A proposal for interoperable health information exchange with two Esperantos: ICF and LOINC. Presented at the 2010 NAAC ICF Conference: Enhancing our Understanding of the ICF.
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A proposal for interoperable health information exchange with two
Esperantos: ICF and LOINC® ICF and Biomedical Informatics – Part II
Daniel J. Vreeman, PT, DPT, MSc Assistant Research Professor, Indiana University School of Medicine Associate Director of Terminology Services, Regenstrief Institute, Inc
MSH|^~\&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay||||||||||||||| PID|||$patientId$||$patientName$|||||||||||||||||||| PV1|||||||$attendingDoctor$||$consultingDoctor$|||||||| OBR|1|||44249-1^PHQ-9 Quick Depression Assessment Pnl^LN||$requestDate||||||||| OBX|1|ST|44250-9^Little interest or pleasure in doing thing in last 2W^LN|1|3^More than half the days^LN||||||||||||| OBX|2|ST|44255-8^Feeling down, depressed, or hopeless in last 2W^LN|1|2^Several days||||||||||||| …
OBX|10|ST|44261-6^PHQ-9 Total Score^LN|1|11|||||||||||||
HL7 v.2.X Message
A brief digression about data models…
“Flat” Data Model
Patient_ID Provider_ID Date Height Weight Heart_Rate
1111 77777 2010 04 09 183 cm 90.7 kg 74 bpm
2222 77777 2010 04 09 152 cm 49.9 kg 65 bpm
One record per patient
“Stacked” Data Model Patient_ID Provider_ID Date Observation_Code Observation_Name Value Units
1111 77777 2010 04 09 1234-5 Body Height 183 cm
1111 77777 2010 04 09 2345-6 Body Weight 90.7 kg
1111 77777 2010 04 09 3456-7 Heart Rate 74 bpm
2222 77777 2010 04 09 1234-5 Body Height 152 cm
2222 77777 2010 04 09 2345-6 Body Weight 49.9 kg
2222 77777 2010 04 09 3456-7 Heart Rate 65 bpm
One record per observation
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
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
― Ophthalmology Measurements ― Clinical Documents
― Radiology Reports ― Document Sections
― Patient Assessment Instruments
The LOINC Community Open, Nimble, Pragmatic
A Highly ‘Open Source’ Model • LOINC (the database) and RELMA (the
mapping program) are available freely worldwide for nearly any purpose
• Much work is done by volunteers • Content additions are end-user driven
10 new members per day 300+ new members per month
Translation Efforts
Downloads: ~1100/month
US Adoption A few key highlights
Consolidated Health Informatics
• CHI Goal: – Adopting interoperability standards for all US federal
health agencies
• Adopted LOINC as standard – Laboratory result names (2003) – Laboratory test order names (2006) – Meds: structured product labeling sections (2006) – Federally-required patient assessment instruments
with functioning and disability content (2007) • Same process that adopted ICF as a standard for functioning
and disability domain
Other Key US Adoptions • eLINCS
– Messaging standard for results delivery from LIS to an EHR
• NAACCR – Volumes II (Data Standards/Dictionary) and V (Path Lab e-Reporting)
• CDISC – Pharmaceutical research specs
• NCQA/HEDIS – Used by 90% of US health plans to measure quality
ICF supporBng clinical observaBons panel Any supporBng clinical measurements for that ICF classificaBon (direct measures, assessment scores, etc)
1 to many
0 to many
Example ICF Result Package in LOINC
R/O/C Example Answers
NN-‐N ICF classifica9on panel
NN-‐N ICF classificaBon collecBon R Full
NN-‐N PopulaBon descripBon O Clinic population >65 years
NN-‐N DuraBon of observaBon period O Point in time
NN-‐N ICF classifica9on results panel R
NN-‐N ICF code stem R d450
NN-‐N ICF funcBoning classificaBon O d450.12
NN-‐N AcBviBes and parBcipaBon performance qualifier C 1 – MILD difficulty
NN-‐N AcBviBes and parBcipaBon capacity without assistance qualifier
C 2 – MODERATE difficulty
NN-‐N ICF suppor9ng clinical observa9ons panel O
59460-‐6 Morse Fall Risk Total 55
4195703 Mean walking speed 24H 0.9 m/sec
1 to N
0 to N
Benefits of Nested Model • Uses HL7-LOINC messaging framework while minimizing
redundant modeling • Accommodates ‘meta-data’ about the result package • Flexes to accommodate large or small sets of ICF codes • Enables explicit connection between ICF classification
and supporting clinical data • Accommodates sending alternate identifiers (e.g. UMLS
or SNOMED) for ICF components • Could also use the ICF classification result panel in
another context – nested under a regular clinical observation to convey the
higher level interpretation of that result
Next Steps • Looking for collaborators with live
systems that have a need to exchange ICF classifications electronically – And want to used established messaging