2012 12 06 - LOINC Introduction - Brief

7/29/2019 2012 12 06 - LOINC Introduction - Brief

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[email protected]

Laboratory LOINC Workshop - Indianapolis, IN

Introduction and Overview
mailto:[email protected]:[email protected]:[email protected]


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http://loinc.org/slideshowshttp://loinc.org/slideshows


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Acknowledgements

LOINC Development TeamKathy Mercer, Jaci Phillips, Jami Deckard, Kelly Malott,

David Baorto, Clem McDonald

RELMA Development Team

John Hook, Anandhi Sowmyan, James Dennis

LOINC Committee

Sandy Poremba


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photo via noshaMcDonald et al. Canopy Computing: using the Web in Clinical Practice.JAMA

. 1998;280(15):1325-1329.


7/164photo 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.


8/164photo via beckstei
http://www.flickr.com/photos/beckstei/6269438822/sizes/o/in/photostream/http://www.flickr.com/photos/beckstei/6269438822/sizes/o/in/photostream/


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40 years of EMR workndiana etwork for atient are

Arboreal Informatics Pioneers

Regenstrief

the Data Switzerland

Nations most comprehensive and longest tenured HIE


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Fundamental challenge:Local systems have different ways of

identifying the same concept.


13/164photo via pfarrell95
http://www.flickr.com/photos/65005341@N03/http://www.flickr.com/photos/65005341@N03/http://www.flickr.com/photos/65005341@N03/


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A vocabulary standard

would serve as theRosetta Stone.

Image Hans Hillewaert /CC-BY-SA-3.0
http://creativecommons.org/licenses/by-sa/3.0/http://creativecommons.org/licenses/by-sa/3.0/http://creativecommons.org/licenses/by-sa/3.0/http://creativecommons.org/licenses/by-sa/3.0/


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ogical

bservation

dentifiers

ames and

odesA universal code system that facilitates exchange,

pooling, and processing of results


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Established in 1994 byRegenstrief Institute.

Vocabulary standard for

observation identifiers.


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Similar name, different meaning

photo via Caption Time
http://captiontime.tumblr.com/http://captiontime.tumblr.com/


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Similar name, different meaning

meerkat meerkat mere cat meerkat

photo via Caption Time
http://captiontime.tumblr.com/http://captiontime.tumblr.com/


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MEASUREMENTS

US

R

photo via puuikibeach
http://www.flickr.com/photos/puuikibeachhttp://www.flickr.com/photos/puuikibeachhttp://www.flickr.com/photos/puuikibeach


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If an observation is a question and

the observation value is

an answer

LOINC provides codes for questions Where needed, other vocabularies 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
http://www.flickr.com/photos/yourdon/http://www.flickr.com/photos/yourdon/http://www.flickr.com/photos/yourdon/


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Indiana Network for Patient Care


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HL7 v2.x Message

di k f i


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HL7 v2.x Message

I di N k f P i C


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HL7 v2.x Message

I di N k f P i C


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HL7 v2.x Message

I di N k f P i C


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HL7 v2.x Message

I di N t k f P ti t C


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HL7 v2.x Message



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HL7 v2.x Message



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HL7 v2.x Message



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HL7 v2.x Message



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HL7 v2.x Message



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HL7 v2.x Message



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HL7 v2.x Message


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Result with a Coded Value


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Data type of result

(OBX-5) is a coded

element


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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 )


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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 )


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photo via eye of einstein
http://www.flickr.com/photos/35188692@N00/466404658/sizes/o/in/photostream/http://www.flickr.com/photos/35188692@N00/466404658/sizes/o/in/photostream/http://www.flickr.com/photos/35188692@N00/466404658/sizes/o/in/photostream/http://www.flickr.com/photos/35188692@N00/466404658/sizes/o/in/photostream/http://www.flickr.com/photos/35188692@N00/466404658/sizes/o/in/photostream/


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LOINC(noun)


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LOINC(noun)o LOINC, LOINCing, LOINCed (verb)


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[Chief, Head, etc] LOINCer(noun)


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LOINCification (noun)


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From Standardizing the MDS with LOINC and Vocabulary Matcheshttp://aspe.hhs.gov/daltcp/reports/2007/MDS-LOINC.htm
http://aspe.hhs.gov/daltcp/reports/2007/MDS-LOINC.htmhttp://aspe.hhs.gov/daltcp/reports/2007/MDS-LOINC.htmhttp://aspe.hhs.gov/daltcp/reports/2007/MDS-LOINC.htmhttp://aspe.hhs.gov/daltcp/reports/2007/MDS-LOINC.htm


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SNOMED (noun)


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SNOMED (noun)

SNOMEDicated???


