2011 06 06 - LOINC Workshop and Tutorial

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2011 06 06 - LOINC Workshop and Tutorial

  1. 1.  Using  RELMA     Or…In  Search  of  the  Missing  LOINC   Laboratory  LOINC  Meeting  –  June  2011   James  T.  Case  MS,  DVM,  PhD   Health  Program  Specialist,  SNOMED  CT   National  Library  of  Medicine   ©2011 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   ©2011 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     ©2011 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)   ©2011 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  standardized   content  (vocabularies)  within  the  data   structure   ©2011 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  •  Words  are  not  enough   •  Codes  –  uniquely  idenJfy  terms   •  Vocabulary  –  specialized,  precise  terms  that  remove   ambiguity   •  Ontology  –  describes  nature  of  enJJes  and  their  relaJons   •  ClassificaJon  –  groups  related  terms   ©2011 Regenstrief Institute and James Case
  7. 7. Potential  Uses  of  Health  Data  are  Constrained  by  Data  Quality  Factors   •  Data  quality  issues   •  Different  for  client/paJent  communicaJons  vs.   clinical  decision  support  vs.  epidemiological   analysis   •  Oen  constrained  by  external  forces   •  e.g.  criteria  for  diagnosis  oen  differs  from  the  criteria   for  reporJng   •  UnidirecJonal  effect  of  data  consolidaJon   •  Detailed   General   •  General      Detailed   ©2011 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   ©2011 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   ©2011 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   ©2011 Regenstrief Institute and James Case
  11. 11. LOINC®  101  Emphasis  on  Laboratory   LOINC   ©2011 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   ©2011 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   ©2011 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   ©2011 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   ©2011 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 ©2011 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 ©2011 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   ©2011 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   ©2011 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.  (e.g.  Serum^BPU)   ©2011 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)   ©2011 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  in  other  contexts  •  MulJ  –  structured  text  “globs”   •  e.g.  chromatography  output   •  Use  is  discouraged  •  Doc  –  Clinical  documents  •  Set  –  Clinical  aFachments  (headers)   ©2011 Regenstrief Institute and James Case
  23. 23. Method  •  Methods  only  needed  if  interpretaJon  affected   •  Different  normal  ranges   •  Test  SensiJvity/Specificity  •  Generally  listed  only  at  the  generic  level   •  AggluJnaJon  (limited  subtypes)   •  Immunoassay     •  Probe  with  target  amplificaJon   ©2011 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?)   ©2011 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  (increasing  number)  •  Text  descripJons  –  links  to  info  sources   about  individual  tests     •  Panel  structures   •  Foreign  language  translaJons     ©2011 Regenstrief Institute and James Case
  26. 26. RELMA®  Regenstrief  LOINC  Mapping  Assistant   ©2011 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   ©2011 Regenstrief Institute and James Case
  28. 28. RELMA  Functions  •  LOINC  files  and  indexes  •  Manual  and  automated  mapping  funcJons  •  Same  free  use  as  LOINC  (see  license)  •  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  •  “Common  tests”  subset  to  speed  mapping  •  Context  sensiJve  hierarchies  for  local  use.  •  Flexible  “Google-­‐like”  search  funcJons   ©2011 Regenstrief Institute and James Case
