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2011 08 15 - Clinical LOINC Tutorial - Intro and Foundations

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The document provides an introduction and overview of LOINC (Logical Observation Identifiers Names and Codes), a universal standard for identifying health measurements, observations, and documents. LOINC codes are organized using a six-axis model and include over 55,000 codes for laboratory tests, clinical observations, surveys, and claims attachments. The document outlines the history, development, and governance of LOINC, as well as examples of how LOINC codes are structured and used in clinical documents and messages.

Health & MedicineBusinessTechnology
1 of 54
An Introduction to Clinical LOINC Stanley M. Huff, M.D. Intermountain Healthcare [email_address]
Outline for All Tutorials ,[object Object],[object Object],[object Object],[object Object],08/21/11
Outline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11
Important facts ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11
Coverage ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11
The Messaging Paradigm 08/21/11 System A System B Trigger Event Network Order Result
HL7 Result Message (ORU) 08/21/11 Segment Data Field MSH|^~amp;|||||19981105131523||ORU^R01| PID|||100928782^9^M11||Smith^John^J| OBR||||Z0063-0^BP^LN| OBX||CE|8361-4^POSITION^LN||SIT^Sitting| OBX||NM|8479-8^SBP^LN||138|mmHg| Component
OBX: a name-value pair approach 08/21/11 A code that identifies the data in OBX-5 (Temp Reading) OBX||NM|11289-6^^LN||38|C^^ISO+|||||F Other data fields include: date of observation, identity of provider giving observation, normal ranges, abnormal flags Status A code that identifies the units of numerical data in OBX-5 A code that identifies the datatype of OBX-5 OBX-5: Data
OBX: with a coded value 08/21/11 OBX||CE|883-9^ Blood Group ^LN||58460004^ Group O ^SCT| The code is from SNOMED The code is from LOINC OBX-5: Data A code for Group O A code that identifies the datatype as a coded element A code that identifies the data in OBX-5 (ABO Blood Group)
So we are all using HL7, what is the problem? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],You and I may know that these are similar results, but our computers will not.
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],The Goal 08/21/11 Agree on a universal coding system for clinical observations.
How terminologies fit into the model ,[object Object],[object Object],[object Object],[object Object],08/21/11
Focus of LOINC ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11
Brief History of LOINC ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11
Approach ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11
LOINC makes names for things in use ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11
Two LOINC committees ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11
Current and Former Clinical LOINC Members ,[object Object],08/21/11
Clinical LOINC Subject Areas ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11
LOINC Mascot 08/21/11
Outline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11
[object Object],General Form of Clinical LOINC Names 08/21/11 <component> : <property> : <timing> : <system> : <scale> : <method> The first 5 parts are mandatory, but method is optional. Subparts of the six axes are created as needed in specific subject areas. 8331-1 Body Temperature :TEMP :PT :MOUTH :QN
Summary of the six primary axes (clinical) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11
Component 08/21/11 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Subtypes – period as a separator ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11
Challenge/Pre condition - ^ as a separator ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11
Adjustments - ^ ^ as a separator ,[object Object],[object Object],08/21/11
Kind of Property ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11 The characteristic or attribute of the component that is measured, evaluated, or observed.
Timing ,[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11 The interval of time over which the observation or measurement was made.
System ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11 The system (context) or body part about which the observation was made.
Patient, Control, or Donor (as part of system) ,[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11 Non-patient values for this axis should be used with care, or combinatorial explosion could result
Scale ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11
Method ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11 Procedure used to make the measurement or observation. Only used when it makes an important distinction in sensitivity or specificity.
Putting it all together ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11
Use of XXX and {} (curly braces) ,[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11
Pre and post coordination with LOINC codes # 70 Dry Weight: Site #1 kg Weight: Site #2 kg 70 70 70 Dry Wet Ideal
Two ways to say the same thing ,[object Object],[object Object],[object Object],[object Object],[object Object],#
Model fragment in XML ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],#
Relational database implications # How would you calculate the desired weight loss during the hospital stay? Patient Identifier Date and Time Observation Type Observation Value Units 123456789 7/4/2005 Dry Weight 70 kg 123456789 7/19/2005 Current Weight 73 kg Patient Identifier Date and Time Observation Type Weight type Observation Value Units 123456789 7/4/2005 Weight Dry 70 kg 123456789 7/19/2005 Weight Current 73 kg
More complex examples ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11
Outline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11
HL7 & the Claims Attachment Recommendation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11
Unsolicited Attachment 08/21/11
Request for Additional Information 08/21/11
Organizations & Documents 08/21/11 X12 277 Transaction 12748-1 9832-1 X12 275 Transaction HL7 CDA R1 15748-3 7832-8 20118-5 4332-7 12748-1 9832-1 ASC X12 & Subcommittee X12N X12 Trans. Sets 277, 275 TG2 Impl. Guides 277, 275 Health Level Seven HL7 CDA R 1 HL7 Claims Attachments Impl. Guide LOINC Consortium LOINC Codes LOINC Attachment Booklets
Attachment Types Selected for HIPAA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11
CDA: Semi- or fully-structured HIPAA Claims Attachments 08/21/11 Autoadjudicate Provider Payer Transcription * Scanned Paper or Document Imaging * Level 3 CPR Image + XML Semistructured Structured and coded Specific XML forms *
Outline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11
Use cases for Context Specific Hierarchies ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11
Consultation Note Example ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11
Outline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11
Issues related to “collections” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11
Proposed strategy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11
Literature References ,[object Object],[object Object],[object Object],[object Object],08/21/11