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SNOMED (noun)

SNOMEDicated???


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Different standards for differentparts of the elephant.

photo via Ludovic Hirlimann
http://www.flickr.com/photos/lhirlimann/http://www.flickr.com/photos/lhirlimann/http://www.flickr.com/photos/lhirlimann/http://www.flickr.com/photos/lhirlimann/http://www.flickr.com/photos/lhirlimann/http://www.flickr.com/photos/lhirlimann/http://www.flickr.com/photos/lhirlimann/


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photo via x-ray delta one

Laboratory LOINC
http://www.flickr.com/photos/x-ray_delta_onehttp://www.flickr.com/photos/x-ray_delta_onehttp://www.flickr.com/photos/x-ray_delta_one


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Laboratory LOINC

Clinical LOINC


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Clinical LOINC


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photo via LuzA

Standardized Assessments and Collections
http://www.flickr.com/photos/luchilu/http://www.flickr.com/photos/luchilu/


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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 InformPersonal Med. 2010;3(4):273-291.


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Laboratory LOINC Committee Chair:

Clem McDonald, MD

Clinical LOINC Committee Chair:

Stan Huff, MD


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Open Development


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Open Development

Worldwide distribution at no costNew terms from end-users

Welcome all comersCommittees are volunteers

Open Development


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Open Development



Open Development


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Open Development



Its free, but invaluable

R i f I i


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Regenstrief Institute

StewardDeveloper of content

Developer of toolsDeveloper of community

DistributorVoice

F di S


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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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0!10,000!20,000!30,000!40,000!50,000!60,000!70,000!80,000!

4/2

4/19

95|1

.0!

5/24

/199

5|1

.0a!

6/23

/199

5|1

.0b!

6/28

/199

5|1

.0c!

7/14

/199

5|1

.0d!

9/15

/199

5|1

.0e!

12/21

/199

5|1

.0f!

4/28

/199

6|1

.0g!

8/29/19

96|1

.0h(

2)!

12/3/19

96|1

.0h(

3)!

1/8/

1999

7|1

.0i!

10/9/

1997

|1.0j-a

!

5/1

/199

8|1

.0k!

2/12

/199

9|1

.0l!

7/23/

1999

|1.0

m!

8/6

/199

9|1

.0m

a!

2/4

/200

0|1

.0n!

6/13

/200

0|1

.00!

1/1

/200

1|2

.00!

1/31

/200

1|2

.01!

7/1

/200

1|2

.03!

1/1

/200

2|2

.04!

2/1

/200

2|2

.05!

2/19

/200

2|2

.06!

8/1

/200

2|2

.07!

9/1

/200

2|2

.08!

5/1

/200

3|2

.09!

10/1

/200

3|2

.10!

1/1

/200

4|2

.11!

2/1

/200

4|2

.12!

12/1

/200

4|2

.13!

12/1

/200

4|2

.14!

6/1

/200

5|2

.15!

12/1

/200

5|2

.16!

6/1

/200

6|2

.17!

12/2

1/20

06|2

.19!

6/2

1/20

07|2

.21!

12/0

3/20

07|2

.22!

7/1

0/20

08|2

.24!

1/1

0/20

09|2

.26!

07/0

6/20

09|2

.27!

12/3

0/20

09|2

.29!

2/2

6/20

10|2

.30!

6/1

5/20

10|2

.32!

12/2

9/20

10|2

.34!

06/3

0/20

11|2

.36!

12/3

0/20

11|2

.38!

6/3

0/20

12|2

.40!

LOINC Codes!Lab Codes!

y

laboratory terms only



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0!10,000!20,000!30,000!40,000!50,000!60,000!70,000!80,000!

4/2

4/19

95|1

.0!

5/24

/199

5|1

.0a!

6/23

/199

5|1

.0b!

6/28

/199

5|1

.0c!

7/14

/199

5|1

.0d!

9/15

/199

5|1

.0e!

12/21

/199

5|1

.0f!

4/28

/199

6|1

.0g!

8/29/1

996

|1.0h(

2)!

12/3/1

996

|1.0h(

3)!

1/8/

1999

7|1

.0i!

10/9/

1997

|1.0j-a

!

5/1

/199

8|1

.0k!

2/12

/199

9|1

.0l!

7/23/

1999

|1.0

m!

8/6

/199

9|1

.0m

a!

2/4

/200

0|1

.0n!

6/13

/200

0|1

.00!

