2013 02 27 - LOINC from Regenstrief - A lingua franca for clinical observations in electronic messages and attachments

8/13/2019 2013 02 27 - LOINC from Regenstrief - A lingua franca for clinical observations in electronic messages and attachments

1/57

[email protected] 02 27

National Committee on Vital and Health Statistics

Subcommittee on Standards

A lingua francafor clinical observations in

electronic messages and attachments
mailto:[email protected]:[email protected]:[email protected]


2/57


3/57

40 years of EMR workndiana

etwork for

atient

are

Regenstrief Informatics Pioneers

Nations most comprehensive and longest tenured HIE


4/57

Fundamental challenge:

Local systems have different ways ofidentifying the same concept. And,

things that look alike arent the same.


5/57

Same or Different?

Lab ATest Name: Lyme Disease Serology


6/57

Same or Different?


Lab BTest Name:Lyme Disease Antibody


7/57

Same or Different?


Lab BTest Name:Lyme Disease Antibody

What you see in the test catalog


8/57

Same or Different?


What you see in the test catalogLab BTest Name: Lyme Disease Antibody

Measures: B. burgdorferiAb IgM

Method: Immune blot

Scale: qualitative

e.g.: Positive


9/57

Same or Different?


Measures: B. burgdorferiAb IgG

Method: ELISA

Scale: quantitative

e.g.: Titer 1:40



Method: Immune blot

Scale: qualitative

e.g.: Positive


10/57

Same or Different?


Measures: B. burgdorferiAb IgG

Method: ELISA

Scale: quantitative

e.g.: Titer 1:40



Method: Immune blot

Scale: qualitative

e.g.: Positive


11/57

Outpatient

Pain Note

Dr. Evils Tues

PM Pain Clinic

Note

Chronic Pain

Clinic

Same phenomenon in many domains...


12/57

A vocabulary standard

would serve as theRosetta Stone.

Image Hans Hillewaert / CC-BY-SA-3.0
http://creativecommons.org/licenses/by-sa/3.0/http://creativecommons.org/licenses/by-sa/3.0/http://creativecommons.org/licenses/by-sa/3.0/http://creativecommons.org/licenses/by-sa/3.0/


13/57

ogical

bservation

dentifiers

ames and

odesA universal code system that facilitates exchange,

pooling, and processing of results


14/57

Born in 1994 by Regenstrief Institute.

Worldwide distribution at no cost.

Copyrighted, but open license.

Released twice per year.


15/57






16/57





Its free, but invaluable.


17/57







18/57






Just dont use it to make another standard!


19/57

Laboratory LOINC


20/57

Clinical LOINC

LOINC C d O Ti b R l


21/57

12345678

4/24

/199

5|1

.0

5/24/

1995

|1.0

a

6/23/

1995

|1.0b

6/28/

1995

|1.0

c

7/14/

1995

|1.0

d

9/15/

1995

|1.0

e

12/21/

1995

|1.0

f

4/28/

1996

|1.0

g

8/29/1

996|1

.0h(

2)

12/3/1

996

|1.0h(

3)

