2011 12 08 - LOINC Introduction

Laboratory LOINC Workshop – Indianapolis, IN LOINC Introduction and Overview Daniel J. Vreeman, PT, DPT, MSc Assistant Research Professor, Indiana University School of Medicine Research Scientist, Regenstrief Institute, Inc 12.08.2011 dvreeman@regenstrief.org © 2011

http://loinc.org/slideshows

Origins of LOINC The lingua franca of clinical observation exchange

Regenstrief’s 40+ Years ofCanopy Computing making a forest out of individual trees of data McDonald et al. Canopy Computing: using the Web in Clinical Practice. JAMA. 1998;280(15):1325-1329.

photo via nosha

Arboreal Informatics Pioneers 40 years of EMR work Indiana Network for Patient Care Nation’s most comprehensive and longest tenured HIE Regenstrief – the neutral 3rd party convener

Fundamental challenge: local systems haveidiosyncratic ways ofidentifying similar concepts

Vocabulary standardsprovide the linuga franca.

Logical Observation Identiﬁers Names and Codes A universal code system that facilitates exchange, pooling, and processing of results

Similar name, diﬀerent meaning… photo via Caption Time meerkat meerkat mere cat meerkat

If an observation is a questionand the observation value isan answer… LOINC provides codes for questions Other vocabularies provide codes for the answers

What is my patient’shemoglobin level? 718-7:Hemoglobin:MCnc:Pt:Bld:Qn

How fast does mypatient usually walk? 41959-8:Walking speed:Vel:1W^mean:^Patient:Qn:Calculated

Indiana Network for Patient Care HL7 v.2.X Message MSH|^~&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay|||||||||||||||PID|||$patientId$||$patientName$|||||||||||||||||||| LocalCode^LocalName^CodeSystem^LOINCcode^LOINCname^CodeSystemPV1|||||||$attendingDoctor$||$consultingDoctor$||||||||OBR|1|||012^CBC/Auto Diff^HSPA^57021-8^CBC W Auto Diff^LN||$reqDate|||||||||OBX|2|NM|123^WBC^HSP_A^26464-8^Leukocytes [#/volume] in Blood^LN||10.8|K/MM3|||||F|OBX|3|NM|234^RBC^HSP_A^26453-1^Erythrocytes [#/volume] in Blood^LN||4.82|MIL/MM3|||||F|OBX|4|NM|345^HGB^HSP_A^718-7^Hemoglobin [Mass/volume] in Blood^LN||15.7|GM/DL|||||F|OBX|5|NM|456^HCT^HSP_A^20570-8^Hematocrit [Volume Fraction] of Blood^LN||45|%|||||||F| A Message Processor A Institutional Repository

Result with a Coded Value Data type of result (OBX-5) is a This code is This code is coded element from LOINC from SNOMED OBX||CE|57131-5^Newborn conditions with pos markers^LN||7573000^PKU^SCT Code identifying this observation (what are these results? Code identifying theConditions identiﬁed by result (Phenylketonuria ) newborn screening )

A brief aside aboutterminology… photo via eye of einstein

LOINC Terminology LOINC (noun) From “Standardizing the MDS with LOINC® and Vocabulary Matches” Tohttp://aspe.hhs.gov/daltcp/reports/2007/MDS-LOINC.htm LOINC, LOINCing, LOINCed (verb) [Chief, Head, etc] LOINCer (noun) LOINCiﬁcation (noun) SNOMED Terminology SNOMED (noun) SNOMEDicated???

Diﬀerent standards for diﬀerentparts of the elephant. photo via Ludovic Hirlimann

SNOMED CT Systematized Nomenclature of Medicine - Clinical Terms photo via Bruce McKay~YSP

LOINC + SNOMED?

International Classiﬁcation ofDiseases (ICD) and the rest of the family photo via Esparta

RxNorm normalized names for clinical drugs photo via e-MagineArt.com

We now return to our regularly scheduled program… photo via x-ray delta one

Laboratory LOINC

Clinical LOINC

The LOINC Community Open. Nimble. Pragmatic.