  29. 29. New  in  This  Version  (Rel.  5.2)    •  Searches    now  have  opJon  to  use  “Auto  Mapper”  methods   •  Select  "Use  Auto  Mapper  Search"  checkbox.  •  Revised  screen  for  reviewing  Terms  Mapped  to  Deprecated/ Discouraged  LOINCs     •  The  "Replacement  LOINC"  secJon  gives  the  user  access    to  all   the  replacement  LOINC  codes.       •  The    Comment  field  has  been  added.  (RaJonal  for  replacement   term)   •  Added  navigaJon  buFons.  •  Lucene  proximity  and  fuzzy  searches  are  now  supported  on   the  mapping  and    simple  search  screens.    •  Lucene  score  is  displayed  on  the  mapping  and  the  simple   search  screens.   ©2011 Regenstrief Institute and James Case
  30. 30. New  in  This  Version  (Rel.  5.2)    •  Column  headers  on  screens  are  the  same  as   Lucene  field  names.     •  Example:  [  ExUnits:mg  ]    -­‐"ExUnits"  =  example   units.          •  Double-­‐clicking  displays  the  details  for   selected  row.  •  LOINC  Part  quoJents  (e.g.  "CreaJne   kinase.MB/CreaJne  kinase.total“)  displayed   in  the  Part  secJon  of  details  screen.   ©2011 Regenstrief Institute and James Case
  31. 31. LOINC  Web  Site   ©2011 Regenstrief Institute and James Case
  32. 32. 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  •  New  guidance  documents  for  mappers   ©2011 Regenstrief Institute and James Case 32
  33. 33. RELMA  Highlights  •  Browse-­‐able  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   ©2011 Regenstrief Institute and James Case
  34. 34. Installing RELMA® ©2011 Regenstrief Institute and James Case
  35. 35. 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   ©2011 Regenstrief Institute and James Case
  36. 36. 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   ©2011 Regenstrief Institute and James Case
  37. 37. Running RELMA® Version 5.2 ©2011 Regenstrief Institute and James Case
  38. 38. Copyright  Screen   ©2011 Regenstrief Institute and James Case
  39. 39. Main  Menu/Welcome  Screen   ©2011 Regenstrief Institute and James Case
  40. 40. Set  Preferred  Language   Click  File,  Set  Preferred   Language   ©2011 Regenstrief Institute and James Case
  41. 41. Select  Linguistic  Variant(s)   Selecting  a  translation  may   require  indexes  to  be  built   ©2011 Regenstrief Institute and James Case
  42. 42. LOINC  Terms  with  Spanish  Linguistic  Variant   All  Spanish!   ©2011 Regenstrief Institute and James Case
  43. 43. Setting  User  Preferences   ©2011 Regenstrief Institute and James Case
  44. 44. Set  User  Preferences   Select  User  Preferences   From  the  File  Menu   ...or  from  Welcome  Screen   ©2011 Regenstrief Institute and James Case
  45. 45. Set  User  Preference  Dialog   New  File  Locations:   (See  prior  slide  for  location)   Startup  Screen  Preference   ©2011 Regenstrief Institute and James Case
  46. 46. User  Map  Screen  Preferences   Click  Map  Screen  Tab   Include/Exclude  Battery   Terms   Add  comments  on  Mappings   ©2011 Regenstrief Institute and James Case
  47. 47. Importing  Local  Terms  into  RELMA   ©2011 Regenstrief Institute and James Case
  48. 48. 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   ©2011 Regenstrief Institute and James Case
  49. 49. 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   ©2011 Regenstrief Institute and James Case
  50. 50. 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)   ©2011 Regenstrief Institute and James Case
  51. 51. Entering  New  Local  Terms     into  RELMA   ©2011 Regenstrief Institute and James Case
  52. 52. Manual  Enter/Edit     View/Add/Edit  Local  Terms   ©2011 Regenstrief Institute and James Case
  53. 53. Edit  Term  Dialog   EditAddDelete  Terms   Export  Terms  Text  alignment  option   Print  Preview  List   ©2011 Regenstrief Institute and James Case
  54. 54. Export  Local  Term  File  Delimiters  supported:   Tab,  comma,  bar  (|)   ©2011 Regenstrief Institute and James Case
