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![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$||||||||!
OBR|1|||012^CBC/Auto Diff^HSPA^57021-8^CBC ! Auto Diff^LN||$reqDate|||||||||!
W
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](https://image.slidesharecdn.com/20120320-loinc-introduction-amia-120321105433-phpapp02/75/2012-03-20-LOINC-Introduction-AMIA-KRS-WG-21-2048.jpg)
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Similar to 2012 03 20 - LOINC Introduction - AMIA KRS-WG
2012 03 20 - LOINC Introduction - AMIA KRS-WG
- 1. AMIA Knowledge andSemantics WG Webinar LOINC An Introduction to the Universal Catalog of Laboratory and Clinical Observations Daniel J. Vreeman, PT, DPT, MSc Assistant Research Professor, Indiana University School of Medicine Associate Director for Terminology Services, Regenstrief Institute, Inc 03.20.2012 loinc@loinc.org © 2012
- 2. Overview 1. Origins and Evolution of LOINC 2. LOINC Introduction 3. Mapping Tools and Resources 4. Closing Thoughts photo via Vernio77
- 3. Acknowledgements LOINC Development Team ClemMcDonald, Kathy Mercer, Jaci Phillips, Jami Deckard, David Baorto, Kelly Malott RELMA Development Team John Hook, Mark Fisher, Karen Ahmed, Anandhi Sowmyan, James Dennis LOINC Committee Supporters: NLM, Regenstrief Institute, Regenstrief Foundation
- 4. Biomedical Informatics at RegenstriefInstitute Building data-rich systems for clinicians
- 5. Origins of LOINC Thelingua franca of clinical observation exchange
- 6. 40+ Years of CanopyComputing 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.
- 7. e rain forestcanopy is a seamless web through which arboreal creatures efficiently move to reach the edible fruits without any attention to the individual trees. photo via nosha
- 8. 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
- 11. Fundamental challenge: local systemshave different ways of identifying the same concept
- 12. A vocabulary standard wouldserve as the Rosetta Stone. Image © Hans Hillewaert / CC-BY-SA-3.0
- 13. Logical Observation Identifiers Names and Codes A universal code system that facilitates exchange, pooling, and processing of results
- 14. Established in 1994by Regenstrief Institute. Vocabulary standard for observation identifiers.
- 16. Same or Different? 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
- 17. Similar name, differentmeaning… photo via Caption Time meerkat meerkat mere cat meerkat
- 18. If an observationis a question and the observation value is an answer… LOINC provides codes for questions Other vocabularies provide codes for the answers
- 19. What is mypatient’s hemoglobin level? 718-7:Hemoglobin:MCnc:Pt:Bld:Qn
- 20. How fast doesmy patient usually walk? 41959-8:Walking speed:Vel:1W^mean:^Patient:Qn:Calculated photo via Ed Yourdon
- 21. Indiana Network forPatient 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$||||||||! OBR|1|||012^CBC/Auto Diff^HSPA^57021-8^CBC ! Auto Diff^LN||$reqDate|||||||||! W 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
- 22. Result with aCoded 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)
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- 25. Laboratory LOINC CommitteeChair: Clem McDonald, MD Clinical LOINC Committee Chair: Stan Huff, MD
- 26. The LOINC Community Open.Nimble. Pragmatic.
- 27. Open Development Worldwide distributionat no cost End-user content additions Welcome all comers Volunteers
- 28. Funding Support Principal currentsources are: U.S. National Library of Medicine Regenstrief Foundation Prior support from Several other U.S. federal agencies, John A. Hartford Foundation
- 29. Regenstrief Institute Steward Developer ofcontent Developer of tools Developer of community Distributor Voice
- 31. 5/ 0! 10,000! 12,000! 14,000! 16,000! 18,000! 2,000! 4,000! 6,000! 8,000! 2/ 08 ! 7/ 2/ 08 ! 9/ 2/ 08 11 ! /2 /0 8! 1/ 2/ 09 3/ ! 2/ 09 ! 5/ 2/ 09 ! 7/ 2/ 09 ! 9/ 2/ 09 11 ! /2 /0 9! 1/ 2/ 10 3/ ! 2/ 10 ! 5/ 2/ 10 ! 7/ 2/ 10 ! 9/ 2/ 10 11 ! /2 /1 0! 1/ 2/ 11 Doubled in 19 months! 3/ ! 2/ 11 ! 5/ loinc.org members 2/ 11 ! 7/ 2/ 11 ! 9/ 2/ 11 11 ! /2 /1 1! 14 new members per day 1/ 2/ 12 ! 410 new members per month
- 32. 16,300+ users in145 countries
- 33.
- 34. Major releases twice peryear (June and December) photo via striatic
- 35. LOINC Codes OverTime By Release 80,000 LOINC Codes Lab Codes 70,000 Slope = 2200 60,000 50,000 Slope = 600 40,000 30,000 20,000 10,000 laboratory terms only 0
- 36. Lots Cooking… Always morelab tests Genetic reporting Flow cytometry Lots of survey instruments, forms, and assessments More radiology reports Structured document titles … photo via liber
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- 39. Just kidding. Copyright isa good thing for standards. It’s the licensing part that is interesting.
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- 42. Any purpose: commercial non-commercial photo via Refracted Moments™
- 43. Cannot use any LicensedMaterial to develop or promulgate a different standard for orders or observations.
