2012 10 25 - Meeting Terminology Requirements for Order Entry and Result Reporting
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Transcript of 2012 10 25 - Meeting Terminology Requirements for Order Entry and Result Reporting
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8/13/2019 2012 10 25 - Meeting Terminology Requirements for Order Entry and Result Reporting
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Meeting terminology requirements for
order entry and result reporting
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Overview
! Requirements! Background and status of the agreement! An introduction to LOINC! Practical details of the agreement!
Implementing the agreement and looking forward
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Requirements for order entry & result reporting
! Consistent ways to represent types tests andmeasurements in!! Requests (or orders) for investigation! Reports of results of investigations! Clinical records of subjects of investigation
! Aggregated clinical information for research! Aggregated data for service management and audit
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Possible ways of meeting the requirements for orderentry & result reporting
! SNOMED CT the leading global clinical terminology! Contains concepts representing laboratory tests & observables! However, its coverage in the laboratory domain is incomplete
! LOINC the most widely used code system for requestingand reporting laboratory tests! Contains codes for specific tests in ways that meets practical
requirements for communication of orders and reports! However, it lacks some of the detailed semantics that the SNOMED
CT concept model offers
! A combination of LOINC and SNOMED CT! Already used in several countries! However, currently this results in duplication of effort, perceived
competition and mixed semantics where the domains overlap
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Practical overlaps betweenlaboratory and clinical terminology
Clinical Terminology
Laboratory Terminology
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Logical overlaps betweenlaboratory and clinical terminologies
Findings Procedures
Organism
Body structure
Morphology
Substance
Method
!
Attribute Values
Laboratory
Tests / Observables
When reported
with a value
represent findings
Are observed or
measured byprocedures
Can be definedby common
attributes
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Background: An Opportunity for Cooperation
! SNOMED CT is the leading global clinical terminology! IHTSDO, the owner of SNOMED CT, is a not for profit organisation
with objectives directed at enhancing health care delivery to servethe public good.
! LOINC is the worlds most widely used code system for
requesting and reporting laboratory tests! Regenstrief Institute (RI), the owner of LOINC, is a not for profit
organisation with objectives directed at enhancing health caredelivery to serve the public good.
! An cooperation agreement between IHTSDO and RI!
Should be possible due to shared objectives! Could address SNOMED CT/LOINC boundary issues! Would thus provide an effective way to address requirements for
order entry and result reporting
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Update: The Opportunity is being Taken
! Good progress has been made! Shared objectives! Agreement on practical issues at operational level in both
organizations! Common understanding on key business issues at executive level in
both organizations! The governance bodies in both organization have accepted theproposed agreement in principle (subject to contract)
! Next step! Drafting and signature of a final legal agreement
!
Future steps! Undertaking work on implementing the agreement including!! Making links between SNOMED CT and LOINC content! Providing implementation advice on using SNOMED CT and
LOINC together
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Objectives of the proposed agreement
! To support consistent coding of order entry and resultreporting! by addressing coding and modeling of terminology content in the
domains covered by LOINC orders and observations
! To avoid unnecessary duplication of effort
! To develop cooperation between IHTSDO & Regenstrief" Not a one-off activity" Not an acquisition or merger" Not an exclusive arrangement
#A long-term working relationship
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An introduction to LOINC
Daniel Vreeman
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12/56photo via noshaMcDonald et al. Canopy Computing: using the Web in Clinical Practice.JAMA. 1998;280(15):1325-1329.
The rain forest canopy is aseamless web through which
arboreal creatures efficientlymove to reach the edible
fruits without any attentionto the individual trees.
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40 years of EMR workIndiana Network for Patient Care
Arboreal Informatics Pioneers
Regenstrief the Data Switzerland
Nations most comprehensive and longest tenured HIE
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Same or Different?
