2013 08 27 - LOINC Introduction and Mapping Best Practices

7/30/2019 2013 08 27 - LOINC Introduction and Mapping Best Practices

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[email protected]

LOINC Webinar - dbMotion Clinical Vocabulary Forum

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 TeamJami 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.

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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Same or Different?

Lab ATest Name: Lyme Disease Serology

Measures: B. burgdorferi Ab IgG

Method: ELISA

Scale: quantitative

e.g.: Titer 1:40

Lab BTest Name:Lyme Disease Antibody

Measures:B. burgdorferi Ab IgM

Method: Immune blot

Scale: qualitative

e.g.: Positive

What you see in the test catalog


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Fundamental challenge:

Local systems have different ways ofidentifying the same concept. And,

things that look alike arent the same.


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More than Meets the Eye

photo via chadlewis
http://www.flickr.com/photos/chadlewishttp://www.flickr.com/photos/chadlewishttp://www.flickr.com/photos/chadlewis


12/147photo 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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Born in 1994 by Regenstrief Institute.

Worldwide distribution at no cost.

Copyrighted, but open license.

Released twice per year.

Its free, but invaluable.

Just dont use it to make another standard!


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Funding Support

Main current sources are:U.S. National Library of Medicine

Regenstrief Foundation

Prior support fromSeveral other U.S. federal agencies

John A. Hartford Foundation


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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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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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If an observation is a question andthe observation value isan 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

HL7 v2.x Message


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Result with a Coded Value

Data type of result

(OBX-5) is a coded

element

This code is

from LOINC

Code identifying thisobservation

(what are these results?

Conditions identified by

newborn screening )

This code is from

SNOMED

Code identifying the result

(Phenylketonuria )

b


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Laboratory LOINC

Cli i l O C


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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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photo via LuzA

St d di d A t d C ll ti
http://www.flickr.com/photos/luchilu/http://www.flickr.com/photos/luchilu/


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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.

LOINC Codes Over Time by Release


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010,00020,00030,00040,00050,00060,00070,00080,000

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5|1

.0

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1995

|1.0

a

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1995

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1995

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1995

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1995

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1995

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f

4/28/

1996

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g

8/29/1

996

|1.0h(

2)

12/3/1

996

|1.0h(

3)

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/199

97|1

.0i

10/9/1

997

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1998

|1.0k

2/1

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.0l

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/199

9|1

.0m

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99|1

.0m

a

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n

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0

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0

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2002

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2002

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8

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2003

|2.0

9

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2003

|2.1

0

1/1/

2004

|2.1

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2004

|2.1

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2005

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2006

|2.17

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1/20

06|2

.19

6/2

1/20

07|2

.21

12/0

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07|2

.22

7/1

0/20

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.24

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09|2

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07/0

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.36

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11|2

.38

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0/20

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.40

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.42

06/2

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.44

LOINC Codes

Only Lab LOINC Codes

LOINC Codes Over Time by Release

Slope = 600

Slope = 2200

laboratory terms onlynot a lab cliff, just no data available


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


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25 000 i 155 i


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25,000+ users in 155 countries

loinc org members


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0

5,000

10,000

15,000

20,000

25,000

6/1/08

12/1/08

6/1/09

12/1/09

6/1/10

12/1/10

6/1/11

12/1/11

6/1/12

12/1/12

6/1/13

loinc.org members

18 new members per day

550 new members per month

Doubled in 19 months!

d l d 1500/ th


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downloads: ~1500/month


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forum loinc org


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forum.loinc.org


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LOINC Submitters


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LOINC Submitters

Since 2009: 150+ organizations LOINC Translators


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LOINC Translators

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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Adopted as National Standard

AustraliaAustria

Belgium

Brazil

Canada

Cyprus

Estonia

Finland

France

Germany

Iceland

Mexico

MongoliaThe Netherlands

New Zealand

Philippines

Portugal

Rwanda

Slovakia

Slovenia

Spain

Thailand

Turkey

United States


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Large Implementations

SIGA Sade project7+ Provincial systems in Canada

15+ Regional Health Information Exchanges in Spain

ePSOSAssistance publique - Hpitaux de Paris

Hong Kong Hospital Authority

Philippine Health Insurance Corporation

InFSE Project in 5 regions in Italy (LOINC Italia)

Many re


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Vandenbussche PY, Cormont S, Andr C, et al. Implementation and management of a biomedical observation dictionary in a large healthcare information system.