- 44. That would defeat the purpose of having a standard!
- 45. International Adoption participation, translation,implementation
- 46. LOINC Submitters Since 2009 79 organizations from 14 countries
- 47. LOINC Translators 19 organizations
- 48. 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)
- 50. Vreeman DJ etal. Enabling international adoption of LOINC through translation. J Biomed Inform (2012), doi:10.1016/j.jbi.2012.01.005
- 51.
- 52. Adopted as NationalStandard Brazil Canada France Germany The Netherlands Mexico Rwanda Thailand
- 53. Large Implementations SIGA Saúdeproject Canada Health Infoway ePSOS Assistance publique - Hôpitaux de Paris Red Agrolab BiTAC Hong Kong Hospital Authority Many more…
- 55. US Adoption A fewkey highlights
- 56. Some Key USAdoptions All the big labs All health-related federal agencies Lots of care organizations HIE’s Insurance companies EHR vendors Instrument manufacturers (nascent)
- 57. EHR Incentive Program a.k.a. “Meaningful Use”
- 61. LOINC adopted for: 1. View, download, transmit data to third party 2. Cancer case reporting to state registry 3. Send/receive electronic lab results in ambulatory settings 4. Provide a care summary at care transition 5. Provide clinical summaries for patients 6. Submit reportable lab results to public health
- 62. LOINC Names Introduction toLOINC Naming Conventions
- 63. Anatomy of aLOINC 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
- 64. NOT part ofa LOINC Name Reason for the test (disease it diagnoses) Testing instrument Specific 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 Stuff carried in other parts of HL7 message
- 65. Component The substance or entity that is measured, evaluated, or observed Sodium Glucose Brucella sp. organism Influenza A Virus antigen Cytomegalovirus antibody Lipids.total 5193-8:Hepatitis B virus surface Ab:ACnc:Pt:Ser:Qn:EIA
- 66. 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
- 67. Property * the most difficult 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
- 68. Property * the most difficult LOINC axis Fully Named Properties MCnc mass concentration mg/dL SCnc substance concentration umol/L MCnt mass content mg/g CCnc catalytic concentration U/L 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
- 69. Timing The interval oftime 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 5193-8:Hepatitis B virus surface Ab:ACnc:Pt:Ser:Qn:EIA found with Rate Property
- 70. 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 fluid photo via AlishaV Tiss tissue XXX specified elsewhere 5193-8:Hepatitis B virus surface Ab:ACnc:Pt:Ser:Qn:EIA
- 71. System Structure System^Super System Super System Patient is the default Used to indicate: blood product unit, bone marrow donor, fetus 818-5:A Ag:ACnc:Pt:RBC^BPU:Ord: 11670-7:Blood flow.mean:Vel:Pt:Aortic arch^fetus:Qn:US.doppler
- 72. Scale Qn Quantitative continuous numeric can have operators Ord Ordinal Ranked set (1+, 2+, 3+) photo via puuikibeach Nom Nominal unranked collection Taxonomy (e.g. bacteria) Nar Narrative 5193-8:Hepatitis B virus surface Ab:ACnc:Pt:Ser:Qn:EIA
- 73. Method Only needed ifinterpretation affected Different normal ranges Test sensitivity Listed at the generic level Agglutination Enzyme Immunoassay Probe with target amplification 5193-8:Hepatitis B virus surface Ab:ACnc:Pt:Ser:Qn:EIA
- 74. LOINC Collections Panels, forms,surveys, and other patient assessments photo via LuzA
- 75. Standardized Assessments andCollections 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.
- 76. Iteratively expanded the baselab panel model to accommodate more complex attributes
- 77. Hierarchy of aPanel in LOINC
- 78. Purpose Assessments are widelyused… …and not unlike other clinical observations
- 79. LOINC could bea master question file and uniform representation
- 81. Panels/Forms Available as Separate Download
- 82. Tools for Implementers photo via Robert S Donovan
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- 85. A Few TestsGive 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.
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- 88. search.loinc.org If you wantto poke around…start here!
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- 92. RELMA® REgenstrief LOINC MappingAssistant
- 93. What’s it GoodFor? Browse LOINC Map local terms to LOINC import/export translate local words to LOINC-speak manual/automated mapping
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- 95. Mapping Screen Navigate through the local terms Begin a search (or hit “enter”)
- 96.
- 97. LOINC Terms withSpanish Linguistic Variant All Spanish!
- 98. Closing Themes General recommendationsfor health data exchange with LOINC photo via janeandd
- 99. Not just anIT problem
- 100. Don’t Assume Units ofmeasure are critical. Sample results can help identify the correct LOINC Scale. Local experts, package inserts can be very informative.
- 101. Clean water act photo via Fishking_1
- 102.
- 103. A journey. Nota destination.
- 104. Ongoing Journey Plan forupdating as your testing changes (less common), or your local code identifiers change (more common).
- 105. Ongoing Journey Replace mappingsto deprecated terms with new LOINC releases. (RELMA can help)
- 107. Prioritization Local or nationalpolicies may help prioritize mapping subsets. For example: common results + panel elements + public health reportable tests
- 108. Jump In! photo via Justin Ornellas
- 109. The Race isOn! Happy LOINCing! photo via ryarwood
- 110. photo via milosmilosevic