Lab ATest Name: Lyme Disease Serology
Measures: B. burgdorferiAb IgG
Method: ELISA
Scale: quantitative
e.g.: Titer 1:40
Lab BTest Name:Lyme Disease Antibody
Measures:B. burgdorferiAb IgM
Method: Immune blot
Scale: qualitative
e.g.: Positive
What you see in the test catalog
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Similar name, different meaning
meerkat meerkat mere cat meerkat
photo via Caption Time
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MEASUREMENTS
US
R
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5671-3 LOINC Code
Lead
MCnc
Pt
Bld
Qn
Component
Property Measured
Timing
System
Scale
Method
There are six major LOINC axes
Anatomy of a LOINC Term
We call these
LOINC Parts
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If an observation is a question and the
observation value is an answer LOINC provides codes for
questions
Where needed, othervocabularies (e.g. SNOMED CT)provide codes for answers
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What is my patients
hemoglobin level?718-7:Hemoglobin:MCnc:Pt:Bld:Qn
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How fast does my patient
usually walk?41959-8:Walking speed:Vel:1W^mean:^Patient:Qn:Calculated
photo via Ed Yourdon
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Indiana Network for Patient Care
HL7 v2.x Message
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Result with a Coded Value
This code is from
LOINC
Data type of
result (OBX-5) is a
coded element
Code identifying thisobservation
(what are these results?
listeria culture )
This code is from
SNOMED CT
Code identifying the
result
(L. monocytogenes )
b O C
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Laboratory LOINC
Cli i l LOINC
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Clinical LOINC
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Laboratory LOINC Committee Chair:
Clem McDonald, MD
Clinical LOINC Committee Chair:
Stan Huff, MD
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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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Open Development
Worldwide distribution at no cost
New terms from end-users
Welcome all comersCommittees are volunteers
Its free, but invaluable
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Funding Support
Main current sources are:U.S. National Library of Medicine
Regenstrief Foundation
Prior support from
Several other U.S. federal agencies,
John A. Hartford Foundation
LOINC Codes Over Time by Release
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010,00020,00030,00040,00050,00060,00070,00080,000
4/24/1
995
|1.0
5/24/19
95|1
.0a
6/23/
1995
|1.0b
6/28/19
95|1
.0c
7/14/
1995
|1.0
d
9/15/19
95|1
.0e
12/21/
1995
|1.0f
4/28/
1996
|1.0
g
8/29
/1996
|1.0h(
2)
12/3
/1996
|1.0h(
3)
1/8/1
9997
|1.0i
10/9/1
997
|1.0j-a
5/1/19
98|1
.0k
2/12/1
999
|1.0l
7/23/1
999
|1.0
m
8/6/19
99|1
.0m
a
2/4/20
00|1
.0n
6/13/20
00|1
.00
1/1/20
01|2
.00
1/31/20
01|2
.01
7/1/20
01|2
.03
1/1/20
02|2
.04
2/1/20
02|2
.05
2/19/20
02|2
.06
8/1/20
02|2
.07
9/1/20
02|2
.08
5/1/20
03|2
.09
10/1/20
03|2
.10
1/1/20
04|2
.11
2/1/20
04|2
.12
12/1/20
04|2
.13
12/1/20
04|2
.14
6/1/20
05|2
.15
12/1/20
05|2
.16
6/1/20
06|2
.17
12/21
/200
6|2.
19
6/21/2
007|
2.21
12/03
/200
7|2.
22
7/10/2
008|
2.24
1/10/2
009|
2.26
07/06
/200
9|2.
27
12/30
/200
9|2.
29
2/26/2
010|
2.30
6/15/2
010|
2.32
12/29
/201
0|2.
34
06/30
/201
1|2.
36
12/30
/201
1|2.
