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2009 12 07 - LOINC Introduction and Overview


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2009 12 07 - LOINC Introduction and Overview

  1. 1. Laboratory  LOINC  Workshop   LOINC®   Overview  and  Introduction   12.07.2009   Daniel  J.  Vreeman,  PT,  DPT,  MSc   Assistant  Research  Professor  |  Indiana  University  School  of  Medicine   Research  Scientist  |  Regenstrief  Institute,  Inc   Copyright  ©  2009  
  2. 2. Overview   • Origins  of  LOINC   – Background   – Growth   – Participation   • Successes   –  International   –  US  
  3. 3. Origins  of  LOINC   The  Lingua  Franca  of  Clinical   Observation  Exchange  
  4. 4. Introduction   •  Regenstrief’s  30-­‐year  history   •  The  Indiana  Network  for  Patient  Care     –  A  working  HIE  for  ~15  years   –  More  than  100  sources   –  Regenstrief:  3rd  party  convener   •  Local  systems  use  idiosyncratic  codes   •  Vocabulary  standards   –  LOINC  ®    -­‐  universal  code  system  for  clinical  observations   –  The  lingua  franca  of  information  exchange   •  Laboratory  and  Radiology  results*     –  Often  unavailable  at  the  time  of  a  clinical  visit  (6%,  4%)   –  Often  located  outside  of  their  clinical  system   *Smith  CP,  Araya-­‐Guerra  R,  Bublitz  C,  et  al.  Missing  clinical  information  during  primary  care  visits.  JAMA.  2005;293(5):565-­‐571  
  5. 5. Indiana  Network  for  Patient  Care  
  6. 6. From  whence  comes  LOINC?   • LOINC®   –  Logical  Observation  Identiiiers  Names  and  Codes   –  A  universal  code  system  for  laboratory  and  other   clinical  observations   –  The  lingua  franca  of  information  exchange  for   clinical  observations   McDonald  CJ,  Huff  SM,  Suico  JG,  et  al.  LOINC,  a  universal  standard  for  identifying  laboratory  observations:  a  5-­‐year  update.  Clin  Chem.  2003;49(4):624-­‐633.  
  7. 7. Indiana Network for Patient Care HL7 v.2.X Message MSH|^~&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay||||||||||||||| LocalCode^LocalName^CodeSystem^LOINCcode^LOINCname^CodeSystem PID|||$patientId$||$patientName$|||||||||||||||||||| PV1|||||||$attendingDoctor$||$consultingDoctor$|||||||| OBR|1|||CBC^CBC/Auto Diff^HSPA^57021-8^CBC W Auto Diff^LN||$reqDate||||||||| OBX|2|ST|WBC^WBC^HSP_A^26464-8^Leukocytes [#/volume] in Blood^LN||10.8|K/MM3|||||F| OBX|3|ST|RBC^RBC^HSP_A^26453-1^Erythrocytes [#/volume] in Blood^LN||4.82|MIL/MM3|||||F| OBX|4|ST|HGB^HGB^HSP_A^718-7^Hemoglobin [Mass/?volume] in Blood^LN||15.7|GM/DL|||||F| OBX|5|CE|HCT^HCT^HSP_A^20570-8^Hematocrit [Volume Fraction] of Blood^LN||45|%|||||||F| A A
  8. 8. LOINC  Purpose   To  facilitate  the  exchange  and  pooling  of  results  for  clinical   care,  outcomes  management,  and  research   •  Speciiically,  to  provide  a  universal  ID  for   the  OBX-­‐3  iield  in  HL7  ORU  messages   •  LOINC  codes  “questions”,  not  answers   – Orders/Panels  (OBR-­‐4)   – Questions  (OBX-­‐3)   – NOT  Values  (OBX-­‐5)   • Numbers,  organisms  (E.  coli)   McDonald  CJ,  Huff  SM,  Suico  JG,  et  al.  LOINC,  a  universal  standard  for  identifying  laboratory  observations:  a  5-­‐year  update.  Clin  Chem.  2003;49(4):624-­‐633.  