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2011 08 15 - Clinical LOINC Tutorial - Intro and Foundations

  • 1. An Introduction to Clinical LOINC Stanley M. Huff, M.D. Intermountain Healthcare [email_address]
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  • 6. The Messaging Paradigm 08/21/11 System A System B Trigger Event Network Order Result
  • 7. HL7 Result Message (ORU) 08/21/11 Segment Data Field MSH|^~amp;|||||19981105131523||ORU^R01| PID|||100928782^9^M11||Smith^John^J| OBR||||Z0063-0^BP^LN| OBX||CE|8361-4^POSITION^LN||SIT^Sitting| OBX||NM|8479-8^SBP^LN||138|mmHg| Component
  • 8. OBX: a name-value pair approach 08/21/11 A code that identifies the data in OBX-5 (Temp Reading) OBX||NM|11289-6^^LN||38|C^^ISO+|||||F Other data fields include: date of observation, identity of provider giving observation, normal ranges, abnormal flags Status A code that identifies the units of numerical data in OBX-5 A code that identifies the datatype of OBX-5 OBX-5: Data
  • 9. OBX: with a coded value 08/21/11 OBX||CE|883-9^ Blood Group ^LN||58460004^ Group O ^SCT| The code is from SNOMED The code is from LOINC OBX-5: Data A code for Group O A code that identifies the datatype as a coded element A code that identifies the data in OBX-5 (ABO Blood Group)
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  • 36. Pre and post coordination with LOINC codes # 70 Dry Weight: Site #1 kg Weight: Site #2 kg 70 70 70 Dry Wet Ideal
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  • 39. Relational database implications # How would you calculate the desired weight loss during the hospital stay? Patient Identifier Date and Time Observation Type Observation Value Units 123456789 7/4/2005 Dry Weight 70 kg 123456789 7/19/2005 Current Weight 73 kg Patient Identifier Date and Time Observation Type Weight type Observation Value Units 123456789 7/4/2005 Weight Dry 70 kg 123456789 7/19/2005 Weight Current 73 kg
  • 40.
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  • 44. Request for Additional Information 08/21/11
  • 45. Organizations & Documents 08/21/11 X12 277 Transaction 12748-1 9832-1 X12 275 Transaction HL7 CDA R1 15748-3 7832-8 20118-5 4332-7 12748-1 9832-1 ASC X12 & Subcommittee X12N X12 Trans. Sets 277, 275 TG2 Impl. Guides 277, 275 Health Level Seven HL7 CDA R 1 HL7 Claims Attachments Impl. Guide LOINC Consortium LOINC Codes LOINC Attachment Booklets
  • 46.
  • 47. CDA: Semi- or fully-structured HIPAA Claims Attachments 08/21/11 Autoadjudicate Provider Payer Transcription * Scanned Paper or Document Imaging * Level 3 CPR Image + XML Semistructured Structured and coded Specific XML forms *
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Editor's Notes

  1. 08/21/11
  2. 08/21/11
  3. 08/21/11
  4. 08/21/11
  5. 08/21/11 The pig picture was on an old t-shirt that was found stuffed under something when we moved offices. I cut the pig out and put it in an 8 x 10 frame that we had. I took a picture of it with my cell phone and emailed it to myself. Then I inserted the picture into a blank powerpoint and VOILA - The French Pig. (Sandy Poremba) Do we know who the original artist was?  (Stan) I think it was Jill Warvel - a programmer from here. (Sandy Poremba)
  6. 08/21/11
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