Overview and Introduction to LOINC a universal catalog of laboratory observations

Public Laboratory LOINC Workshop and Committee Meeting

Daniel J. Vreeman, PT, DPT, MSc Assistant Research Professor, Indiana University School of Medicine Associate Director of Terminology Services, Regenstrief Institute, Inc

06.07.2010 Copyright © 2010

Overview •  Origins of LOINC – Background, growth, and participation

•  The LOINC Community – Growth and adoption successes

Origins of LOINC The lingua franca of clinical observation exchange

Introduction •  Regenstrief’s 35-year history •  Indiana Network for Patient Care

–  A working HIE for 15 years –  200+ source systems –  10.5 million patients, 3 billion results –  Regenstrief: 3rd party convener

•  A fundamental challenge –  Local systems use idiosyncratic codes

•  Vocabulary standards –  Provide the lingua franca of information exchange

Indiana Network for Patient Care

LOINC Background •  Logical Observation Identifiers Names and Codes •  Organized by Regenstrief Institute in 1994 –  Ongoing support from NLM and Regenstrief

•  Covers domain of Clinical Observations –  Laboratory Observations (since 1995) –  Clinical Observations (since 1996)

•  A universal code system that facilitates exchange, pooling, and processing of results

LOINC’s General Role •  If an observation is a question, and the

observation value an answer: –  LOINC provides codes for the questions {OBR-4, OBX-3} –  Other systems (eg SNOMED) provide codes for the answers

718-7:Hemoglobin:MCnc:Pt:Bld:Qn

What is my patient’s hemoglobin level?

41959-8:Walking speed:Vel:1W^mean:^Patient:Qn:Calculated

How fast does my patient usually walk?

Indiana Network for Patient Care

A  

A  

MSH|^~\&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay||||||||||||||| PID|||$patientId$||$patientName$|||||||||||||||||||| PV1|||||||$attendingDoctor$||$consultingDoctor$|||||||| OBR|1|||012^CBC/Auto Diff^HSPA^57021-8^CBC W Auto Diff^LN||$reqDate||||||||| OBX|2|ST|123^WBC^HSP_A^26464-8^Leukocytes [#/volume] in Blood^LN||10.8|K/MM3|||||F| OBX|3|ST|234^RBC^HSP_A^26453-1^Erythrocytes [#/volume] in Blood^LN||4.82|MIL/MM3|||||F| OBX|4|ST|345^HGB^HSP_A^718-7^Hemoglobin [Mass/volume] in Blood^LN||15.7|GM/DL|||||F| OBX|5|CE|456^HCT^HSP_A^20570-8^Hematocrit [Volume Fraction] of Blood^LN||45|%|||||||F|

HL7 v.2.X Message

LocalCode^LocalName^CodeSystem^LOINCcode^LOINCname^CodeSystem

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

― Patient Assessment Instruments ― Document Sections

― Radiology Reports

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

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Lab Codes

Laboratory  terms  only  (estimate)  data  prior  to  2000  not  available  

Slope = 600

Slope = 2200

LOINC codes over time by release

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loinc.org members

10 new members per day 300+ new members per month

7255+ users in 131 countries

Downloads: ~1100/month

http://loinc.org/websearch (alpha)

~ 87 Organizations Listed

International Adoption Submissions, Translations, Implementations

Submissions 2009 05 to 2010 04

Since 2003 … 125+ organizations 43 organizations

Translation Efforts

Existing Translations •  Spanish

–  BiTAC (Spain); 39,000 terms –  Conceptum Medical Terminology Center; 38,000 terms, Users’ Guide –  Mexican Institute of Social Security; Users’ Guide

•  French –  Canada Health Infoway; 38,000 terms

•  pan Canadian Laboratory Observation Code Database (pCLOCD)

–  Société Française d'Informatique de Laboratoires; 4,400 terms

•  Simplified Chinese –  Bethune International Peace Hospital; 38,000 terms, Users’ Guide,

tutorial

•  Korean –  Korean Ministry for Health, Welfare and Family Affairs; 27,000 terms

Existing Translations •  German

–  DIMDI; Companion website, Users’ Guide

•  Estonian –  Estonian LOINC working group of the Estonian Society for Clinical

Chemistry; Users’ Guide, Tutorial

•  Portuguese –  Brazilian Federal Agency for Health Plans and Insurance,

Brazilian Clinical Analysis Society, Brazilian Clinical Pathology Society, and Diagnóstico das Américas (DASA); 2,800 terms

•  German, French, Italian, Spanish –  CUMUL (Switzerland); 5000 common terms

In-progress Translations •  French: Assistance Publique-Paris Hospitals

PMID: 18999107 •  Estonian: University of Tartu; Lab terms •  Dutch: SKML (the Dutch Foundation for Quality

Assessment in Medical Laboratories); Lab terms •  Catalan: BiTAC; Lab terms •  Russian: Donetsk National Medical University, corTTex •  German: DIMDI; lab terms •  Italian: HL7 Italia; lab terms •  Greek: Efstratia Kontaxi; Top 300 lab orders

French!

Large-scale Implementations •  SIGA Saúde project- São Paulo city, Brazil – 25+ million lab tests per year

•  Canada (with Canada Health Infoway) – Electronic Child Health Network (Ontario) •  100+ hospitals, community centers, offices

– Ontario Laboratories Information System •  Phase I: 4 hospitals + 3 reference labs

•  European Patients Smart Open Services – European-wide large pilot of patient

summaries and e-prescriptions

Large-scale Implementations •  Assistance publique - Hôpitaux de Paris – 44 hospitals, largest system in Europe

•  Spanish Adoption – Red Agrolab •  Network of 49 labs in Spain •  Quality, food safety, and animal health

– Many regional HIE’s via BiTAC

•  Hong Kong Hospital Authority – 41 hospitals, 48 specialty clinics, 16 clinical

laboratories

US Adoption A few key highlights

Consolidated Health Informatics

•  CHI Goal: –  Adopting interoperability standards for all 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)

Other Key US Adoptions •  HITSP

–  C80: vital signs, lab results, lab orders, genetic results, other results –  C83: Patient assessment instruments (sections, questions, answers) –  IS92: newborn screening

•  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

Other Key US Adoptions •  HL7 – many implementation guides, CDA, etc •  HIPAA Claims Attachments •  Many Regional HIEs –  Maine Health InfoNet –  Florida Health Information Network –  Vermont Information Technology Leaders

•  Many large care delivery organizations

–  Intermountain Healthcare, Kaiser Permanente

•  Insurance Companies –  UnitedHealth Group, Anthem, etc

EHR “Meaningful Use” •  Health Information Technology for Economic

and Clinical Health Act (HITECH Act) in ARRA •  CMS authorized to give reimbursement

incentives for eligible providers/hospitals who become “meaningful users” of certified EHR technology

•  LOINC chosen as standard for Lab Results –  Phase I: when received from lab and for patient

summaries –  Phase II: LOINC