The document provides information about an upcoming Laboratory LOINC Workshop in Chicago, Illinois. It includes an agenda for the workshop covering topics such as the origins of LOINC, using the RELMA mapping tool, searching and mapping local terms to LOINC codes, and hands-on practice mapping terms. The workshop will be led by Daniel Vreeman from Indiana University and Clem McDonald from the National Library of Medicine.
2. Acknowledgements!
LOINC Development Team!
Kathy Mercer, Jaci Phillips, Ian Pyle, David Baorto,
Fran Brahmi!
!
RELMA Development Team!
John Hook, Mark Fisher, Karen Ahmed, Anandhi
Sowmyan, James Dennis!
!
LOINC Committee!
Supporters: NLM, Regenstrief, CHITREC,
Metropolitan Chicago Healthcare Council,
Chicago Department of Public Health!
3. Overview!
1. Origins of LOINC!
2. LOINC 101!
3. Using RELMA!
4. Searching and Mapping to LOINC!
5. Approaches to Mapping and
Domain-speci"c Help!
6. Other RELMA features!
7. Your turn!
8. Soda or Pop?!
what you see in the order list
!
Lab A! Lab B!
Test Name: Lyme Disease Serology! Test Name: Lyme Disease Antibody!
Measures: B. burgdorferi Ab IgG! Measures: B. burgdorferi Ab IgM!
Method: ELISA! Method: Immune blot!
Scale: quantitative! Scale: qualitative!
e.g.: Titer 1:40! e.g.: Positive!
! !
LOINC Code = 5062-5! LOINC Code = 6321-4!
9. Logical
Observation
Identi"ers
Names and
Codes!
A universal code system that facilitates exchange,
pooling, and processing of results!
10. If an observation is a question
and the observation value is
an answer…
!LOINC provides codes for
!questions
!Other vocabularies provide
!codes for the answers!
11. What is my patient’s
hemoglobin level?!
718-7:Hemoglobin:MCnc:Pt:Bld:Qn!
12. How fast does my
patient usually walk?!
41959-8:Walking speed:Vel:1W^mean:^Patient:Qn:Calculated
13. Indiana Network for Patient Care!
HL7 v.2.X Message!
MSH|^~&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay|||||||||||||||
PID|||$patientId$||$patientName$||||||||||||||||||||
LocalCode^LocalName^CodeSystem^LOINCcode^LOINCname^CodeSystem
PV1|||||||$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|
!"
Message Processor! !"
Institutional Repository!
14. 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|6609-2^Listeria ID^LN||36094007^L. monocytogenes^SCT
Code identifying this
observation ! Code identifying the
(what are these results? result (L. monocytogenes)!
Listeria culture)!
31. 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!
43. Currently 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 Classi"cation!
howRU!
Living with HIV (LIV-HIV)!
Morse Fall Scale!
OMAHA!
PHQ (9 and 2)!
Quality Audit Marker (QAM)!
!
50. Anatomy of a LOINC Term!
5193-8:Hepatitis B virus surface Ab:ACnc:Pt:Ser:Qn:EIA!
5193-8! LOINC Code!
Hepatitis B virus surface Ab! Component
!
ACnc
! Property Measured!
Pt
! Timing!
Ser
! System!
Qn! Scale!
EIA! Method!
There are six major LOINC axes
!
51. NOT part of a LOINC Name!
Testing instrument!
Speci"c details about the specimen!
Priority (e.g. STAT)!
Where testing was done!
Who did the test!
Test interpretation!
Anything not part of naming the test!
Stu# carried in other parts of HL7 message!
52. Component!
The substance or entity that is measured,
evaluated, or observed!
Sodium!
Glucose!
Brucella sp. organism!
In$uenza A Virus antigen!
Cytomegalovirus antibody!
Lipids.total!
5193-8:Hepatitis B virus surface Ab:ACnc:Pt:Ser:Qn:EIA!
53. Component Structure !
Analyte Name^Challenge^Adjustments
!
Formal analyte name! Calcium!
Specify “subanalytes”! Coronavirus Ag!
May have subclasses! Calcium.ionized!
! !
Challenge! 1H post 100 g Glucose PO!
Two parts separated <time delay>post<challenge type>!
by “post”! !
! !
Adjustments! Adjusted to pH 7.4!
54. Property! * the most di"cult LOINC axis!
The characteristic or attribute of the analyte that
is measured, evaluated, or observed.!
Major Categories:!
!mass!
!substance!
!catalytic activity!
!arbitrary!
!number!
5193-8:Hepatitis B virus surface Ab:ACnc:Pt:Ser:Qn:EIA!
