 150. Limit  Number  of  Component  Words   Restriction  appears  on   Toggle  Bar     (cannot  toggle  off)  Component  limited  to   1  word   With  Limit  Applied:     69  terms  returned   ©2010 Regenstrief Institute and James Case
  151. 151. Setting  Search  Limits   Include  Trial,  Deprecated  or   Discouraged  LOINC  Codes  with   Returned  Terms   ©2010 Regenstrief Institute and James Case
  152. 152. Include  Deprecated  LOINC  Terms   -­‐ You  cannot  map  to   deprecated  LOINC  terms   -­‐   You  are  warned  before   mapping  to  discouraged   LOINC  terms   Discouraged  LOINC  Terms  appear  as  an   inverted  triangle     Deprecated  LOINC  Terms  appear  as   Strikethrough  Text  with  a  “Do  Not”   Symbol     ©2010 Regenstrief Institute and James Case
  153. 153. Favor  Property  Restriction   Favor  one  type  of  property  over  others   All  other  components   being  equal  MCnc   only  will  be  displayed   ©2010 Regenstrief Institute and James Case
  154. 154. Order/Observation  Restriction  Order  or  Observation   preference   ©2010 Regenstrief Institute and James Case
  155. 155. LOINC  Hierarchies  –  Class  Tree   Three  top-­‐level   branches   Tree  Navigation   Buttons   ©2010 Regenstrief Institute and James Case
  156. 156. Before  Class  Restriction   Most  terms  have  class   of  “CHAL”   Large  number  of   candidate  terms   ©2010 Regenstrief Institute and James Case
  157. 157. Search  Trees  CHAL Restrict  eligible  tests   to  non-­‐challenge   chemistry  tests  only   ©2010 Regenstrief Institute and James Case
  158. 158. Following  Class  Restriction  Only  Non-­‐Challenge   Chemistry  tests   returned   ©2010 Regenstrief Institute and James Case
  159. 159. Improvements  to  Trees   Continued  reorganization  to   provide  a  Specimen   hierarchy   ©2010 Regenstrief Institute and James Case
  160. 160. Improved  Hierarchy  for  Component   Click  on  details  for  more   information  about  the   selection   Show  the  LOINC  Codes   associated  with  these   components   ©2010 Regenstrief Institute and James Case
  161. 161. Details  Screen  LOINC  Part   ©2010 Regenstrief Institute and James Case
  162. 162. Show  Associated  LOINCs   ©2010 Regenstrief Institute and James Case
  163. 163. Details  Screen  LOINC  Term   Detailed  Information  on   LOINC  Parts   ©2010 Regenstrief Institute and James Case
  164. 164. Tree  Export  Tools  Export  according  to   Conjiguration     Conjigure  Export  Format     ©2010 Regenstrief Institute and James Case
  165. 165. Tree  Export  Conjiguration   ©2010 Regenstrief Institute and James Case
  166. 166. 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  •  Use  “Clear  Most  Limits”  buFon  on  Mapping   Screen  to  remove  all  tree  selecJons   ©2010 Regenstrief Institute and James Case
  167. 167. LOINC  Part  Search  •  Same  look  as  term  search  •  Uses  “Google-­‐like”  query  language   •  Extremely  fast   •  Include  and  exclude  criteria   •  ParJal  string  matching  (using  wildcards)  •  Demo   •  Campylobacter  fetus,  not  Ab     ©2010 Regenstrief Institute and James Case
  168. 168. Navigating  through  the   Mapping  Process   ©2010 Regenstrief Institute and James Case
  169. 169. LOINC  Mapping  Tactics  •  Limit  effort  to  one  lab  secJon  at  a  Jme  and   focus  experJse  •  Chemistry  and  hematology  will  be  easiest  •  Consider  prioriJzing  by  frequency   ©2010 Regenstrief Institute and James Case
  170. 170. Vreeman  DJ,  Finnell  JT,  Overhage  JM.  A  Rationale  for  Parsimonious  Laboratory  Term   Mapping  by  Frequency.  AMIA  Annu  Symp  Proc.  2007;:771-­‐775.   ©2010 Regenstrief Institute and James Case
  171. 171. More  LOINC  Mapping  Tactics  •  Try  using  method-­‐less  terms  first   •  Specific  methods  can  be  transmiFed  in:   •   OBX–17  (v2.x),  ObservaJon.methodCode  (v3.0)  •  Examine  local  units  or  real  results  to  verify   correct  properJes   •  ProperJes  are  rarely  disJnguishable  in  tests  •  You  don’t  have  to  do  it  all  at  one  siMng   •  Use  the  “Unmapped”  funcJon  to  return  where  you   le]  off  •  With  every  release  -­‐  Update  previous  mappings   to  idenJfy  deprecated  terms   ©2010 Regenstrief Institute and James Case
  172. 172. 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.  InterpretaJon  •  Available  LOINC  Terms  too  Specific  •  Available  LOINC  Terms  too  General  •  Panel  vs.  Discrete  Test   •  Common  in  Microbiology   ©2010 Regenstrief Institute and James Case
  173. 173. Using  your  Mapped  Terms  •  Print  results  of  LOINC  Mapping  •  Export  to  File   ©2010 Regenstrief Institute and James Case
  174. 174. Conjigure  Export  Format  Context  Sensitive  Export   Conjiguration     ©2010 Regenstrief Institute and James Case
  175. 175. LMOF  Export  Conjiguration  Select  Export  Format     Select  Fields  to  Export   Save  Conjiguration  and   Export   ©2010 Regenstrief Institute and James Case
  176. 176. Print  Mapped  Terms  from  View/Add/ Edit  Menu   Click  Print  button  to  Preview  May  highlight  terms  to  be   output   printed   ©2010 Regenstrief Institute and James Case
  177. 177. Formatted  Report  Output  Click  Print  button  to  output   formatted  report   ©2010 Regenstrief Institute and James Case