  9. 9. LOINC’s  General  Role   •  If  an  observation  is  a  question,  and  the  observation   value  an  answer:   –  LOINC  provides  codes  for  the  questions  {OBR-­4,  OBX-­3}   –  Other  systems  (eg  SNOMED)  provide  codes  for  the  answers   What  is  my  patient’s  hemoglobin  level?   718-­‐7:Hemoglobin:MCnc:Pt:Bld:Qn   How  fast  does  my  patient  usually  walk?   41959-­‐8:Walking  speed:Vel:1W^mean:^Patient:Qn:Calculated  
  10. 10. LOINC  Background   •  Organized  by  Regenstrief  Institute  in  1994   –  Ongoing  support  from  NLM  and  Regenstrief   –  Guided  by  the  LOINC  Committee  (Lab  +  Clinical)   •  Covers  domain  of  Clinical  Observations   –  Laboratory  observations  (since  1995)   –  Clinical  observations  (since  1996)   –  HIPAA  Claims  Attachments  (NPRM  in  2005)   •  LOINC  development  is  a  highly  ‘open  source’  model   –  Open,  nimble,  pragmatic   –  LOINC  and  RELMA  program  are  freely  available   –  Much  work  is  done  by  volunteers   –  Additions  to  the  database  are  end-­‐user  driven  
  11. 11. LOINC  Submissions  2003-­2008   67  Organizations,  13  Countries  
  12. 12. Active  Translation  Efforts   16  Countries  
  13. 13. Laboratory  LOINC    Chemistry    Allergy  Testing    Urinalysis    Blood  Bank    Toxicology    Cell  Markers    Hematology    Skin  Tests    Microbiology    Coagulation    Antibiotic  Susceptibilities    Cytology    Immunology/Serology    HLA  Antigens    Molecular  Genetics    Surgical  Pathology    Cell  Counts  
  14. 14. Clinical  LOINC    Vital  Signs    EKG    Hemodynamic  Measurements    Cardiac  Ultrasound    Fluid  Intake/Output    Obstetrical  Ultrasound    Body  Measurements    Discharge  Summary    Emergency  Department  Variables      History  and  Physical    Respiratory  Therapy    Pathology  Findings    Tumor  Registry    Colonoscopy/Endoscopy    Patient  Assessment  Instruments    Clinical  Documents    Ophthalmology  Measurements    Document  Sections    Radiology  Reports    Patient  Assessment  Instruments  
  15. 15. Slope = 2200 Slope = 600
  16. 16. Downloads:    875/month  
  17. 17. ~  80  Organizations  Listed  
  18. 18. 3,121  email  addresses    
  19. 19. Current  Initiatives/ Successes   International  and  US  Adoption  
  20. 20. International  Adoption  
  21. 21. Existing  Translations   •  Spanish   –  BiTAC  (Spain);  39,000  terms     –  Conceptum  Medical  Terminology  Center;  38,000  terms,  Users’  Guide   –  Mexican  Institute  of  Social  Security;  Users’  Guide   •  French   –  Canada  Health  Infoway;  38,000  terms,  Documentation   –  Société  Française  d'Informatique  de  Laboratoires;  4,000  terms   •  Simpliiied  Chinese   –  Bethune  International  Peace  Hospital;  38,000  terms,  Users’  Guide,  tutorial   •  Korean   –  Korean  Ministry  for  Health,  Welfare  and  Family  Affairs;  27,000   terms   •  German   –  DIMDI;  Companion  website,  Users’  Guide  
  22. 22. New  Translations     (this  release) •  Estonian   –  Estonian  LOINC  working  group  of  the  Estonian  Society  for  Clinical   Chemistry;  Users’  Guide,  Tutorial   •  Portuguese   –  Brazilian  Federal  Agency  for  Health  Plans  and  Insurance,  Brazilian   Clinical  Analysis  Society,  Brazilian  Clinical  Pathology  Society,  and   Diagnóstico  das  Américas  (DASA);  2,800  terms   •  German,  French,  Italian,  Spanish   –  CUMUL  (Switzerland);  5000  common  terms  
  23. 23. In-­‐progress  Translations   •  French   –  Assistance  Publique-­‐Paris  Hospitals  (PMID:  18999107)   •  Estonian   –  University  of  Tartu;  Lab  terms   •  Dutch   –  SKML  (the  Dutch  Foundation  for  Quality  Assessment  in  Medical   Laboratories);  Lab  terms   •  Catalan   –  BiTAC;  Lab  terms   •  Russian   –  Donetsk  National  Medical  University,  corTTex  
  24. 24. How  do  you  say  “glucose?”   Component   Linguistic  Variant   Glukose   German  (Switzerland)   Glucose   French  (Switzerland)   Glucosio   Italian  (Switzerland)   Glucosa   Spanish  (Switzerland)     Simpliiied  Chinese  (China)   Glucosa   Spanish  (Argentina)   Glükoos   Estonian  (Estonia)   Glicose   Portuguese  (Brazil)  -­‐  Draft   Glucosa   Spanish  (Spain)     Korean  (Korea,  South)  
  25. 25. New  Translation  Approach   •  Prior  Method   –  Translate  whole  name  as  one  string   •  New  Method   –  Break  LOINC  terms  into  their  constituent  Parts   –  Remove  duplicate  strings  in  Part  list   –  Translate  the  Part  strings   –  Reassemble  the  full  LOINC  name   •  Beneiits   –  Reduced  translation  work   –  Enables  multilingual  searches  in  RELMA  
  26. 26. US  Adoption     a  few  recent  highlights
  27. 27. Consolidated  Health  Informatics  Initiative   •  CHI  Goal:   –  Adopting  interoperability  standards  to  enable  all   agencies  in  the  federal  health  enterprise  to  “speak   the  same  language”   •  In  2006,  adopted  LOINC  as  standard:   –  Laboratory  test  order  names   –  Medications:  Structured  Product  Labeling  Sections    
  28. 28. Consolidated  Health  Informatics  Initiative   •  In  2007,  CHI  adopted  LOINC  as  standard   for  federally-­‐required  assessments:   – questions  and  answers   – assessment  forms  that  include  functioning   and  disability  content  
  29. 29. Other  Key  US  Adoptions   •  UMLS   •  VA   •  CDC  PHIN  Initiatives   –  Implement  CHI  standards   •  IHS   –  Embarking  on  ~250  facility  mapping  process   •  NCQA/HEDIS   –  Healthcare  Effectiveness  Data  and  Information  Set   –  Used  90%  of  health  plans  to  measure  quality  
  30. 30. Other  Key  US  Adoptions   •  ARRA  “Meaningful  Use”   •  HITSP   –  C80:  vital  signs,  lab  results,  lab  orders,  genetic  results,  other  results   –  IS92:  newborn  screening   •  eLINCS   –  Standard  for  results  delivery  from  LIS  to  an  EHR   •  NAACCR   •  CDISC   –  Pharmaceutical  research  specs   •  NCI  –  caBIG   –  Lab  portion  adopted  as  caBIG  vocab  standard  
  31. 31. Other  Key  US  Adoptions   •  HL7  –  many  implementation  guides,  CDA,  etc   •  HIPAA  Claims  Attachments   •  Many  Regional  HIEs