This document discusses LOINC's model for standardizing patient assessments and forms. It provides an overview of LOINC's current efforts to represent common health assessments, including various government forms and clinical screening tools. The presentation notes that while these assessments address similar concepts, there is significant variation in how the items are structured between different forms. It recommends starting with LOINC's standardized data model to help address inconsistencies and avoid unnecessary variation. Lessons learned include the high costs of losing comparability and that intellectual property issues pose large challenges for standardization.

1. Panels, Forms, and Patient Assessments
Daniel J. Vreeman, PT, DPT, MSc
Assistant Research Professor, Regenstrief Institute, Inc.
Associate Director of Terminology Services, Indiana University School of Medicine
Clinical LOINC Meeting | 01/27/2011
Copyright © 2011

2. Overview
Background
Standard Panels in LOINC
Patient Assessment Model
Current Projects
Lessons Learned

3. Introduction
Assessments are widely used…
…and not unlike other clinical observations

4. LOINC could be a
master question file
and
uniform representation

5. AMIA 2010 Paper

6. Upcoming paper in Int J Funct Inform Personal Med

7. Iterative Refinement
Started almost 10 years ago
Gradually expanded the base panel model
Informing ideas:
– Survey instruments have psychometric properties
– Question meaning tightly coupled with answers
Many collaborators
– esp Tom White, Susan Bakken
– CHI Functioning and Disability workgroup
– ASPE, AHIMA, CMS, RTI, HL7, HITSP

8. Consolidated Health Informatics

11. LOINC Model for
Patient Assessments

12. Hierarchy of a Panel in LOINC

13. Assessment Items
Question Text
Question Source
External Copyright
Terms of Use
Description/Definition
Units of Measure (UCUM)
HL7 Data Types (v2, v3)

14. Structured Answer Lists
Answer List Attributes
– OID
– External Link
Answer Item Attributes
– ID (contains “LA” prefix)
– String
– Sequence
– Local code
– Score

15. Attributes of Items in a Panel Instance
Display name override
Coding instructions
Cardinality
Local code on that form
Skip logic
Data type in form
Answer sequence override
Consistency/validation checks
Relevance equation

17. Panels/Forms Available as
Separate Download

18. 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 Classification
howRU
Living with HIV (LIV-HIV)
Morse Fall Scale
OMAHA
PHQ (9 and 2)
Quality Audit Marker (QAM)

19. Find them in RELMA

20. Latest Additions…

21. Opportunities
CDC
APA
APTA
Many more…

22. Lessons
and
Recommendations

23. Advantages of the Master Catalog
PHQ
GDS
TIMP
LOINC

24. Advantages of the Master Catalog

25. Lesson 1
Variation Abounds

26. Variation Abounds
Despite similarity items, much
variation…
…many differences might have
been avoided

27. Original PHQ-9
CARE
MDSv3

28. MDSv3
MDSv2
OASIS
CARE

29. MDSv2
• Frequency with which resident complains or shows evidence of
pain (in last 7 days)?
• No pain, Pain less than daily, Pain daily
• How much of the time have you experienced pain or hurting over
MDSv3
the last 5 days?
• Almost constantly, Frequently, Occasionally, Rarely, Unable to
answer
CARE
• Have you had pain or hurting at any time during the last 2 days?
• Yes, no, unable to respond
• Frequency of Pain Interfering with patient's activity or movement
OASIS-B1
• Patient has no pain or pain does not interfere with activity or
movement, Less often than daily, Daily but not constantly, All of
the time
• Frequency of Pain Interfering with patient's activity or movement
OASIS-C
• Patient has no pain, Patient has pain that does not interfere with
activity or movement, Less often than daily, Daily but not
constantly, All of the time

30. Weigh the cost of losing
comparability before
inventing something new

31. Lesson 2
Starting from a uniform data
model may bring clarity

32. We usually started from paper forms…
…but some had custom programs and databases

33. Discrepancies and Incongruences
How do you store “Other specified ____________”
Which text is the question and which is help
Storing “unknown” or “unable to determine” as
answers versus flavors of null
Every “check all that apply” stored as a separate
yes/no binary value item

34. Many Yes/No Diseases

35. Starting with the LOINC
model may help elucidate
hidden challenges

36. Lesson 3
IP issues present large
challenges

38. Funders should require
developers to
avoid restrictive licenses

39. Conclusion
LOINC has a uniform model with a
(rapidly) growing “master question file”
that enables interoperable exchange of
assessment data

40. Acknowledgements
Clinical LOINC Committee
Kathy Mercer, Jo Anna Hernandez, Jaci Phillips
Regenstrief Software Engineers
Michelle Dougherty, Barbara Gage, Jennie
Harvell, Tom White
Funding Support
NLM: HHSN2762008000006C
AHIMA Foundation: FORE-ASPE-2007-5
RTI International: 0-312-0209853