38
6/30/2
012|
2.40
LOINC CodesLab Codes
LOINC Codes Over Time by Release
Slope = 600
Slope = 2200
laboratory terms only
loinc org
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loinc.org
18 900 i 148 t i
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18,900+ users in 148 countries
loinc org members
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0
5,000
10,000
15,000
20,000
5/2/0
8
7/2/0
8
9/2/0
8
11/2/0
8
1/2/0
9
3/2/0
9
5/2/0
9
7/2/0
9
9/2/0
9
11/2/0
9
1/2/1
0
3/2/1
0
5/2/1
0
7/2/1
0
9/2/1
0
11/2/1
0
1/2/1
1
3/2/1
1
5/2/1
1
7/2/1
1
9/2/1
1
11/2/1
1
1/2/1
2
3/2/1
2
5/2/1
2
7/2/1
2
loinc.org members
15 new members per day
480 new members per month
Doubled in 19 months!
d l d 1400/ th
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downloads: ~1400/month
search loinc org
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search.loinc.org
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Just kidding.
Copyright is agoodthing for
standards.
Its the licensing part that isinteresting.
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No cost
Worldwide
In perpetuity
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Use
Copy
Distribute
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Any purpose:
commercial
non-commercial
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CANNOTuse anyLicensed Material to
develop or promulgate adifferent standard for
orders or observations.
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That would defeat
the purpose of
having a standard!
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Adopted as National Standard
BrazilCanada
France
GermanyThe Netherlands
Mexico
Rwanda
Thailand
USA
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Large Implementations
SIGA Sade projectCanada Health Infoway
ePSOS
Assistance publique - Hpitaux de Paris
Red Agrolab
BiTACHong Kong Hospital Authority
Many re
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EnablingSNOMED CT and LOINC
to work together
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The practical approach
! Maps between LOINC Parts and SNOMED CT!Addition of content where necessary to complete these maps
! LOINC terms linked to SNOMED CT Expressions toprovide SNOMED CT semantic view of LOINC Terms! Limited additions of content subject to specific restrictions intended
to limit duplication of effort and content
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Planned outcomes
!
Additions to SNOMED CT International Release! Map Refset to/from LOINC Parts! Association Refset from LOINC Terms to SNOMED CT Expressions
! Additions to LOINC release files! Equivalent SNOMED CT concept identifiers added to relevant LOINC Parts
! SNOMED CT Expressions linked to LOINC Terms
! Associations between LOINC Terms & sets of SNOMED CT answer values! Licensing and distribution of LOINC and SNOMED CT will continue
according to the policies & practices of each organization
! Consistent advice on implementing SNOMED CT and LOINC together
supported by both IHTSDO and RI!
Taking account of recommendations of HL7 TermInfo R2 project! Based on a model of observables which will allow semantic comparison of
combinations of LOINC questions and
SNOMED CT coded answers
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How Much Work is Involved?
!Putting this agreement into effect will require both IHTSDOand the LOINC Committee to do some work! Creating maps & associations between LOINC & SNOMED CT! Adding content! Developing implementation guidance
!Without this agreement work would have been needed tocover the known content gaps in SNOMED CT coverage ofthe laboratory domain
! With the agreement there are many benefits! Working together reduces the barriers to adoption of both SNOMED
CT and LOINC! Cooperation will also encourage IHTSDO Membership growth in
countries that have already adopted LOINC
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Summary
!Objective and approach have been agreed at operationallevels in both organization
! The governance bodies of IHTSDO and RegenstriefInstitute have accepted the principles of the agreement
! The next step is to finalize a legal agreement
! Beyond this there is work to be done!
! Note:! This presentation is a brief summary of key points from the agreement! More details of the proposal will be made publicly available as soon as possible
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Thank you for your attention
Questions?
IHTSDO! Contact IHTSDO: [email protected]! Web site: www.ihtsdo.org
Regenstrief! Contact LOINC: [email protected]! Web site: loinc.org
http://www.ihtsdo.org/http://loinc.org/mailto:[email protected]:[email protected]://www.ihtsdo.org/http://www.ihtsdo.org/mailto:[email protected]:[email protected]