  55. 55. Add  Local  Term  MICRO!BUBPLAG!BUBONIC PLAGUE – RRT PCR! Click  to  Add  to  Current   Working  File   ©2011 Regenstrief Institute and James Case
  56. 56. Search  Local  Term  File  Calcium Enter  Keyword  from  any   Return  to  Full  List   Field   ©2011 Regenstrief Institute and James Case
  57. 57. Print  Preview  Local  Term  File   ©2011 Regenstrief Institute and James Case
  58. 58. 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.   ©2011 Regenstrief Institute and James Case
  59. 59. Example  Tab-­‐Delimited  File   ©2011 Regenstrief Institute and James Case
  60. 60. Importing  Local  Files   Select  Import  Local  Terms   from  Delimited  File…   ©2011 Regenstrief Institute and James Case
  61. 61. Navigate  to  File  Location   Select  File  iles  stored  ipen Sample  j and  Click  O n     RELMA  Directory   ©2011 Regenstrief Institute and James Case
  62. 62. Open  File  in  RELMA   Name  your  working  set.     RELMA  allows  multiple  sets  in   LMOF  database  Select  your  delimiter   Import  Button   ©2011 Regenstrief Institute and James Case
  63. 63. Fields  Segregated   Assign LMOF Attribute Choose  jield  name   ©2011 Regenstrief Institute and James Case
  64. 64. Ready  to  Import  Minimum  assignments   Now  you  can  click  the   Import  button!   ©2011 Regenstrief Institute and James Case
  65. 65. Post-­‐Processing  of  Local  File  •  Aer  import,  RELMA  Searches  for  terms   (words)  that  it  does  not  recognize  •  Stored  in  a  file  for  future  reconciliaJon   ©2011 Regenstrief Institute and James Case
  66. 66. Local  Term  File  Options   ©2011 Regenstrief Institute and James Case
  67. 67. Change  Local  Term  File   Select  the  Working  Set   Current  mapping  status   ©2011 Regenstrief Institute and James Case
  68. 68. 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   ©2011 Regenstrief Institute and James Case
  69. 69. Generate  Local  term  jile  from  HL7  messages     Select  Import  Terms  from   HL7  File   ©2011 Regenstrief Institute and James Case
  70. 70. Select  File  to  Import   Select  HL7  File   ©2011 Regenstrief Institute and James Case
  71. 71. Specify  HL7  File  Name  and  Sample  Size   Skip  import  of   sample  values  Name  the  Local  Term   Select  the  number  of   File  (working  set)   sample  values   Select  which  codes  to  store   ©2011 Regenstrief Institute and James Case
  72. 72. HL7  Messages  Data  Statistics   ©2011 Regenstrief Institute and James Case
  73. 73. New  Terms  added  to  LMOF  Click  on  “Edit  Term”  to  see   Sample  Data   New  Battery  Code   ©2011 Regenstrief Institute and James Case
  74. 74. Sample  Results  for  Observation   New  Test  Code   Sample  Values  from   Messages   ©2011 Regenstrief Institute and James Case
  75. 75. 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  ©2011 Regenstrief Institute and James Case
  76. 76. Cleaning  your  data   ©2011 Regenstrief Institute and James Case
  77. 77. 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   ©2011 Regenstrief Institute and James Case
  78. 78. RELMA  Cleaning  Tools   Use  this  tool  to  edit   unknown  terms   ©2011 Regenstrief Institute and James Case
  79. 79. Review  Unknown  Local  Terms   May  Re-­‐Scan  File  for   Unknown  Terms   ©2011 Regenstrief Institute and James Case
  80. 80. Replace  Local  Terms   Assign  LMOF  Attribute Replacement Options     ©2011 Regenstrief Institute and James Case
  81. 81. RELMA  Cleaning  Tools   Use  this  tool  to  make   global  substitutions   ©2011 Regenstrief Institute and James Case
  82. 82. Term  Substitution  Save  this  global  substitution   for  only  this  working  set   ©2011 Regenstrief Institute and James Case
  83. 83. 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.  ©2011 Regenstrief Institute and James Case
  84. 84. Searching  for  LOINC  Terms   ©2011 Regenstrief Institute and James Case