J Am Med Inform Assoc. 2013 May 1. PMID: 23635601.

The results of our workvalidate the choice made to

develop a local dictionaryaligned with LOINC.
http://www.ncbi.nlm.nih.gov/pubmed/23635601http://www.ncbi.nlm.nih.gov/pubmed/23635601http://www.ncbi.nlm.nih.gov/pubmed/23635601


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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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Some not-so-serious LOINCing


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Talking about LOINC at the Thai Ministry of

Information and Communication Technology


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Dr Case leading some LOINCing in Cyprus


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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

loinc.or /collaboration/ihtsdo


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loinc.or /collaboration/ihtsdo


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US AdoptionA few key highlights


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Some Key US Adoptions

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

Program

a.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 mccaughan
http://www.flickr.com/photos/mccaughan/3484111996/http://www.flickr.com/photos/mccaughan/3484111996/http://www.flickr.com/photos/mccaughan/3484111996/


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LOINC 101Introduction to LOINC Naming Conventions

A f LOINC T


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5193-8 LOINC Code

Hepatitis B virus surface Ab

ACncPt

Ser

Qn

EIA

Component

Property MeasuredTiming

System

Scale

Method

There are six major LOINC axes

Anatomy of a LOINC Term

NOT t f LOINC N


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NOT part of a LOINC Name

Reason for the test (disease it diagnoses)Testing instrument

Specific details about the specimen

Priority (e.g. STAT)Where testing was done

Who did the test

Test interpretationAnything not part of naming the test

Stuff carried in other parts of HL7 message

C t


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Component

Sodium

GlucoseBrucella sp. identifiedInfluenza virus A antigenCytomegalovirus antibody

Erythrocyte mean corpuscular volume

C t St t


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Component Structure

Formal analyte nameSpecify subanalytes

May have subclasses

ChallengeTwo parts separated by

post

Adjustments

CalciumCoronavirus Ag

Calcium.ionized

1H post 100 g Glucose POpost

Adjusted to pH 7.4

Property * h diffi l LOINC i


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Property

Major Categories:

masssubstancecatalytic activityarbitrary

number

* the most difficult LOINC axis

Property * th t diffi lt LOINC i


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Fully Na ed PropertiesMCnc mass concentration

SCnc substance concentration

MCnt mass content

CCnc catalytic concentration

Prid presence or identity

Imp impression

Type kind of

mg/dL

umol/L

mg/g

U/L

Property * the most difficult LOINC axis


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photo via SMcGarigle

Timing
http://www.flickr.com/photos/mcbarnicle/http://www.flickr.com/photos/mcbarnicle/


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Timing

Pt

12H24H

point in time

12 hour collection24 hour collection

System


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System

SerSer/PlasBldUrFlu

TissXXX

serumserum or plasmawhole bloodurinebody fluid

tissuespecified elsewhere

photo via AlishaV

System Structure
http://www.flickr.com/photos/AlishaV/http://www.flickr.com/photos/AlishaV/


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System Structure

Super SystemPatient is the default

Used to indicate:blood product unit, bone marrow donor, fetus

Scale


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Scale

Qn

Ord

Nom

Nar

Quantitativecontinuous numeric

can have operators

Ordinal

Ranked set (1+, 2+, 3+)Nominal

unranked collection

Taxonomy (e.g. bacteria)

Narrative

photo via puuikibeach

Method
http://www.flickr.com/photos/puuikibeach/http://www.flickr.com/photos/puuikibeach/


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Method

Only needed if interpretation affectedDifferent normal ranges

Test sensitivity

Listed at the generic levelAgglutination

Enzyme Immunoassay

Probe with target amplification


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MappingA fundamental challenge to healthinformation exchange


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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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Mapping might not be rocket

science, but it requires bothexpertise and effort that iseasy to underestimate.

Baorto DM, Cimino JJ, Parvin CA, Kahn MG. Combining laboratory data sets from multiple institutions using the logical observation identifier

names and codes (LOINC). Int J Med Inform.1998 Jul;51(1):29-37.


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Centralized mapping

consolidates, but doesnteliminate the effort.

Vreeman DJ. Stark M, Tomashefski GL, Phillips DR, Dexter PR. Embracing Change in a Health Information Exchange. AMIA Annu Symp Proc. 2008;:768-772.

If Ambiguous Dont Assume


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If Ambiguous, Don t Assume

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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Clean water act

photo via Fishking_1

Upstream standardization.

