LOINC Introduction and Overview

Daniel J. Vreeman, PT, DPT, MSc Assistant Research Professor, Indiana University School of Medicine

Research Scientist, Regenstrief Institute, Inc

Laboratory LOINC Workshop – Indianapolis, IN

12.08.2011 © 2011 dvreeman@regenstrief.org

http://loinc.org/slideshows

Origins of LOINC The lingua franca of clinical observation exchange

Regenstrief’s 40+ Years of Canopy Computing making a forest out of individual trees of data

McDonald et al. Canopy Computing: using the Web in Clinical Practice. JAMA. 1998;280(15):1325-1329.

photo via nosha

Arboreal Informatics Pioneers 40 years of EMR work

Indiana Network for Patient Care Nation’s most comprehensive and longest tenured HIE

Regenstrief – the neutral 3rd party convener

Fundamental challenge: local systems have idiosyncratic ways of identifying similar concepts

Vocabulary standards provide the linuga franca.

Logical

Observation

Identifiers

Names and

Codes A universal code system that facilitates exchange,

pooling, and processing of results

Similar name, different meaning…

meerkat meerkat mere cat meerkat photo via Caption Time

If an observation is a question and the observation value is an answer…

LOINC provides codes for questions

Other vocabularies provide codes for the answers

What is my patient’s hemoglobin level? 718-7:Hemoglobin:MCnc:Pt:Bld:Qn

How fast does my patient usually walk? 41959-8:Walking speed:Vel:1W^mean:^Patient:Qn:Calculated

Institutional Repository

A  

A  Message Processor

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|NM|123^WBC^HSP_A^26464-8^Leukocytes [#/volume] in Blood^LN||10.8|K/MM3|||||F| OBX|3|NM|234^RBC^HSP_A^26453-1^Erythrocytes [#/volume] in Blood^LN||4.82|MIL/MM3|||||F| OBX|4|NM|345^HGB^HSP_A^718-7^Hemoglobin [Mass/volume] in Blood^LN||15.7|GM/DL|||||F| OBX|5|NM|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

Indiana Network for Patient Care

OBX||CE|57131-5^Newborn conditions with pos markers^LN||7573000^PKU^SCT

Result with a Coded Value

Data type of result (OBX-5) is a

coded element

This code is from LOINC

Code identifying this observation

(what are these results? Conditions identified by

newborn screening )

This code is from SNOMED

Code identifying the result (Phenylketonuria )

photo via eye of einstein

A brief aside about terminology…

LOINC Terminology LOINC (noun) To LOINC, LOINCing, LOINCed (verb) [Chief, Head, etc] LOINCer (noun) LOINCification (noun) SNOMED Terminology SNOMED (noun) SNOMEDicated???

From “Standardizing the MDS with LOINC® and Vocabulary Matches”

http://aspe.hhs.gov/daltcp/reports/2007/MDS-LOINC.htm

Different standards for different parts of the elephant.

photo via Ludovic Hirlimann

SNOMED CT Systematized Nomenclature of Medicine - Clinical Terms

photo via Bruce McKay~YSP

LOINC + SNOMED?

International Classification of Diseases (ICD) and the rest of the family

photo via Esparta

RxNorm normalized names for clinical drugs

photo via e-MagineArt.com

We now return to our regularly scheduled program…

photo via x-ray delta one

Laboratory LOINC

Clinical LOINC

The LOINC Community Open. Nimble. Pragmatic.

Open Development Worldwide distribution at no cost

End-user content additions Welcome all comers

Volunteers

Regenstrief Institute Steward Developer of content

Developer of tools Developer of community Distributor

Voice

LOINC Codes Over Time By Release

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000 LOINC Codes

Lab Codes

laboratory terms only

Slope = 600

Slope = 2200

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000 loinc.org members

14 new members per day 410 new members per month

14,420+ users in 145 countries

@LOINC

Downloads: ~1400/month

The LOINC Distribution

http://search.loinc.org

http://search.loinc.org

http://forum.loinc.org

loinc.org/usage

“Top 2000 Results”

a.k.a. “Top 300 Orders”

a.k.a. “Common Units of Measure”

International Adoption participation, translation, implementation

LOINC Submitters

2009 to April 2011 84 organizations from 14 countries

LOINC Translators

18 organizations

Chinese  (CHINA)    Dra$  Portuguese  (BRAZIL)    English  (UNITED  STATES)    Estonian  (ESTONIA)    French  (CANADA)    French  (FRANCE)    French  (SWITZERLAND)    German  (GERMANY)    German  (SWITZERLAND)    Greek  (GREECE)    Italian  (ITALY)    Italian  (SWITZERLAND)    Korean  (KOREA,  REPUBLIC  OF)    Spanish  (ARGENTINA)    Spanish  (SPAIN)    Spanish  (SWITZERLAND)    

In-progress Catalan

Dutch French

Russian

Large Implementations

SIGA Saúde project Canada Health Infoway ePSOS Assistance publique - Hôpitaux de Paris Hong Kong Hospital Authority Red Agrolab BiTAC

Lots more…success is often silent

US Adoption A few key highlights

US Federal Agencies NLM VA

DoD IHS NCI

CDC

Other Key US Adoptions

HITSP eLINCS

NAACCR CDISC

NCQA/HEDIS, NQF

HL7

HIPAA

HIE’s

EHR Incentive Program

a.k.a. “Meaningful Use”

Standards ^

New Frontiers in Content Modeling

LOINC Collections Panels, forms, surveys, and other patient assessments

photo via LuzA

Standardized Assessments

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.

Assessments are widely used…

…and not unlike other clinical observations

Purpose

LOINC could be a

master question file and

uniform representation

Hierarchy of a Panel in LOINC

Panels/Forms Available as Separate Download

Sample of Assessments 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)

Translational Research Variables

11,000+ variables

Oh snap!

Lots More Cooking… Lots of forms and assessments

More radiology reports Structured document titles

Genetic testing

…

photo via liber

Key Lessons for Today

photo via IMLS DCC

Not just an IT problem photo via wakefielddavid

Get real. units, results, experts

Don’t be a one hit wonder.

photo via gsz

A journey. Not a destination.

Clean water act

photo via Fishking_1

photo via milos milosevic

The Race is On!

Get LOINCing! photo via ryarwood