  85. 85. Simplijied  Search     Only  Tool  ©2011 Regenstrief Institute and James Case
  86. 86. Search  Window   Help  File  Enter  Search   Terms     Limit  to     Limit  to  Common     Specijic  Units   Tests   Restrict  to  “Common   “Common  Tests”  rank   Tests”   Use  Automapper   logic   New!    Lucene  score   indicates  relevance   of  search  result   ©2011 Regenstrief Institute and James Case
  87. 87. New  RELMA  Helpjile   ©2011 Regenstrief Institute and James Case
  88. 88. Context  Menu  Right  click  to  bring   up  context  menu   ©2011 Regenstrief Institute and James Case
  89. 89. Mapping  Local  Terms   ©2011 Regenstrief Institute and James Case
  90. 90. 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   ©2011 Regenstrief Institute and James Case
  91. 91. 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   ©2011 Regenstrief Institute and James Case
  92. 92. Mapping  Screen     View  or  edit  local  term   Enter  local  term  number  Quick  select  button  list   Custom  Grid  Conjiguration   ©2011 Regenstrief Institute and James Case
  93. 93. Conjigure  Grid   Select  elements  to  display   Reorder  grid  elements   Visually  resize  elements  Reset  Default  Conjiguration   ©2011 Regenstrief Institute and James Case
  94. 94. Quick  choice  buttons   Viewing  LOINC  term  detail     ©2011 Regenstrief Institute and James Case
  95. 95. View  Local  Term  Details   Select  level  of  detail  to   display   ©2011 Regenstrief Institute and James Case
  96. 96. View  Local  Term  Details   Select  text  size   ©2011 Regenstrief Institute and James Case
  97. 97. Select  detail  display  level  Select  level  of  detail  to   display   ©2011 Regenstrief Institute and James Case
  98. 98. Standard  Mapping  Screen   EEK!    What’ll  I  Begin  a  search   do?!  (or  hit  “enter”)   ©2011 Regenstrief Institute and James Case
  99. 99. Standard  Mapping  Screen   Click  to  show  words   used  in   search   ©2011 Regenstrief Institute and James Case
  100. 100. Initial  Mapping  Results  Use  term   Number  of  LOINC   Battery  terms  checkbox   terms  containing   included  in   keyword   search   ©2011 Regenstrief Institute and James Case
  101. 101. Revised  Mapping  Results   Match  units   Number  of   selected  by   matching   default   records  found   ©2011 Regenstrief Institute and James Case
  102. 102. Re-­‐revised  Mapping  Results   Number  of   matching   Match  units   records  found   unselected   ©2011 Regenstrief Institute and James Case
  103. 103. Standard  Mapping  Screen   CANINE DISTEMPER VIRUS IFEnter  keywords  here   Clear  all   input  jields   ©2011 Regenstrief Institute and James Case
  104. 104. Ad  hoc  term  search   ©2011 Regenstrief Institute and James Case
  105. 105. Standard  Mapping  Screen   Navigate  through   the  local  terms   ©2011 Regenstrief Institute and James Case
  106. 106. Tabbed  Access  to  Functions   Navigate  to  Functions   from  Mapping  Page   Switch  between  Grid  and   Tree  Views   ©2011 Regenstrief Institute and James Case
  107. 107. Tree  View   ©2011 Regenstrief Institute and James Case
  108. 108. 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   ©2011 Regenstrief Institute and James Case
  109. 109. Tree  View   Can  map  to  terms   Cannot  map  to   with  LOINC  Codes   terms   representing   LOINC  parts  Tree  Navigation   Buttons   ©2011 Regenstrief Institute and James Case
  110. 110. Assigning  a  LOINC  Map   Click  “Map”  Button     (or  doubleclick)   Highlight  correct   term   ©2011 Regenstrief Institute and James Case
  111. 111. Adding  Mapping  Comments  Check with Frank in Chemistry If  comments   option  is  selected,   prompt  appears   ©2011 Regenstrief Institute and James Case
  112. 112. Assigning  a  LOINC  Map   LOINC  Term   Assigned   ©2011 Regenstrief Institute and James Case
