Daniel J. Vreeman, PT, DPT, MSc Assistant Research Professor, Regenstrief Institute, Inc.

Associate Director of Terminology Services, Indiana University School of Medicine

Clinical LOINC Meeting | 01/27/2011 Copyright © 2011

Panels, Forms, and Patient Assessments

Overview Background

Standard Panels in LOINC Patient Assessment Model

Current Projects Lessons Learned

Introduction

Assessments are widely used…

…and not unlike other clinical observations

LOINC could be a

master question file and

uniform representation

AMIA 2010 Paper

Upcoming paper in Int J Funct Inform Personal Med

Iterative Refinement Started almost 10 years ago Gradually expanded the base panel model Informing ideas: –  Survey instruments have psychometric properties

–  Question meaning tightly coupled with answers

Many collaborators –  esp Tom White, Susan Bakken

–  CHI Functioning and Disability workgroup –  ASPE, AHIMA, CMS, RTI, HL7, HITSP

Consolidated Health Informatics

LOINC Model for Patient Assessments

Hierarchy of a Panel in LOINC

Assessment Items Question Text Question Source

External Copyright Terms of Use

Description/Definition

Units of Measure (UCUM)

HL7 Data Types (v2, v3)

Structured Answer Lists Answer List Attributes –  OID –  External Link

Answer Item Attributes –  ID (contains “LA” prefix)

–  String –  Sequence

–  Local code –  Score

Attributes of Items in a Panel Instance

Display name override Coding instructions Cardinality

Local code on that form Skip logic Data type in form

Answer sequence override Consistency/validation checks Relevance equation

Panels/Forms Available as Separate Download

Currently in LOINC US Government Forms

–  CARE, MDSv2, MDSv3, OASIS B1, OASIS C, RFC –  US Surgeon General’s Family Health Portrait

Brief Interview for Mental Status (BIMS)

Confusion Assessment Method (CAM)

Geriatric Depression Scale (GDS)

HIV Signs and Symptoms Checklist

Home Health Care Classification howRU

Living with HIV (LIV-HIV)

Morse Fall Scale

OMAHA

PHQ (9 and 2) Quality Audit Marker (QAM)

Find them in RELMA

Latest Additions…

Opportunities

CDC APA

APTA

Many more…

Lessons

and

Recommendations

LOINC

TIMP

GDS PHQ

Advantages of the Master Catalog

Advantages of the Master Catalog

Lesson 1 Variation Abounds

Variation Abounds

Despite similarity items, much variation…

…many differences might have been avoided

Original PHQ-9

CARE

MDSv3

MDSv3

MDSv2

OASIS

CARE

• Frequency with which resident complains or shows evidence of pain (in last 7 days)?

• No pain, Pain less than daily, Pain daily MDSv2

• How much of the time have you experienced pain or hurting over the last 5 days?

• Almost constantly, Frequently, Occasionally, Rarely, Unable to answer

MDSv3

• Have you had pain or hurting at any time during the last 2 days? • Yes, no, unable to respond CARE

• Frequency of Pain Interfering with patient's activity or movement • Patient has no pain or pain does not interfere with activity or

movement, Less often than daily, Daily but not constantly, All of the time

OASIS-B1

• Frequency of Pain Interfering with patient's activity or movement • Patient has no pain, Patient has pain that does not interfere with

activity or movement, Less often than daily, Daily but not constantly, All of the time

OASIS-C

Weigh the cost of losing comparability before inventing something new

Lesson 2 Starting from a uniform data model may bring clarity

We usually started from paper forms…

…but some had custom programs and databases

!

Discrepancies and Incongruences How do you store “Other specified ____________” Which text is the question and which is help Storing “unknown” or “unable to determine” as answers versus flavors of null Every “check all that apply” stored as a separate yes/no binary value item

Many Yes/No Diseases

Starting with the LOINC model may help elucidate hidden challenges

Lesson 3 IP issues present large challenges

Funders should require developers to avoid restrictive licenses

Conclusion LOINC has a uniform model with a (rapidly) growing “master question file” that enables interoperable exchange of assessment data

Acknowledgements Clinical LOINC Committee Kathy Mercer, Jo Anna Hernandez, Jaci Phillips Regenstrief Software Engineers

Michelle Dougherty, Barbara Gage, Jennie Harvell, Tom White

Funding Support NLM: HHSN2762008000006C

AHIMA Foundation: FORE-ASPE-2007-5

RTI International: 0-312-0209853