Open Development Worldwide distribution at no cost End-user content additions Welcome all comers Volunteers

Regenstrief Institute Steward Developer of content Developer of tools Developer of community Distributor Voice

LOINC Codes Over Time By Release 70,000 LOINC Codes Lab Codes 60,000 Slope = 2200 50,000 Slope = 600 40,000 30,000 20,000 10,000 laboratory terms only 0

16,000 loinc.org members 14,000 12,000 10,000 8,000 6,000 4,000 2,000 14 new members per day 410 new members per month 0

14,420+ users in 145 countries

@LOINC

Downloads: ~1400/month

The LOINC Distribution

http://search.loinc.org

http://forum.loinc.org

loinc.org/usage “Top 2000 Results”

a.k.a. “Top 300 Orders”

a.k.a. “Common Units of Measure”

International Adoption participation, translation, implementation

LOINC Submitters 2009 to April 2011 84 organizations from 14 countries

LOINC Translators 18 organizations

Chinese (CHINA) Dra$ Portuguese (BRAZIL) English (UNITED STATES) Estonian (ESTONIA) French (CANADA) French (FRANCE) French (SWITZERLAND) German (GERMANY) German (SWITZERLAND) Greek (GREECE) Italian (ITALY) Italian (SWITZERLAND) Korean (KOREA, REPUBLIC OF) Spanish (ARGENTINA) Spanish (SPAIN) Spanish (SWITZERLAND)

In-progress Catalan Dutch French Russian

Large Implementations SIGA Saúde project Canada Health Infoway ePSOS Assistance publique - Hôpitaux de Paris Hong Kong Hospital Authority Red Agrolab BiTAC Lots more…success is often silent

US Adoption A few key highlights

US Federal Agencies NLM VA DoD IHS NCI CDC

Other Key US Adoptions HITSP eLINCS NAACCR CDISC NCQA/HEDIS, NQF HL7 HIPAA HIE’s

EHR Incentive Programa.k.a. “Meaningful Use”

St a n da rds^

New Frontiers inContent Modeling

LOINC Collections Panels, forms, surveys, and other patientassessments photo via LuzA

Standardized Assessments Vreeman DJ, McDonald CJ, Huﬀ SM. Representing patient assessments in LOINC®. AMIA Annu Symp Proc. 2010;832-836. PMID: 21347095 . Vreeman DJ, McDonald CJ, Huﬀ SM. LOINC® - A Universal Catalog of Individual Clinical Observations and Uniform Representation of Enumerated Collections. Int J Funct Inform Personal Med. 2010;3(4):273-291.

Purpose Assessments are widely used… …and not unlike other clinical observations

LOINC could be a master question ﬁle anduniform representation

Hierarchy of a Panel in LOINC

Panels/Forms Available as Separate Download

Sample of Assessments in LOINC US Government Forms CARE, MDSv2, MDSv3, OASIS B1, OASIS C, RFC US Surgeon General’s Family Health Portrait Brief Interview for Mental Status (BIMS) Confusion Assessment Method (CAM) Geriatric Depression Scale (GDS) HIV Signs and Symptoms Checklist Home Health Care Classiﬁcation howRU Living with HIV (LIV-HIV) Morse Fall Scale OMAHA PHQ (9 and 2) Quality Audit Marker (QAM)

Translational Research Variables 11,000+ variables Oh snap!

Lots More Cooking… Lots of forms and assessments More radiology reports Structured document titles Genetic testing … photo via liber

Key Lessonsfor Today photo via IMLS DCC

photo via wakeﬁelddavid Not just an IT problem

Get real. units, results, experts

Don’t be a one hit wonder. photo via gsz

A journey. Not a destination.

Clean water act photo via Fishking_1

photo via milos milosevic

The Race is On! Get LOINCing! photo via ryarwood

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2011 12 08 - LOINC Introduction

by dvreeman on Dec 08, 2011

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