  113. 113. View  LOINC  Term  Details   View  details  for  a   specijic  LOINC  Term   Right  clicking  on  a  LOINC  term  brings  up  a  Task  Menu   ©2011 Regenstrief Institute and James Case
  114. 114. 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   ©2011 Regenstrief Institute and James Case
  115. 115. View  Panel  Children  Select  View  Panel  Children   from  context  menu   ©2011 Regenstrief Institute and James Case
  116. 116. Panel  Children   ©2011 Regenstrief Institute and James Case
  117. 117. Conjigure  Export  Options   Output  Options   Include    Save  Conjiguration   column  headers   and/or  Export   ©2011 Regenstrief Institute and James Case
  118. 118. Excel  Export  Format   ©2011 Regenstrief Institute and James Case
  119. 119. More  on  Searching     Mapping  Screen   ©2011 Regenstrief Institute and James Case
  120. 120. Basic  Search  Syntax  Special  Character Example   Defini7on  (s)  “    “   Influenza  “virus  A”   Linked  terms  must  appear  together  AND   Morphine  AND   Both  terms  must  appear  in  the  search  result   Opiates   term  OR   Influenza  OR   Either  or  both  terms  must  appear  in  the   Parainfluenza   search  result  term  NOT     Influenza  NOT  equine   Excludes  terms  with  the  word  following  the   NOT.    Cannot  be  used  alone.  ?   Gluc?se   SubsJtutes  a  single  character  in  the  string.     (glucose,glucase)   Cannot  be  used  as  the  first  character;  cannot   be  used  in  “phrases”  *   Gluc*se   SubsJtute  mulJple  characters  in  the  string.     (glucose,   Cannot  be  used  as  the  first  character;  cannot   glucuronidase,  etc.)   be  used  in  “phrases”   ©2011 Regenstrief Institute and James Case
  121. 121. Search  Qualijiers     Detailed  help  available   Includes  Glucuronidase,   Glucosidase,   Glucosylceramidase,  etc.   ©2011 Regenstrief Institute and James Case
  122. 122. Combining  Search  Terms   Exclude  Glucosidase   Reduced  number  of  terms   ©2011 Regenstrief Institute and James Case
  123. 123. Advanced  Search  Syntax    based  on  Google-­‐like  search  syntax  Parameter   Descrip7on  +   Term  must  be  included  in  search  -­‐   Term  must  be  excluded  from  the  search  (  )   Group  terms  for  subquery  (i.e.  A  OR  B;  A  AND  B)  Fieldname:   Limit  term  search  to  the  associated  field  (e.g.  Component:  glucose)  Fieldname:()   Group  mulJple  terms  in  a  single  field  ~   Fuzzy  search  (e.g.  Hemo„ilus~)  “  “~   Proximity  search  for  mulJple  terms  (e.g.  “funcJon  panel”~1)  {},  []   Upper  and  lower  bounds;  {}  exclusive,  []  inclusive     Special  character  escape   ©2011 Regenstrief Institute and James Case
  124. 124. Applying  advanced  search   ©2011 Regenstrief Institute and James Case
  125. 125. Limiting  Searches   ©2011 Regenstrief Institute and James Case
  126. 126. 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   ©2011 Regenstrief Institute and James Case
  127. 127. 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  aer  each  search  •  Use  carefully  or  search  may  not  be  successful    (Note  parallel  control  switches  at  boFom  of  screen)     ©2011 Regenstrief Institute and James Case
  128. 128. Setting  Search  Limits  Click  Hierarchy  &  Search   Limits  Tab   ©2011 Regenstrief Institute and James Case
  129. 129. Setting  search  limits  Can  also  set  most  of  them  by  toggling  buFons   at  the  boFom  of  the  screen     Toggle  Buttons   ©2011 Regenstrief Institute and James Case
  130. 130. Search  Constraints   Attribute  trees   Local  Unit  Constraint:   Default  is  “ON”   New!  Type  toggle  boxes  Predejined,  general  search   constraints   ©2011 Regenstrief Institute and James Case
  131. 131. Terms  Consistent  with  Units   Only  terms  consistent   with  mmol/L  appear   ©2011 Regenstrief Institute and James Case
  132. 132. Setting  Search  Limits   Specimen   constraints   ©2011 Regenstrief Institute and James Case