55. Property! * the most di"cult LOINC axis!
Fully Named Properties! mg/dL!
MCnc! mass concentration! umol/L!
SCnc! substance concentration! mg/g!
MCnt! mass content ! U/L!
CCnc! catalytic concentration!
Prid! presence or identity!
Imp! impression!
Type! “kind of”!
Property is related to units of measure!
5193-8:Hepatitis B virus surface Ab:ACnc:Pt:Ser:Qn:EIA!
56. Common Property Issues!
Fraction versus Ratio!
Fraction = Part/Whole!
!NFr: % Eosinophils / leukocytes!
!SFr: % HGB which is A2!
! photo via jurvetson!
Ratio = multiple analytes from same system!
!MCrto: BUN/Creatinine in urine!
!
Relative Ratio = measures from di"erent system!
!RelRto: actual to normal control!
!
57. Timing!
The interval of time over which the observation
or measurement was made!
Pt! point in time!
12H! 12 hour collection!
24H! 24 hour collection!
Non-Pt timings are often !
found with Ratio Property!
58. System!
The system (context) or specimen type upon which the
observation was made.!
Ser! serum!
Ser/Plas! serum or plasma!
Bld! whole blood !
Ur! urine!
Flu! body #uid! photo via AlishaV!
Tiss! tissue!
XXX! speci$ed elsewhere !
5193-8:Hepatitis B virus surface Ab:ACnc:Pt:Ser:Qn:EIA!
59. System Structure!
System^Super System!
Super System!
Patient is the default!
Used to indicate!
blood product unit!
bone marrow donor!
fetus!
photo via Xurble!
818-5:A Ag:ACnc:Pt:RBC^BPU:Ord: !
11670-7:Blood $ow.mean:Vel:Pt:Aortic arch^fetus:Qn:US.doppler
!
61. Method!
Only needed if interpretation a#ected!
Di#erent normal ranges!
Test sensitivity!
Listed at the generic level!
Agglutination!
Immunoassay!
Probe with target ampli"cation!
5193-8:Hepatitis B virus surface Ab:ACnc:Pt:Ser:Qn:EIA
62. LOINC Parts !
Uses !
translation, synonymy, building hierarchies,
creating display names, linking descriptions!
66. What’s it Good For?!
Browse LOINC!
Map your local terms to LOINC!
!import/export!
!translate local words to LOINC-speak!
!manual/automated mapping!
70. Search Syntax!
Google-like!
AND, OR, -<word>, +<word>!
Limit by category (e.g. micro)!
Wildcards (? and *)!
!
Assumes EXACT MATCH
! unless you use wildcards!
71. More RELMA Features !
User Speci"ed Search Limits !
Selectable trees for:!
Class!
Multiaxial (component/system)!
System (specimen)!
Component!
Method!
73. Installation Steps!
Need Windows (or a VM on a Mac)!
Got disk space? 2Gb is recommended!
Start installer <drive>:RELMASetup!
Specify installation directory keep default!
Two database "les installed!
RELMA.MDB – LOINC terms database!
LMOF3.MDB – Local Master Observation File!
Two sample "les included !
Run it!!
74. File Locations!
Database and Ancillary Files!
Windows XP!
!
C:Documents and SettingsAll UsersDocumentsRELMA
Windows Vista and 7!
!C:UsersPublicDocumentsRELMA
!
Sample "les!
Windows XP!
!
C:Documents and SettingsAll UsersDocumentsRELMASamples
Windows Vista and 7!
!C:UsersPublicDocumentsRELMASamples
!
90. 4 Ways to Build LMOF!
1. Hand enter! bad!
2. Make your own table ! bad!
3. Import text "le from good!
your test catalog! !
4. Import from real HL7 best!
v2.x messages !
91. Make a Local Dataset!
Extract from Your Test Catalog!
Battery code!
Battery description or name!
*Local code !
*Test description or name!
Include method if important!
Units!
Example Values!
Laboratory Section!
92. Make a Delimited Text File!
Need separate "elds!
Use any delimiter!
Fields in any order!
Required "elds (minimum):!
Local Code!
Local Description!
Units (highly recommended)!
93. Importing Local Terms!
1. Start it up!
2. Find local term "le!
C:Documents and SettingsAll UsersDocumentsRELMASamples
C:UsersPublicDocumentsRELMASamples
3. Name your working set!
4. Identify "eld delimiter in your "le!
5. Match your "elds to LMOF
attributes!
6. Import!!
111. Prep Your Data for Mapping!
Improve mapping success!