1/1

/200

1|2

.00!

1/31

/200

1|2

.01!

7/1

/200

1|2

.03!

1/1

/200

2|2

.04!

2/1

/200

2|2

.05!

2/19

/200

2|2

.06!

8/1

/200

2|2

.07!

9/1

/200

2|2

.08!

5/1

/200

3|2

.09!

10/1

/200

3|2

.10!

1/1

/200

4|2

.11!

2/1

/200

4|2

.12!

12/1

/200

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.13!

12/1

/200

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.14!

6/1

/200

5|2

.15!

12/1

/200

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.16!

6/1

/200

6|2

.17!

12/2

1/20

06|2

.19!

6/2

1/20

07|2

.21!

12/0

3/20

07|2

.22!

7/1

0/20

08|2

.24!

1/1

0/20

09|2

.26!

07/0

6/20

09|2

.27!

12/3

0/20

09|2

.29!

2/2

6/20

10|2

.30!

6/1

5/20

10|2

.32!

12/2

9/20

10|2

.34!

06/3

0/20

11|2

.36!

12/3

0/20

11|2

.38!

6/3

0/20

12|2

.40!


y

Slope = 600




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0!10,000!20,000!30,000!40,000!50,000!60,000!70,000!80,000!

4/2

4/19

95|1

.0!

5/24

/199

5|1

.0a!

6/23

/199

5|1

.0b!

6/28

/199

5|1

.0c!

7/14

/199

5|1

.0d!

9/15

/199

5|1

.0e!

12/21

/199

5|1

.0f!

4/28

/199

6|1

.0g!

8/29/1

996

|1.0h(

2)!

12/3/1

996

|1.0h(

3)!

1/8

/199

97|1

.0i!

10/9/

1997

|1.0j-a

!

5/1

/199

8|1

.0k!

2/1

2/19

99|1

.0l!

7/2

3/19

99|1

.0m

!

8/6

/199

9|1

.0m

a!

2/4

/200

0|1

.0n!

6/13

/200

0|1

.00!

1/1

/200

1|2

.00!

1/31

/200

1|2

.01!

7/1

/200

1|2

.03!

1/1

/200

2|2

.04!

2/1

/200

2|2

.05!

2/19

/200

2|2

.06!

8/1

/200

2|2

.07!

9/1

/200

2|2

.08!

5/1

/200

3|2

.09!

10/1

/200

3|2

.10!

1/1

/200

4|2

.11!

2/1

/200

4|2

.12!

12/1

/200

4|2

.13!

12/1

/200

4|2

.14!

6/1

/200

5|2

.15!

12/1

/200

5|2

.16!

6/1

/200

6|2

.17!

12/2

1/20

06|2

.19!

6/2

1/20

07|2

.21!

12/0

3/20

07|2

.22!

7/1

0/20

08|2

.24!

1/1

0/20

09|2

.26!

07/0

6/20

09|2

.27!

12/3

0/20

09|2

.29!

2/2

6/20

10|2

.30!

6/1

5/20

10|2

.32!

12/2

9/20

10|2

.34!

06/3

0/20

11|2

.36!

12/3

0/20

11|2

.38!

6/3

0/20

12|2

.40!


y

Slope = 600

Slope = 2200



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photo via liber
http://www.flickr.com/photos/liberhttp://www.flickr.com/photos/liber


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19,600+ users in 149 countries


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19,600 users in 149 countries

loinc.org members


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0

5,000

10,000

15,000

20,000

6/1/08

12/1/08

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12/1/09

6/1/10

12/1/10

6/1/11

12/1/11

6/1/12

g

loinc.org members


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15,000

20,000

6/1/08

12/1/08

6/1/09

12/1/09

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6/1/11

12/1/11

6/1/12

g

17 new members per day520 new members per month

loinc.org members


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0

5,000

10,000

15,000

20,000

6/

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12/

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6/1/09

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Doubled in 19 months!

loinc.org members


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0

5,000

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6/

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12/

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Mental Tipping Point -Oh Snap!


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downloads: ~1500/month


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search.loinc.org


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search.loinc.org


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Alternate Language Search


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Alternate Language Search


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Everything in Italian!