  133. 133. Terms  Consistent  with  Specimen     CSF Enter  default   Specimen   ©2011 Regenstrief Institute and James Case
  134. 134. Terms  Consistent  with  Specimen    Only  CSF  Terms   are  returned   ©2011 Regenstrief Institute and James Case
  135. 135. Setting  Search  Limits  Methodless  Terms   Override  Methodless  Terms   Restriction   Restriction   ©2011 Regenstrief Institute and James Case
  136. 136. Limit  to  Methodless  Terms   ©2011 Regenstrief Institute and James Case
  137. 137. Limit  to  Methodless  Terms  Only  Methodless   Terms  Appear   ©2011 Regenstrief Institute and James Case
  138. 138. 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   ©2011 Regenstrief Institute and James Case
  139. 139. Methodless  Only  Unchecked   All  terms  returned   ©2011 Regenstrief Institute and James Case
  140. 140. Methodless  Only  Checked   Only  Methodless   terms  returned   Differ  in  one  or  more  components   ©2011 Regenstrief Institute and James Case
  141. 141. Conditional  Methodless   More  terms   returned  No  methodless  term;  all  shown   ©2011 Regenstrief Institute and James Case
  142. 142. Setting  Search  Limits   Limit  to  Lab  Tests  Only     (No  Clinical  LOINC  Terms)   ©2011 Regenstrief Institute and James Case
  143. 143. Setting  Search  Limits   Limit  to  common  lab  tests   ©2011 Regenstrief Institute and James Case
  144. 144. Setting  Search  Limits   Limit  Number  of  Words  in  the   Component  Attribute   ©2011 Regenstrief Institute and James Case
  145. 145. Limit  Number  of  Component  Words   Without  Limit  Applied:   792  terms  returned   ©2011 Regenstrief Institute and James Case
  146. 146. Limit  Number  of  Component  Words   Restriction  appears  on   Toggle  Bar     (cannot  toggle  off)  Component  limited  to   1  word   With  Limit  Applied:     57  terms  returned   ©2011 Regenstrief Institute and James Case
  147. 147. Setting  Search  Limits   Include  Trial,  Deprecated  or   Discouraged  LOINC  Codes  with   Returned  Terms   ©2011 Regenstrief Institute and James Case
  148. 148. 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     ©2011 Regenstrief Institute and James Case
  149. 149. Favor  Property  Restriction   Favor  one  type  of  property  over  others   All  other  components   being  equal  MCnc   only  will  be  displayed   ©2011 Regenstrief Institute and James Case
  150. 150. Order/Observation  Restriction  Order  or  Observation   preference   ©2011 Regenstrief Institute and James Case
  151. 151. LOINC  Hierarchies  –  Class  Tree   Three  top-­‐level   branches   Tree  Navigation   Buttons   ©2011 Regenstrief Institute and James Case
  152. 152. Before  Class  Restriction   Most  terms  have  class   of  “CHAL”   Large  number  of   candidate  terms   ©2011 Regenstrief Institute and James Case
  153. 153. Search  Trees  +Non +Chem Restrict  eligible  tests   to  non-­‐challenge   chemistry  tests  only   ©2011 Regenstrief Institute and James Case
  154. 154. Following  Class  Restriction   Only  Non-­‐Challenge   Chemistry  tests   returned   ©2011 Regenstrief Institute and James Case
  155. 155. Improvements  to  Trees   Continued  reorganization  to   provide  a  Specimen   hierarchy   ©2011 Regenstrief Institute and James Case
  156. 156. Improved  Hierarchy  for  Component   Click  on  details  for  more   information  about  the   selection   Show  the  LOINC  Codes   associated  with  these   components   ©2011 Regenstrief Institute and James Case
  157. 157. Details  Screen  LOINC  Part   ©2011 Regenstrief Institute and James Case
  158. 158. Show  Associated  LOINCs   ©2011 Regenstrief Institute and James Case
  159. 159. LOINC  Term  Details  Screen     Detailed  Information  on   LOINC  Parts   ©2011 Regenstrief Institute and James Case
  160. 160. Tree  Export  Tools  Export  according  to   Conjiguration     Conjigure  Export  Format     ©2011 Regenstrief Institute and James Case