  178. 178. Custom  Export  Conjiguration   Select  the  Format  you  wish   to  Export   Select  the  Fields  you  wish  to   Export   ©2010 Regenstrief Institute and James Case
  179. 179. Excel™  Export   ©2010 Regenstrief Institute and James Case
  180. 180. New  and  Improved     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.   ©2010 Regenstrief Institute and James Case
  181. 181. Picking  the  Intelligent  Mapper   Begin  by  jinding  qualifying   candidates  based  on  local   jile  attributes   ©2010 Regenstrief Institute and James Case
  182. 182. Intelligent  Mapper  Start  Screen   Maximum  number  of  terms   May  Apply  Hierarchy   Restrictions  Prior  to  Run to  return     ©2010 Regenstrief Institute and James Case
  183. 183. Intelligent  Mapper  -­‐  Mapping  Screen   ©2010 Regenstrief Institute and James Case
  184. 184. Exporting  Mapped  Terms   Export  Terms  to   Delimited  File   ©2010 Regenstrief Institute and James Case
  185. 185. Export  Terms  Dialog  Select  Term  Set   Select  Delimiter  Check  Fields  you   wish  to  export   ©2010 Regenstrief Institute and James Case
  186. 186. Other  RELMA ®   Features   ©2010 Regenstrief Institute and James Case
  187. 187. Panels,  Forms  and  Survey  Review   Review  Panels,  Forms  and   Surveys   Review  Panels,  Forms  and   Surveys   ©2010 Regenstrief Institute and James Case
  188. 188. Government  Forms   Component  LOINC   terms   Form  Name   ©2010 Regenstrief Institute and James Case
  189. 189. Laboratory  Panels   Expand  category  to   see  panels     Double-­‐click   panel  name  to  see   components   ©2010 Regenstrief Institute and James Case
  190. 190. Expanded  Panel  Detail   ©2010 Regenstrief Institute and James Case
  191. 191. Expanded  Clinical  Panel   ©2010 Regenstrief Institute and James Case
  192. 192. Clinical  Panels   Find  where  a  term  has   been  used   ©2010 Regenstrief Institute and James Case
  193. 193. LOINC  Term  Panel  Usage   ©2010 Regenstrief Institute and James Case
  194. 194. Other  Survey  Instruments   ©2010 Regenstrief Institute and James Case
  195. 195. HIPAA  Attachments   View  Various  HIPAA   Attachments     ©2010 Regenstrief Institute and James Case
  196. 196. HIPPA  Attachment  Tree   ©2010 Regenstrief Institute and James Case
  197. 197. Expanded  Attachment  Data   ©2010 Regenstrief Institute and James Case
  198. 198. Context  Specijic  Hierarchies  •  Allows  local  definiJon  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  mulJple   code  systems   ©2010 Regenstrief Institute and James Case
  199. 199.  Access  Context-­‐Specijic  Hierarchies Select  Context  Specijic   Hierarchies   ©2010 Regenstrief Institute and James Case
  200. 200. Select  Directory   ©2010 Regenstrief Institute and James Case
  201. 201. Context  Specijic  Hierarchies   Locally  dejined   aggregation   ©2010 Regenstrief Institute and James Case
  202. 202. Can’t  jind  the   term  you   want?   ©2010 Regenstrief Institute and James Case
  203. 203. 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   ©2010 Regenstrief Institute and James Case
  204. 204. Proposing  New  LOINC  Terms   ©2010 Regenstrief Institute and James Case
  205. 205. Proposing  New  Terms  •  Make  sure  the  term  is  really  needed   •  Think  of  other  names  for  the  same  concept   •  Avoid  detailed  methods  or  localizaJons   •  Is  the  disJncJon  really  important?  •  Supply  sufficient  annotaJon  to  jusJfy  the  new  term   •  Package  inserts,  sample  reports  (email  to  Regenstrief)   •  The  more  the  beFer!  •  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   ©2010 Regenstrief Institute and James Case
  206. 206. Propose  new  LOINC  terms   Select  Propose  a   LOINC   ©2010 Regenstrief Institute and James Case
  207. 207. Navigate  through   proposed  terms   Create  new  term,   save  current  term   or  Exit  form   Required  jields   ©2010 Regenstrief Institute and James Case
  208. 208. Click  double  arrow   New!    Roll  up   minor  parts!  ©2010 Regenstrief Institute and James Case
  209. 209. Preview  Proposed  Terms   Review  your  new   terms   ©2010 Regenstrief Institute and James Case
  210. 210. Review  Proposed  Terms   Choose  whether  to   send  or  postpone   All  proposed  terms   fully  editable   ©2010 Regenstrief Institute and James Case
  211. 211. Submitting  New  Terms  •  Must  supply  name,  organizaJon,  phone   and  email  of  submiFer  •  Must  select  at  least  one  proposed  term  to   send  •  “Configure  export”  does  not  affect   submission  output  •  Email  resulJng  file  to  Regenstrief   ©2010 Regenstrief Institute and James Case
  212. 212. Use  Existing  Terms  as  Template   Click  the  Propose   Term  button   Select  your  closest   match   ©2010 Regenstrief Institute and James Case
  213. 213. Use  Existing  Terms  as  Template   All  required   components  jilled  in   ©2010 Regenstrief Institute and James Case
  214. 214. Using  LOINC  and  SNOMED   Together   ©2010 Regenstrief Institute and James Case
  215. 215. Where  do  LOINC  and  SNOMED  Fit?  Remember:   •  LOINC  represents  the  quesJon:   •  Is  there  any  Botulism  toxin  in  my  specimen?   (33708-­‐9) €
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