2011 12 08 - LOINC Introduction

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2011 12 08 - LOINC Introduction

  1. 1. 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
  2. 2. http://loinc.org/slideshows
  3. 3. Origins of LOINC The lingua franca of clinical observation exchange
  4. 4. 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.
  5. 5. photo via nosha
  6. 6. 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
  7. 7. Fundamental challenge: local systems haveidiosyncratic ways ofidentifying similar concepts
  8. 8. Vocabulary standardsprovide the linuga franca.
  9. 9. Logical Observation Identifiers Names and Codes A universal code system that facilitates exchange, pooling, and processing of results
  10. 10. Similar name, different meaning… photo via Caption Time meerkat meerkat mere cat meerkat
  11. 11. If an observation is a questionand the observation value isan answer… LOINC provides codes for questions Other vocabularies provide codes for the answers
  12. 12. What is my patient’shemoglobin level? 718-7:Hemoglobin:MCnc:Pt:Bld:Qn
  13. 13. How fast does mypatient usually walk? 41959-8:Walking speed:Vel:1W^mean:^Patient:Qn:Calculated
  14. 14. 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
  15. 15. 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 )
  16. 16. A brief aside aboutterminology… photo via eye of einstein
  17. 17. 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???
  18. 18. Different standards for differentparts of the elephant. photo via Ludovic Hirlimann
  19. 19. SNOMED CT Systematized Nomenclature of Medicine - Clinical Terms photo via Bruce McKay~YSP
  20. 20. LOINC + SNOMED?
  21. 21. International Classification ofDiseases (ICD) and the rest of the family photo via Esparta
  22. 22. RxNorm normalized names for clinical drugs photo via e-MagineArt.com
  23. 23. We now return to our regularly scheduled program… photo via x-ray delta one
  24. 24. Laboratory LOINC
  25. 25. Clinical LOINC
  26. 26. The LOINC Community Open. Nimble. Pragmatic.
  27. 27. Open Development Worldwide distribution at no cost End-user content additions Welcome all comers Volunteers
  28. 28. Regenstrief Institute Steward Developer of content Developer of tools Developer of community Distributor Voice
  29. 29. 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
  30. 30. 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
  31. 31. 14,420+ users in 145 countries
  32. 32. @LOINC
  33. 33. Downloads: ~1400/month
  34. 34. The LOINC Distribution
  35. 35. http://search.loinc.org
  36. 36. http://search.loinc.org
  37. 37. http://forum.loinc.org
  38. 38. loinc.org/usage “Top 2000 Results”
  39. 39. a.k.a. “Top 300 Orders”
  40. 40. a.k.a. “Common Units of Measure”
  41. 41. International Adoption participation, translation, implementation
  42. 42. LOINC Submitters 2009 to April 2011 84 organizations from 14 countries
  43. 43. LOINC Translators 18 organizations
  44. 44. 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)    
  45. 45. In-progress Catalan Dutch French Russian
  46. 46. 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
  47. 47. US Adoption A few key highlights
  48. 48. US Federal Agencies NLM VA DoD IHS NCI CDC
  49. 49. Other Key US Adoptions HITSP eLINCS NAACCR CDISC NCQA/HEDIS, NQF HL7 HIPAA HIE’s
  50. 50. EHR Incentive Programa.k.a. “Meaningful Use”
  51. 51. St a n da rds^
  52. 52. New Frontiers inContent Modeling
  53. 53. LOINC Collections Panels, forms, surveys, and other patientassessments photo via LuzA
  54. 54. 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.
  55. 55. Purpose Assessments are widely used… …and not unlike other clinical observations
  56. 56. LOINC could be a master question file anduniform representation
  57. 57. Hierarchy of a Panel in LOINC
  58. 58. Panels/Forms Available as Separate Download
  59. 59. 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)
  60. 60. Translational Research Variables 11,000+ variables Oh snap!
  61. 61. Lots More Cooking… Lots of forms and assessments More radiology reports Structured document titles Genetic testing … photo via liber
  62. 62. Key Lessonsfor Today photo via IMLS DCC
  63. 63. photo via wakefielddavid Not just an IT problem
  64. 64. Get real. units, results, experts
  65. 65. Don’t be a one hit wonder. photo via gsz
  66. 66. A journey. Not a destination.
  67. 67. Clean water act photo via Fishking_1
  68. 68. photo via milos milosevic
  69. 69. The Race is On! Get LOINCing! photo via ryarwood

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