1/8

/199

97|1

.0i

10/9/1

997

|1.0j-a

5/1/

1998

|1.0k

2/1

2/19

99|1

.0l

7/23

/199

9|1

.0m

8/6/19

99|1

.0m

a

2/4/

2000

|1.0

n

6/13/

2000

|1.0

0

1/1/

2001

|2.0

0

1/31/

2001

|2.0

1

7/1/

2001

|2.0

3

1/1/

2002

|2.0

4

2/1/

2002

|2.0

5

2/19/

2002

|2.0

6

8/1/

2002

|2.07

9/1/

2002

|2.0

8

5/1/

2003

|2.0

9

10/1/

2003

|2.1

0

1/1/

2004

|2.1

1

2/1/

2004

|2.1

2

12/1/

2004

|2.1

3

12/1/

2004

|2.1

4

6/1/

2005

|2.1

5

12/1/

2005

|2.1

6

6/1/

2006

|2.17

12/2

1/20

06|2

.19

6/2

1/20

07|2

.21

12/0

3/20

07|2

.22

7/1

0/20

08|2

.24

1/1

0/20

09|2

.26

07/0

6/20

09|2

.27

12/3

0/20

09|2

.29

2/2

6/20

10|2

.30

6/1

5/20

10|2

.32

12/2

9/20

10|2

.34

06/3

0/20

11|2

.36

12/3

0/20

11|2

.38

6/3

0/20

12|2

.40

12/3

0/20

12|2

.42

LOINC Codes

Only Lab LOINC Codes

LOINC Codes Over Time by Release

laboratory terms onlyno data on the lab/clinical split prior to 2000


22/57

21,000+ users in 150 countries

l i b


23/57

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

22,000

6/1/08

12/1/08

6/1/09

12/1/09

6/1/10

12/1/10

6/1/11

12/1/11

6/1/12

12/1/12

loinc.org members


24/57


25/57


26/57


27/57


28/57

Adopted as National Standard

AustraliaBrazil

Canada

Cyprus

Estonia

FranceGermany

MexicoMongolia

The Netherlands

Rwanda

Thailand

TurkeyUnited States


29/57

US AdoptionA few key highlights


30/57

Some Key US Adoptions

All the big labsAll health-related federal agencies

Lots of care organizations

HIEs

Insurance companies

EHR vendorsInstrument manufacturers (nascent)


31/57

CMS EHR Incentive

Program

a.k.a. Meaningful Use


32/57


33/57


34/57


35/57


36/57

photo via IMLS DCC
http://www.flickr.com/photos/imlsdcc/5637868432/sizes/o/in/photostream/http://www.flickr.com/photos/imlsdcc/5637868432/sizes/o/in/photostream/http://www.flickr.com/photos/imlsdcc/5637868432/sizes/o/in/photostream/


37/57

with LOINC insideC-CDA


38/57

In attachments,

LOINC codes are usedfor 3 main purposes

claimso

rother

^


39/57

To identify the specific kind ofinformation being communicated

in both a request and response.

Each LOINC code that is allowed as an attachment is flagged

for use as Structured or Unstructured in the database.


40/57

To identify the specific kind ofinformation being communicated

in both a request and response.

Each LOINC code that is allowed as an attachment is flagged

for use as Structured or Unstructured in the database.

e.g. discharge summary, radiology report,

consent form, etc


41/57

To (optionally) specify variables

that modify parameters used in

fulfilling the request forinformation.


42/57

To (optionally) specify variables

that modify parameters used in

fulfilling the request forinformation.

e.g. codes that indicate a modification tothe default time period


43/57

In attachment responses using HL7

(C-)CDA, LOINC codes identify the

attachment (document) type, sections,

and sometimes individual entries (testsor observations).


44/57

In attachment responses using HL7

(C-)CDA, LOINC codes identify the

attachment (document) type, sections,

and sometimes individual entries (testsor observations).

e.g. for a Continuity of Care DocumentDocument Type: 34133-9 (Summarization of episode note)

Section: 8716-3 (Vital signs)

Entry: 9279-1 (Respiratory Rate)


45/57

Tools forImplementers

photo via Robert S Donovan

loinc org/attachments
http://www.flickr.com/photos/booleansplit/http://www.flickr.com/photos/booleansplit/


46/57

loinc.org/attachments


47/57

search.loinc.orgonline look-up tool for LOINC

search loinc org


48/57

search.loinc.org


49/57

RELMA Search Window


50/57

RELMA Search Window

RELMA Search Window

i l tt h t i


51/57

RELMA Search Windowspecial attachments viewer

Structured Attachments


52/57



ll t C C A


53/57

Structured Attachmentsallowed sections from C-CDA

Unstructured Attachments


54/57

Unstructured Attachments

Request Modifier Codes


55/57

q


56/57


57/57

2013 02 27 - LOINC from Regenstrief - A lingua franca for clinical observations in electronic messages and attachments

Documents