  161. 161. Tree  Export  Conjiguration   ©2011 Regenstrief Institute and James Case
  162. 162. 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   ©2011 Regenstrief Institute and James Case
  163. 163. 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     ©2011 Regenstrief Institute and James Case
  164. 164. Navigating  through  the   Mapping  Process   ©2011 Regenstrief Institute and James Case
  165. 165. LOINC  Mapping  Tactics  •  Limit  effort  to  one  lab  secJon  at  a  Jme  and   focus  experJse  •  Chemistry  and  hematology  will  be  easiest  •  For  manufactured  assays,  use  package  insert  as   source  informaJon  •  Sample  results  give  clue  to  property  and  scale  •  Consider  prioriJzing  by  frequency  of  use   ©2011 Regenstrief Institute and James Case
  166. 166. Vreeman  DJ,  Finnell  JT,  Overhage  JM.  A  Rationale  for  Parsimonious  Laboratory  Term   Mapping  by  Frequency.  AMIA  Annu  Symp  Proc.  2007;:771-­‐775.   ©2011 Regenstrief Institute and James Case
  167. 167. 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  property  and  scale   •  ProperJes  are  rarely  disJnguishable  in  test  names  •  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   ©2011 Regenstrief Institute and James Case
  168. 168. Common  Mapping  Issues  •  Locally  Defined  Test  Name  Ambiguity   •  Reuse  of  local  test  code  •  “Analyte-­‐free”  Local  Test  Names   •  (Miscellaneous  serology)  •  Incongruent  Value  sets  (Scale  ambiguity)  •  Result  vs.  InterpretaJon  •  Available  LOINC  Terms  too  Specific/General  •  Panel  vs.  Discrete  Test   •  Common  in  Microbiology   ©2011 Regenstrief Institute and James Case
  169. 169. Using  your  Mapped  Terms  •  Print  results  of  LOINC  Mapping  •  Export  to  File   ©2011 Regenstrief Institute and James Case
  170. 170. Conjigure  Export  Format  Context  Sensitive  Export   Conjiguration     ©2011 Regenstrief Institute and James Case
  171. 171. LMOF  Export  Conjiguration  Select  Export  Format     Select  Fields  to  Export   Save  Conjiguration  and   Export   ©2011 Regenstrief Institute and James Case
  172. 172. Print  Mapped  Terms  from  View/Add/ Edit  Menu   Click  Print  button  to  Preview  May  highlight  terms  to  be   output   printed   ©2011 Regenstrief Institute and James Case
  173. 173. Formatted  Report  Output  Click  Print  button  to  output   formatted  report   ©2011 Regenstrief Institute and James Case
  174. 174. Custom  Export  Conjiguration   Select  the  Format  you  wish   to  Export   Select  the  Fields  you  wish  to   Export   ©2011 Regenstrief Institute and James Case
  175. 175. Excel™  Export   ©2011 Regenstrief Institute and James Case
  176. 176. New  and  Improved     Lab  Auto  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   ©2011 Regenstrief Institute and James Case
  177. 177. Picking  the  Lab  Auto  Mapper   ©2011 Regenstrief Institute and James Case
  178. 178. Lab  Auto  Mapper  Start  Screen   Can  restrict  search  to   Maximum  number  of  terms   common  tests   to  return   ©2011 Regenstrief Institute and James Case
  179. 179. Lab  Auto  Mapper  Start  Screen   Local  test  code   Local  terms  used  for   mapping   ©2011 Regenstrief Institute and James Case
  180. 180. Lab  Auto  Mapper  -­‐  Mapping  Screen   ©2011 Regenstrief Institute and James Case
  181. 181. Exporting  Mapped  Terms   Export  Terms  to   Delimited  File   ©2011 Regenstrief Institute and James Case
  182. 182. Export  Terms  Dialog  Select  Term  Set   Select  Delimiter  Check  Fields  you   wish  to  export   ©2011 Regenstrief Institute and James Case
  183. 183. Other  RELMA ®   Features   ©2011 Regenstrief Institute and James Case
  184. 184. Panels,  Forms  and  Survey  Review   Review  Panels,  Forms  and   Surveys   Review  Panels,  Forms  and   Surveys   ©2011 Regenstrief Institute and James Case
