2008 06 09 - Laboratory LOINC Workshop and Tutorial

1. Using RELMA Or… In Search of the Missing LOINC © 2007 Regenstrief Institute & James Case James T. Case MS, DVM, PhD Professor, Clinical Diagnostic Informatics California Animal Health and Food Safety Laboratory University of California, Davis Laboratory LOINC Meeting – June 2008

11. LOINC ® 101

12. Anatomy of a LOINC Term 5193-8 LOINC Code Hepatitis B virus surface Ab ACnc Pt Ser Qn EIA Component Property Measured Timing System Scale Method There are six major LOINC axes 5193-8:Hepatitis B virus surface Ab:ACnc:Pt:Ser:Qn:EIA

20. System The system (context) or specimen type upon which the observation was made. Super System Second subpart (^). When not included, “patient” is the default. Used to indicated blood product unit (BPU), a bone marrow donor, or a fetus.

25. RELMA ® Regenstrief LOINC Mapping Assistant

37. Installing RELMA®

39. Running RELMA®

40. Copyright Screen © 2006 Regenstrief Institute & James Case

41. Main Menu/Welcome Screen © 2006 Regenstrief Institute & James Case Click File, Set Preferred Language

42. Select Linguistic Variant(s)

43. LOINC Terms with Spanish Linguistic Variant Spanish!

44. Welcome Screen

45. Setting User Preferences

46. Select User Preferences From the File Menu Set User Preferences

47. Set User Preference Dialog © 2006 Regenstrief Institute & James Case User Name or Initials File Locations Startup Screen Preference RELMA Color Scheme

48. RELMA Color Schemes Predefined Schemes Create, Save, Delete custom color schemes Customize Colors

49. User Map Screen Preferences Click Map Screen Tab

50. Importing Local Terms into RELMA

54. Entering New Local Terms into RELMA

55. Manual Enter/Edit © 2006 Regenstrief Institute & James Case View/Add/Edit Local Terms

56. Edit Term Dialog Add New Test Print Preview List Text alignment option Custom Export Format

57. Add Local Term Form Click to Add to Current Working File MICRO BUBPLAG BUBONIC PLAGUE – RRT PCR

58. Print Preview Local Term File

59. Text Alignment Truncated vs. Wrapped Truncated terms end with ellipsis

60. Custom Export Options Output Options

61. Exported as Excel File

63. Example Delimited File © 2006 Regenstrief Institute & James Case

64. Importing Local Files © 2006 Regenstrief Institute & James Case Select Import Local Terms

65. Open File in RELMA © 2006 Regenstrief Institute & James Case Name your working set. RELMA allows multiple sets in LMOF database Select your delimiter Import Button

66. Open File in RELMA © 2006 Regenstrief Institute & James Case

67. Fields Segregated © 2006 Regenstrief Institute & James Case Assign LMOF Attribute

68. Ready to Import © 2006 Regenstrief Institute & James Case Now you can click this button!

70. Generate Local term file from HL7 messages Select Import Terms from HL7 File

71. Select File to Import Select HL7 File

72. Specify HL7 File Name and Sample Size Name the Local Term File (working set)

73. HL7 Messages Data Statistics © 2006 Regenstrief Institute & James Case

74. New Terms added to LMOF New Battery Code Sample Data

76. Cleaning your data

79. RELMA Cleaning Tools Use this tool to find unknown terms

80. Scanning Local Terms

81. Replace Local Terms © 2006 Regenstrief Institute & James Case Assign LMOF Attribute Replacement Options

82. RELMA Cleaning Tools Use this tool to make global substitutions

83. Term Substitution Save this global substitution for only this working set

84. Mapping Local Terms

87. Mapping Screen View or edit local term

88. View Local Term Details © 2006 Regenstrief Institute & James Case

89. Standard Mapping Screen Begin a search

90. Initial Mapping Results Click to show words used in search EEK! What’ll I do?!

91. Initial Mapping Results Use term checkbox Number of LOINC terms containing keyword Battery terms included in search

92. Revised Mapping Results Number of matching records found Match units selected by default

93. Re-revised Mapping Results Number of matching records found Match units unselected

94. Standard Mapping Screen Clear all input fields

95. Cleared Mapping Screen Enter keywords here CANINE DISTEMPER VIRUS IF

96. Ad hoc term search

97. Standard Mapping Screen Navigate through the local terms Show entire local term file

98. Show all terms Displays printed report format

99. © 2006 Regenstrief Institute & James Case

100. Additional Search Screen Options Navigate to viewed screens View Mode: Grid (default) or Tree (new)

102. Tree View Cannot map to these Can map to these

103. Assigning a LOINC Map Highlight correct term Click “Map” Button (or doubleclick)

104. Adding Mapping Comments If comments option is selected, prompt appears Check with Frank in Chemistry

105. Assigning a LOINC Map LOINC Term Assigned

106. View LOINC Term Details Right clicking on a LOINC term brings up a Task Menu View details for a specific LOINC Term

107. LOINC Term Details Can scroll through returned subset of terms Change to expanded details view Change text size Can scroll down a single formatted page