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forum.loinc.org


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loinc.org/usage


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loinc.org/usage


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loinc.org/usage


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loinc.org/usage


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loinc.org/usage


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photo via 917press
http://www.flickr.com/photos/917press/http://www.flickr.com/photos/917press/http://www.flickr.com/photos/917press/


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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-commercialphoto via Refracted Moments
http://www.flickr.com/photos/refractedmoments/http://www.flickr.com/photos/refractedmoments/http://www.flickr.com/photos/refractedmoments/


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CANNOT use 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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LOINC Submitters


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105 i ti f 15 t i

Since 2009:

LOINC Translators22 organizations


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22 organizations


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Vreeman DJ et al. Enabling international adoption of LOINC through translation. J Biomed Inform (2012), doi:10.1016/j.jbi.2012.01.005
http://dx.doi.org/10.1016/j.jbi.2012.01.005http://dx.doi.org/10.1016/j.jbi.2012.01.005http://dx.doi.org/10.1016/j.jbi.2012.01.005http://dx.doi.org/10.1016/j.jbi.2012.01.005http://dx.doi.org/10.1016/j.jbi.2012.01.005http://dx.doi.org/10.1016/j.jbi.2012.01.005http://dx.doi.org/10.1016/j.jbi.2012.01.005http://dx.doi.org/10.1016/j.jbi.2012.01.005


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1

st International


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1 International

LOINC PhD student


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Adopted as National Standard


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p

AustraliaBrazil

Canada

CyprusEstonia

France

Germany

MexicoMongolia

The Netherlands

RwandaThailand

Turkey

United States

Large Implementations


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g p

SIGA Sade projectCanada Health Infoway

ePSOS

Assistance publique - Hpitaux de Paris

BiTAC

Hong Kong Hospital Authority

Philippine Health Insurance Corporation

Many more...


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For the last few years, the AP-HP has

been using the LOINC internationalnomenclature

Thanks to this catalogue, the AP-HP isable to use the nomenclature in itstreatment processes, whenever

biology analyses and test results arerequested.


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Members of the Korean National StandardsCommittee have enthusiastically embraced LOINC


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Some serious LOINCing in Hong Kong


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S t i LOINCi


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Talking about LOINC at the Thai Ministry of

I f ti d C i ti T h l y


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D C l di LOINCi i Cy


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This agreement further solidifiesthe wonderful relationship HL7has enjoyed with Regenstrief for

many years.

- Bob Dolin, MDChair of HL7 Board of Directors


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US AdoptionA few key highlights

Some Key US Adoptions


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All the big labsAll health-related federal agencies

Lots of care organizations

HIEs

Insurance companies

EHR vendorsInstrument manufacturers (nascent)


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CMS EHR Incentive

Programa.k.a. Meaningful Use


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vsac.nlm.nih.gov
https://vsac.nlm.nih.gov/https://vsac.nlm.nih.gov/


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photo via IMLS DCC
http://www.flickr.com/photos/imlsdcc/5637868432/sizes/o/in/photostream/http://www.flickr.com/photos/imlsdcc/5637868432/sizes/o/in/photostream/http://www.flickr.com/photos/imlsdcc/5637868432/sizes/o/in/photostream/


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If Murky, Dont Assume


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Units of measure are critical.

Sample results can help identify thecorrect LOINC Scale.

Local experts, package inserts can bevery informative.

Clean water act


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photo via Fishking_1

Upstream standardization.

Ask instrument or test kitmanufacturers.

ivdconnectivity.org
http://www.flickr.com/photos/fishking1/5304638016/sizes/o/in/photostream/http://www.flickr.com/photos/fishking1/5304638016/sizes/o/in/photostream/http://www.flickr.com/photos/fishking1/5304638016/sizes/o/in/photostream/


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A journey.

Not a destination.

Ongoing Journey


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Plan for updating as yourtesting

changes(less common), or your localcode identifiers change (more common).

Ongoing Journey


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Replace mappings to deprecated

terms with new LOINC releases.

(RELMA can help)


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Prioritization


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Local or national policies may helpprioritize mapping subsets.

For example:

common results

+ panel elements

+ public health reportable tests

Jump In!


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photo via Justin Ornellas
http://www.flickr.com/photos/ornellas/http://www.flickr.com/photos/ornellas/http://www.flickr.com/photos/ornellas/http://www.flickr.com/photos/ornellas/


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photo via ryarwood
http://www.flickr.com/photos/yarwood/http://www.flickr.com/photos/yarwood/


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photo via milos milosevic

LOINC Downloads

1800

2000
http://www.flickr.com/photos/21496790@N06/http://www.flickr.com/photos/21496790@N06/http://www.flickr.com/photos/21496790@N06/http://www.flickr.com/photos/21496790@N06/http://www.flickr.com/photos/21496790@N06/


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2012 12 06 - LOINC Introduction - Brief

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Transcript of 2012 12 06 - LOINC Introduction - Brief