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Daniel J. Vreeman, PT, DPT, MScAssociate Research Professor
, Indiana University School of Medicine
Associate Director for Terminology Services, Regenstrief Institute, Inc
2014
Panels, Forms, Assessment
Instruments
Clinical LOINC Meeting
2014 09 04
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Overview
1. Base model for panels
2. Advanced model of panel attributes
3. LOINC Answers4. Panel and Answer features in RELMA
5. Sample of the content
6. Key adoptions7. Lessons learned
photo via Vernio77
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Base Model for Panels inLOINC
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Panels in LOINC
Collector terms that contain links to anenumerated set of discrete child elements
We use the word panel a generic conceptthat synonymous with battery, form, data
set, etc in other domains
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Panels can themselves be children,which allows nesting
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Define elements as Required,Optional, or Conditionally Present
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Categorizing Panel Elements
Required (R)Element is always expected to be present
Optional (O)
Element may not be reported with panel depending on policy
or capabilities of reporting institution
Conditional (C)Element is a key part of the panel, and should be assumed to be
negative or not present if results do not contain it
Null ()
Undeclared. Typically used in convenience panels
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Naming Conventions for Panels
Many (most) include panel in the Component
If defined by an authoritative body, we tend to
use the official name
If elements vary on axis values (e.g. Property), the
panel term name uses a dash - in that field
Timing, Scale, and Method are typically specified
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What Defines a Panel?
Or, when can I map my local one to a LOINC one?
With help from the S&I Framework Initiative, we
are developing a revised set of business rules forpanels
The following summarizes the draft rules
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Business Rules for Panels
1. Base definitions of Required, Optional,Conditional still hold.
2. If a panel is defined with methodless
elements, users could substitute any method-specific code that matched on the otherattributes
1. As a corollary, it is notacceptable to substitute
a qualitative term for a quantitative term
3. If a panel is defined with method-specificcodes, only that method (or equivalent) is
allowed
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Business Rules for Panels
4. Elements that are not measured evaluations(e.g. calculations, derived values, ask at orderentry questions, interpretations, etc) can be
included (or not)5. LOINC may define some panels (in rare cases)
where the exact elements are not enumeratedbut rather described in text. This will be used
only in rare complex cases (e.g. public health,lupus anticoagulant panels, etc).
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Advanced model of panel
attributes in LOINCAn expansion that grew out of our work to representstandardized assessment instruments
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LOINC could be a
master question fileand
uniform representation
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Iterative Refinement
Started about 10 years ago
Informing ideas:
Survey instruments have psychometric properties
Question meaning tightly coupled with answers
Many collaboratorsesp Tom White, Susan Bakken
CHI Functioning and Disability workgroup
ASPE, AHIMA, CMS, RTI, HL7, HITSP
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Standardized Assessments and Collections
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.
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Assessment Instruments
Widely used
and not unlike other kinds of observations
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Item-level Attributes
Question TextQuestion Source
External Copyright
Terms of Use
Description/Definition
Units of Measure (UCUM)Data Types
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Structured Answer Lists
Answer List AttributesOID
External Link
Answer Item AttributesID (contains LA prefix)
String
Sequence
Local codeUniversal code (SNOMED CT)
Score
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Attributes of Items in a Panel Instance
Display name overrideCoding instructions
Cardinality
Local code on that form
Skip logic
Data type in form
Answer sequence override
Consistency/validation checksImages
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Panels Available as Separate DownloadLook for the Panels and Forms File
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LOINC Answers
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LOINC Answers
LOINC is focused on questions, but
Sometimes, questions are best understood by
knowing the set of allowed answer choices
Many answer choices are highly specializedand not present in vocabulary standards
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LOINC Answers
Many answer choices are highly specializedand not present in vocabulary standards
LOINC has a structured representation ofanswer lists
Classify them as Example or Normative
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MAPPING CAUTION
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Normative => This is it. Dont mess with it!
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Panel Features in RELMA
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A sample of the LOINC content
US Government Forms Neonatal Skin Risk Assessment Scale
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US Government Forms
CARE, MDSv2, MDSv3, OASIS B1,
OASIS C, RFC, US Surgeon
Generals Family Health Portrait,
End Stage Renal Disease forms
Borderline Symptom List - 23 Item
Brief Interview for Mental Status (BIMS)
CARE long term care hospital (LTCH)
Confusion Assessment Method (CAM)
Core behavioral health terms (SAMHSA)Edinburgh Postnatal Depression Scale
FACIT
Geriatric Depression Scale (GDS)
HIV Signs and Symptoms Checklist
Home Health Care Classification
howRU
Living with HIV (LIV-HIV)
Morse Fall Scale
My Mood Monitor
Neonatal Skin Risk Assessment Scale
Neuro-QOL
NIH Stroke Scale
OMAHA
OPTIMAL
PROMIS
PhenX
PHQ (9 and 2)
Quality Audit Marker (QAM)VR 12 and 36
US Government Forms Neonatal Skin Risk Assessment Scale
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US Government Forms
CARE, MDSv2, MDSv3, OASIS B1,
OASIS C, RFC, US Surgeon
Generals Family Health Portrait,
End Stage Renal Disease forms
Borderline Symptom List - 23 Item
Brief Interview for Mental Status (BIMS)
CARE long term care hospital (LTCH)
Confusion Assessment Method (CAM)
Core behavioral health terms (SAMHSA)Edinburgh Postnatal Depression Scale
FACIT
Geriatric Depression Scale (GDS)
HIV Signs and Symptoms Checklist
Home Health Care Classification
howRU
Living with HIV (LIV-HIV)
Morse Fall Scale
My Mood Monitor
Neonatal Skin Risk Assessment Scale
Neuro-QOL
NIH Stroke Scale
OMAHA
OPTIMAL
PROMIS
PhenX
PHQ (9 and 2)
Quality Audit Marker (QAM)VR 12 and 36
15,000+ variables
Oh snap!
Fi d P l d F i RELMA
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Find Panels and Forms in RELMA
Fi d P l d F i RELMA
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Find Panels and Forms in RELMA
Hit this!
Lab Panels
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Lab Panels
Clinical Panels
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Clinical Panels
Survey Instruments
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Survey Instruments
View Panel Children
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View Panel Children
View Panel Children
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View Panel Children
Select View Panel Children
from context menu
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Find Panels that Contain this Term
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Find Panels that Contain this Term
Find Panels that Contain this Term
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Find Panels that Contain this Term
Select Find Panels with All TheseLOINCs from context menu
Find Panels that Contain this Term
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Find Panels that Contain this Term
Also on Comprehensive Details Pages
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Also on Comprehensive Details Pages
Also on Comprehensive Details Pages
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Also on Comprehensive Details Pages
These panels all contain this Creatinine term
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LOINC adoption here isgaining some traction
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Lesson 1Variation abounds
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Despitesimilarit
y
in items,much
variatio! exist!
many differences might have been avoided
Original PHQ-9
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CARE
MDSv3
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Weigh the costof losing
comparability beforeinventingsomething new
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Lesson 2IP issues present large
challenges
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Weigh the costof losing
comparability before inventingsomething new
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Lesson 3Not all use-cases need
everything
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Evolve gracefully.photo via Dawn Huczek
Q li M
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Quality Measures
1. Name of some specific instrument used2. Total score from a particular instrument
G f l E l ti
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Graceful Evolution
1. Create "panel" codes that represent thenamed instrument
2. Create a total score term (as a child) for the
instruments where score is needed
3. When they are needed, fully model the
instrument as a complete set of questions
(with answers where appropriate)
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