  185. 185. Government  Forms   Component  LOINC   terms   Form  Name   ©2011 Regenstrief Institute and James Case
  186. 186. Laboratory  Panels   Expand  category  to   see  panels     Double-­‐click   panel  name  to  see   components   ©2011 Regenstrief Institute and James Case
  187. 187. Expanded  Panel  Detail   ©2011 Regenstrief Institute and James Case
  188. 188. Expanded  Clinical  Panel   ©2011 Regenstrief Institute and James Case
  189. 189. Clinical  Panels   Find  where  a  term  has   been  used   ©2011 Regenstrief Institute and James Case
  190. 190. LOINC  Term  Panel  Usage   ©2011 Regenstrief Institute and James Case
  191. 191. Other  Survey  Instruments   ©2011 Regenstrief Institute and James Case
  192. 192. HIPAA  Attachments   View  Various  HIPAA   Attachments     ©2011 Regenstrief Institute and James Case
  193. 193. HIPPA  Attachment  Tree   ©2011 Regenstrief Institute and James Case
  194. 194. Expanded  Attachment  Data   ©2011 Regenstrief Institute and James Case
  195. 195. Can’t  jind  the   term  you   want?   ©2011 Regenstrief Institute and James Case
  196. 196. 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   ©2011 Regenstrief Institute and James Case
  197. 197. Proposing  New  LOINC  Terms   ©2011 Regenstrief Institute and James Case
  198. 198. 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 new LOINC •  Linked  to  the  “trees”  to  allow  browsing  •  Can  review  and  submit  them  to  LOINC  from  within   RELMA   ©2011 Regenstrief Institute and James Case
  199. 199. Propose  new  LOINC  terms   Select  Propose  a   new  LOINC   ©2011 Regenstrief Institute and James Case
  200. 200. Navigate  through   proposed  terms  Required  jields  in   red     Create  new  term,   save  current  term   or  Exit  form   ©2011 Regenstrief Institute and James Case
  201. 201. Preview  Proposed  Terms   Review  your  new   terms   ©2011 Regenstrief Institute and James Case
  202. 202. Review  Proposed  Terms   Choose  whether  to   send  or  postpone   All  proposed  terms   fully  editable   ©2011 Regenstrief Institute and James Case
  203. 203. 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   ©2011 Regenstrief Institute and James Case
  204. 204. Use  Existing  Terms  as  Template   Click  the  Propose   Term  button   Select  your  closest   match   ©2011 Regenstrief Institute and James Case
  205. 205. Use  Existing  Terms  as  Template   All  required   components  jilled  in   ©2011 Regenstrief Institute and James Case
  206. 206. Using  LOINC  and  SNOMED   Together   ©2011 Regenstrief Institute and James Case
  207. 207. Where  do  LOINC  and  SNOMED  Fit?  Remember:   •  LOINC  represents  the  quesJon:   •  Is  there  any  Botulism  toxin  in  my  specimen?   (33708-­‐9)   •  Organisms  idenJfied  in  specimen?  (634-­‐6)   •  SNOMED  represents  the  answer:   •  NegaJve  (SCTID  260385009)   •  E.  coli  O157:H7  (SCTID  103429008)   ©2011 Regenstrief Institute and James Case
  208. 208. Where  do  LOINC  and  SNOMED  Fit?  •  In  an  HL7  message,  LOINC  may  be  used:   •  In  OBR-­‐4  (Universal  Service  IdenJfier)   •  In  OBX-­‐3  (ObservaJon  IdenJfier  •  SNOMED  may  be  used:   •  In  OBX-­‐5  (where  nominal  values  are  needed)   •  Almost  anyplace  else  in  an  HL7  message  where   coded  values  are  needed   ©2011 Regenstrief Institute and James Case
  209. 209. OBX:  With  a  Coded  Value   A  code  that   identijies  the   data  type  in     The  code  is   The  code  is   OBX-­‐5  as  a   from  LOINC   from  SNOMED   coded  element  OBX||CE|6609-2^Listeria ID^LN||36094007^L. monocytogenes^SCT    OBX-­‐3:A  code  that   identijies  the  data  in   OBX-­‐5:  Data          A    c           for  L.          ode   OBX-­‐5   (Listeria  culture)   monocytogenes   ©2011 Regenstrief Institute and James Case

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