!Expand abbreviations!
!Ignore “administrative” words!
!Standardize idiosyncratic words!
!Standardize time references!
RELMA can help!
147. View LOINC Term Details!
View details for a
speci"c LOINC Term !
Right clicking on a LOINC
term brings up a Task Menu !
148. 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!
178. A Few Tests Give Most Results!
100%!
Cumulative Laboratory Observation Volume (%)!
90%!
80%!
70%!
60%!
50%!
40%!
30%!
20%!
10%!
0%!
0! 500! 1000! 1500! 2000! 2500! 3000! 3500! 4000!
Number of Laboratory Observation Codes (N)!
Vreeman DJ, Finnell JT, Overhage JM. A Rationale for Parsimonious Laboratory Term Mapping by Frequency. AMIA Annu Symp Proc. 2007;:771-775.
!
179.
180. Setting Search Limits!
include Trial, Deprecated or
Discouraged LOINC codes with
returned terms !
181. LOINC Term Status!
Trial!
! as the concept and associated attributes may change.
Concept is experimental in nature. Use with caution
Discouraged!
! mappings to this concept are discouraged although
Concept is not recommended for current use. New
existing mappings may continue to be valid in
! context.
Deprecated!
Concept is retired and should not be used, but it is
retained in LOINC for historical purposes.
182. Include Deprecated LOINC Terms!
Can’t map to a deprecated term!
Warning before mapping to discouraged term!
Discouraged LOINC Terms appear as an
inverted triangle!
Deprecated LOINC Terms appear as strikethrough text
with a “Do Not” symbol!
183. LOINC Hierarchies – Class Tree!
Three top-level
branches !
Tree Navigation
Buttons!
191. Hierarchy Wrap-up!
All trees operate the same way!
All grids operate the same way!
Tree is searchable !
Combine tree limits with others!
“Mulligan” button!
192. Search Hints and Tips!
Zero hit keywords are ignored!
!(may need to rephrase)!
!
Common causes of Zero results!
!Too many keywords!
!Limits and keyword contradictions!
!Local term weirdness!
!
Units are GREAT discriminators!
194. What Does It Do?!
Batch processes local term "le to get
N- closest candidate LOINCs!
!
Uses words and units from local terms!
!
Produces a ranked list for your review!
195. Recent Improvements!
Faster. Way faster.!
Better clean-up routine!
New specimen guesser!
Better local to LOINC word "nder!
Break ties with frequency data!
196. Does it Work?!
Lab terms (internal analysis)!
!#1 ranking: 60-70ish%!
!In Top 5: 70-80ish%!
!
Radiology terms!
!#1 ranking: 80-90ish%!
!In Top 5: 90ish%!
!Using CPT-based restriction helped!
!(but we couldn’t distribute it)!
Vreeman DJ, McDonald CJ. A Comparison of Intelligent Mapper and Document Similarity Scores
for Mapping Local Radiology Terms to LOINC. Proc AMIA Symp. 2006;809-813.!
!
Vreeman DJ and McDonald CJ. Automated Mapping of Local Radiology Terms to LOINC. Proc
AMIA Symp. 2005;769-773.!
197. (Lab) Auto Mapper!
launch it here!
a couple of options
!
print report or work through
the ranked list when done !
203. Additional Pearls and
Guidance!
Clem McDonald, MD!
Director, Lister Hill National Center for Biomedical Communications – National Library of Medicine !
204. Other RELMA ®
Features!
Oh yes, there’s more!!
205. Using Your Mapped Terms!
You’ve done the work. Now reap the glory.!
photo via janeandd!
225. Proposing a New Term!
Are you sure?!
Give us all you got!
RELMA is best!
Send them in groups!
226. What We Need!
• Local test/observation name!
• Local order (panel) name!
• Description of the test !
• Name of send out lab (if applicable)!
• Name of healthcare organization that stimulated the request for
this term (if you are submitting on behalf of someone else)!
• Units of measure (for quantitative observations)!
• Answer lists (for qualitative observations)!
• Sample results, reports (if applicable)!
• Package inserts, test kit documentation (if applicable)!
• Vendor, instrument, and/or reagent kit used to perform this test (if
applicable)!
• Description of the project or activity that stimulated the request
for this term, or any other documentation you have!
232. Review Proposed Terms!
Choose whether to
send or postpone!
All proposed terms
fully editable!
233. Submitting New Terms!
Still need to email us the "le!
!submissions@loinc.org!
!
More Information!
!http://loinc.org/submissions!
!
LOINC Submissions Policy!
!http://loinc.org/submissions-policy!
!
!!