Ask instrument or test kit

manufacturers.

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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Ongoing Journey

Plan for updating as yourtesting

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

Ongoing Journey


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Ongoing Journey

Replace mappings to deprecated

terms with new LOINC releases.

(RELMA can help)

Prioritization


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Prioritization

Local or national policies may helpprioritize mapping subsets.

For example:

common results

+ panel elements

+ public health reportable tests


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photo via pagedooley

look for this paper in AMIA 2013 Annual Symposium:Evaluating Congruence Between Laboratory LOINC Value Sets for Quality Measures,

Public Health Reporting, and Mapping Common Tests
http://www.flickr.com/photos/pagedooley/8435953365/sizes/o/in/photostream/http://www.flickr.com/photos/pagedooley/8435953365/sizes/o/in/photostream/


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Tools forImplementers

photo via Robert S Donovan
http://www.flickr.com/photos/booleansplit/http://www.flickr.com/photos/booleansplit/


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loinc.org/usage

loinc.org/usage


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search.loinc.org


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Search Syntax


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Search Syntax

Google-likeAND, OR, -, +

Limit by category(e.g. class:micro)Wildcards (? and *)

RELMA uses the same syntax

search.loinc.org


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RELMAREgenstrief LOINC Mapping Assistant

Whats it Good For?


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Browse LOINCMap local terms to LOINC

import/exporttranslate local words to LOINC-speak

manual/automated mapping

What s it Good For?

Search Window


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Mapping Screen


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navigate through your local term set

hit enter to run a search

LOINC Term Details


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Come to Indy for aworkshop!

photo viajimnix
http://www.flickr.com/photos/jimnix/5059245093http://www.flickr.com/photos/jimnix/5059245093


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loinc.org/meetings


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Mapping Best Practices

photo via cblue98

Helpful Hints
http://www.flickr.com/photos/cblue98/7254347346/http://www.flickr.com/photos/cblue98/7254347346/


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Helpful Hints

Look at common LOINCs first

Sort by Rank column

Limit to only common LOINCs

on search.loinc.org or in RELMA

Helpful Hints


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Helpful Hints

When in doubt, method-less is a good

bet, but...

dont throw away information by

mapping to more general codes!

R t LOINC d h


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Request a new LOINC code whenComponent doesnt match yours exactly

photo viajdhancock

Examples
http://www.flickr.com/photos/jdhancock/http://www.flickr.com/photos/jdhancock/


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Examples

Avian pox virus IgG

Avian pox virus Ab

Bluetongue virus 15 Ab Bluetongue virus Ab

11-Deoxycortisol.free 11-Deoxycortisol

Lots of parent/child relationship cases.Never a match! Request a new LOINC.


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Always capture specimen type

photo via popculturegeek

Specimen Type
http://www.flickr.com/photos/popculturegeek/6888304420/sizes/o/in/photostream/http://www.flickr.com/photos/popculturegeek/6888304420/sizes/o/in/photostream/


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Specimen Type

Specimen should alwaysbe sent in message

Pre-coordinate specimen type if a common oneor reference range is different

Post-coordinate other caseswound drainage, burns, sebum, environmental objects, etc

Pre-Coordinate


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Pre CoordinateAir Hair TPN

Bld Gast Fld Synv Fld

BldA Nail Stool

BldC Pericard fld Tear

BldV Periton fld UrineBldCo Plas Urine sed

BldCoV Plr fld Vitr fld

BldCoA Saliva Water

Bld/Tiss SemenBody fld Ser

CSF Ser/Plas

Dial fld Tiss


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Dig into understandingthe LOINC Property axis

photo via micahtaylor

Properties are Tricky
http://www.flickr.com/photos/micahtaylor/4665476904/sizes/o/in/photostream/http://www.flickr.com/photos/micahtaylor/4665476904/sizes/o/in/photostream/http://loinc.org/downloads/files/LOINCManual.pdf


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p y

Alwayslook at units of measure!