108. Expanded Details View

109. Expanded Details View

112. Limiting Searches

115. Setting Search Limits Click Hierarchy & Search Limits Button

117. Search Constraints Predefined, general search constraints Attribute trees Local Unit Constraint: Now defaults to “ON”

118. Terms Consistent with Units Only terms consistent with mmol/L appear

119. Setting Search Limits Specimen constraints

120. Terms Consistent with Specimen CSF Enter default Specimen

121. Terms Consistent with Specimen Only CSF Terms are returned

122. Setting Search Limits Methodless Terms Restriction Override Methodless Terms Restriction

123. Limit to Methodless Terms

124. Limit to Methodless Terms Only Methodless Terms Appear

126. Methodless Only Unchecked All terms returned

127. Methodless Only Checked Only Methodless terms returned

128. Conditional Methodless More terms returned

129. Setting Search Limits Limit to Lab Tests Only (No Clinical LOINC Terms)

130. Setting Search Limits Limit to lab tests that comprise 99.8% of INPC volume

131. Setting Search Limits Limit Number of Words in the Component Attribute

132. Limit Number of Component Words Without Limit Applied: 698 terms returned

133. Limit Number of Component Words With Limit Applied: 64 terms returned Restriction appears on Toggle Bar (cannot toggle off)

134. Setting Search Limits Include Deprecated LOINC Codes with Returned Terms

135. Include Deprecated LOINC Terms Deprecated LOINC Terms appear as Strikethrough Text with a “Do Not” Symbol

136. Favor Property Restriction Favor one type of property over others

137. Order/Observation Restriction Order or Observation preference

138. LOINC Hierarchies – Class Tree Three top-level branches Tree Navigation Buttons

139. Before Class Restriction Large number of candidate terms Many terms have class of “CHAL”

140. Search Trees chal Restrict eligible tests to non-challenge chemistry tests only

141. Following Class Restriction Only Non-Challenge Chemistry tests returned

142. Improvements to Trees Continued reorganization to provide a Specimen hierarchy

143. Improved Hierarchy for Component Show the LOINC Codes associated with these components

144. Show Associated LOINCs Click on details for more information about the selection

145. Details Screen

146. Tree Export Tools Save tree data to a file Export tree data to Excel Send Tree data as email

148. Navigating through the Mapping Process

150. Vreeman DJ, Finnell JT, Overhage JM. A Rationale for Parsimonious Laboratory Term Mapping by Frequency. AMIA Annu Symp Proc . 2007;:771-775.

155. Picking the Intelligent Mapper

156. Intelligent Mapper Start Screen

157. Intelligent Mapper - Mapping Screen

158. Exporting Mapped Terms Export Terms to Delimited File

159. Export Terms Dialog Check Fields you wish to export Select Delimiter

160. Output File © 2006 Regenstrief Institute & James Case Mapped terms include LOINC code

161. Other RELMA ® Features

162. Panels, Forms and Survey Review New Menu Function: Review Panels, Forms and Surveys

163. Government Forms Form Name Component LOINC terms

164. Laboratory panels Expand category to see panels Double-click panel name to see components

165. Expanded Panel Detail

166. Expanded Clinical Panel © 2006 Regenstrief Institute & James Case

167. Clinical Panels New Feature: Find where a term has been used

168. LOINC Term Usage 35089-2, 35090-0

169. LOINC Term Panel Usage

170. Other Survey Instruments

171. HIPAA Attachments View Various HIPAA Attachments

172. HIPPA Attachment Tree

173. Expanded Attachment Data

174. Can’t find the term you want?

176. Proposing New LOINC Terms

178. Propose new LOINC terms Select Propose a LOINC

179. Propose new LOINC terms Navigate through proposed terms Create new term, save current term or Exit form

180. Preview Proposed Terms Review your new terms

181. Preview Proposed Terms All proposed terms fully editable Choose whether to send or postpone X X X X

182. Use Existing Terms as Template Select your closest match Click the Propose Term button

183. Use Existing Terms as Template All required components filled in

184. Using LOINC and SNOMED Together

187. OBX: With a Coded Value OBX||CE|6609-2^Listeria ID^LN||36094007^L. monocytogenes^SCT The code is from SNOMED The code is from LOINC OBX-5: Data A code for L. monocytogenes A code that identifies the data type in OBX-5 as a coded element OBX-3:A code that identifies the data in OBX-5 (Listeria culture)

189. Q and A Session

190. Exercise Map your own data

191. Need RELMA? http://tinyurl.com/2vrms7