Append them to your query:

exunits:L/L

Look at Table 8 in LOINC Users Guide for the

meaning of the abbreviations(http://loinc.org/downloads/files/LOINCManual.pdf)

Common Property Issues
http://loinc.org/downloads/files/LOINCManual.pdfhttp://loinc.org/downloads/files/LOINCManual.pdfhttp://loinc.org/downloads/files/LOINCManual.pdf


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p y

Fraction = Part/Whole

NFr: % Eosinophils / leukocytes

SFr: % HGB which is A2

Ratio = multiple analytes fromsame system

MCrto: BUN/Creatinine in urine

Relative Ratio = measures from differentsystem

RelRto: Albumin.pericard fld/Albumin.SerPl


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Stay tuned

for morebest practices

photo via blauertm

More in the LOINC Advanced
http://www.flickr.com/photos/blauertmhttp://www.flickr.com/photos/blauertm


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Mapping Topics slidedeck...http://loinc.org/slideshows/advanced-mapping-topics

ACnc/Ord vs Threshold and Presence

Prob.amp.tar and Prob.amp.sig

Domain specific hints: allergen testing, drug/tox, micro, etc
http://loinc.org/slideshows/advanced-mapping-topicshttp://loinc.org/slideshows/advanced-mapping-topicshttp://loinc.org/slideshows/advanced-mapping-topics


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Our newest ideas...

photo via cblue98
http://www.flickr.com/photos/cblue98/7254347346/http://www.flickr.com/photos/cblue98/7254347346/


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Wisdom of the HerdCan it help novice LOINCers?

photo via suffolktouristguide.com
http://www.suffolktouristguide.com/http://www.suffolktouristguide.com/


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photo viajdhancock
http://www.flickr.com/photos/jdhancock/3540861791http://www.flickr.com/photos/jdhancock/3540861791http://www.flickr.com/photos/jdhancock/3540861791


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A corpus-based approach for

automated LOINC mappingMustafa Fidahussein, MD, MS

Daniel J. Vreeman, PT, DPT, MSc


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Fidahussein M, Vreeman DJ. A corpus-based approach for automated LOINC mapping. J Am Med Inform Assoc. 2013 May 15. [Epub ahead of print] PubMed PMID: 23676247.
http://www.ncbi.nlm.nih.gov/pubmed/23676247http://www.ncbi.nlm.nih.gov/pubmed/23676247


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Maxent vs Lucene

photo via jdhancock

Mapping Performance on 3 INPC Labs

Corpus = 101 code sets with about 80,00 local terms
http://www.flickr.com/photos/jdhancock/3540861791http://www.flickr.com/photos/jdhancock/3540861791


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Institun=1,

tion 199

Institn=1

tion 2,705

Institn=

tion 3838

Maxent Top 1 78.6% (864) 73.5% (1,253) 84.6% (709)

Lucene Top 1 72.6% (798) 66.5% (1,133) 76.6% (642)

Maxent Top 5 90.5% (995) 88.8% (1,514) 94.7% (794)

Lucene Top 5 89.8% (987) 86.0% (1,466) 94.3% (790)

~79% = Not bad!

p

57%


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57%of local lab codes would always have

the correct LOINC ranked first byusing a Maxent cutoff of 0.46


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Connecting RELMA to acommunity repository

of LOINC MappingsDaniel J. Vreeman, PT, DPT, MSc

Masoud Hosseini, MS

John HookAnandhi Sowmyan

James Dennis

Brian E. Dixon, MPA, PhD, FHIMSS

photo via jamescridland
http://www.flickr.com/photos/jamescridlandhttp://www.flickr.com/photos/jamescridlandhttp://www.flickr.com/photos/jamescridland


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RELMA Users Survey

photo via idiolector

n=99
http://www.flickr.com/photos/idiolectorhttp://www.flickr.com/photos/idiolectorhttp://www.flickr.com/photos/idiolector


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Other Users Mappingswould be...

Useful = 77%

Relevant = 70%

Make my mapping easier = 73%


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photo via Stig Nygaar
http://www.flickr.com/photos/stignygaard/http://www.flickr.com/photos/stignygaard/http://www.flickr.com/photos/stignygaard/http://www.flickr.com/photos/stignygaard/http://www.flickr.com/photos/stignygaard/http://www.flickr.com/photos/stignygaard/


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27 submissions, 18 organizations, 5 countries

92 000 i


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Now you can just log in with your loinc.org ID


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# of codes and institutions mapped to this LOINC


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Click here to see the local codes!


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When youve got a decent number of mappings,share them back with the community


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y


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photo viajaneandd

Jump In!
http://www.flickr.com/photos/jayneandd/http://www.flickr.com/photos/jayneandd/http://www.flickr.com/photos/jayneandd/


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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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2013 08 27 - LOINC Introduction and Mapping Best Practices

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