![Indiana Network for Patient Care
HL7 v.2.X Message
MSH|^~&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay|||||||||||||||
LocalCode^LocalName^CodeSystem^LOINCcode^LOINCname^CodeSystem
PID|||$patientId$||$patientName$||||||||||||||||||||
PV1|||||||$attendingDoctor$||$consultingDoctor$||||||||
OBR|1|||CBC^CBC/Auto Diff^HSPA^57021-8^CBC W Auto Diff^LN||$reqDate|||||||||
OBX|2|ST|WBC^WBC^HSP_A^26464-8^Leukocytes [#/volume] in Blood^LN||10.8|K/MM3|||||F|
OBX|3|ST|RBC^RBC^HSP_A^26453-1^Erythrocytes [#/volume] in Blood^LN||4.82|MIL/MM3|||||F|
OBX|4|ST|HGB^HGB^HSP_A^718-7^Hemoglobin [Mass/?volume] in Blood^LN||15.7|GM/DL|||||F|
OBX|5|CE|HCT^HCT^HSP_A^20570-8^Hematocrit [Volume Fraction] of Blood^LN||45|%|||||||F|
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2009 12 07 - LOINC Introduction and Overview
- 1. Laboratory LOINC Workshop LOINC® Overview and Introduction 12.07.2009 Daniel J. Vreeman, PT, DPT, MSc Assistant Research Professor | Indiana University School of Medicine Research Scientist | Regenstrief Institute, Inc Copyright © 2009
- 2. Overview • Origins of LOINC – Background – Growth – Participation • Successes – International – US
- 3. Origins of LOINC The Lingua Franca of Clinical Observation Exchange
- 4. Introduction • Regenstrief’s 30-‐year history • The Indiana Network for Patient Care – A working HIE for ~15 years – More than 100 sources – Regenstrief: 3rd party convener • Local systems use idiosyncratic codes • Vocabulary standards – LOINC ® -‐ universal code system for clinical observations – The lingua franca of information exchange • Laboratory and Radiology results* – Often unavailable at the time of a clinical visit (6%, 4%) – Often located outside of their clinical system *Smith CP, Araya-‐Guerra R, Bublitz C, et al. Missing clinical information during primary care visits. JAMA. 2005;293(5):565-‐571
- 5. Indiana Network for Patient Care
- 6. From whence comes LOINC? • LOINC® – Logical Observation Identiiiers Names and Codes – A universal code system for laboratory and other clinical observations – The lingua franca of information exchange for clinical observations McDonald CJ, Huff SM, Suico JG, et al. LOINC, a universal standard for identifying laboratory observations: a 5-‐year update. Clin Chem. 2003;49(4):624-‐633.
- 7. Indiana Network for Patient Care HL7 v.2.X Message MSH|^~&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay||||||||||||||| LocalCode^LocalName^CodeSystem^LOINCcode^LOINCname^CodeSystem PID|||$patientId$||$patientName$|||||||||||||||||||| PV1|||||||$attendingDoctor$||$consultingDoctor$|||||||| OBR|1|||CBC^CBC/Auto Diff^HSPA^57021-8^CBC W Auto Diff^LN||$reqDate||||||||| OBX|2|ST|WBC^WBC^HSP_A^26464-8^Leukocytes [#/volume] in Blood^LN||10.8|K/MM3|||||F| OBX|3|ST|RBC^RBC^HSP_A^26453-1^Erythrocytes [#/volume] in Blood^LN||4.82|MIL/MM3|||||F| OBX|4|ST|HGB^HGB^HSP_A^718-7^Hemoglobin [Mass/?volume] in Blood^LN||15.7|GM/DL|||||F| OBX|5|CE|HCT^HCT^HSP_A^20570-8^Hematocrit [Volume Fraction] of Blood^LN||45|%|||||||F| A A
- 8. LOINC Purpose To facilitate the exchange and pooling of results for clinical care, outcomes management, and research • Speciiically, to provide a universal ID for the OBX-‐3 iield in HL7 ORU messages • LOINC codes “questions”, not answers – Orders/Panels (OBR-‐4) – Questions (OBX-‐3) – NOT Values (OBX-‐5) • Numbers, organisms (E. coli) McDonald CJ, Huff SM, Suico JG, et al. LOINC, a universal standard for identifying laboratory observations: a 5-‐year update. Clin Chem. 2003;49(4):624-‐633.
- 9. LOINC’s General Role • If an observation is a question, and the observation value an answer: – LOINC provides codes for the questions {OBR-4, OBX-3} – Other systems (eg SNOMED) 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
- 10. LOINC Background • Organized by Regenstrief Institute in 1994 – Ongoing support from NLM and Regenstrief – Guided by the LOINC Committee (Lab + Clinical) • Covers domain of Clinical Observations – Laboratory observations (since 1995) – Clinical observations (since 1996) – HIPAA Claims Attachments (NPRM in 2005) • LOINC development is a highly ‘open source’ model – Open, nimble, pragmatic – LOINC and RELMA program are freely available – Much work is done by volunteers – Additions to the database are end-‐user driven
- 11. LOINC Submissions 2003-2008 67 Organizations, 13 Countries
- 12. Active Translation Efforts 16 Countries
- 13. Laboratory LOINC Chemistry Allergy Testing Urinalysis Blood Bank Toxicology Cell Markers Hematology Skin Tests Microbiology Coagulation Antibiotic Susceptibilities Cytology Immunology/Serology HLA Antigens Molecular Genetics Surgical Pathology Cell Counts
- 14. Clinical LOINC Vital Signs EKG Hemodynamic Measurements Cardiac Ultrasound Fluid Intake/Output Obstetrical Ultrasound Body Measurements Discharge Summary Emergency Department Variables History and Physical Respiratory Therapy Pathology Findings Tumor Registry Colonoscopy/Endoscopy Patient Assessment Instruments Clinical Documents Ophthalmology Measurements Document Sections Radiology Reports Patient Assessment Instruments
- 15. Slope = 2200 Slope = 600
- 17. Downloads: 875/month
- 20. ~ 80 Organizations Listed
- 23. Current Initiatives/ Successes International and US Adoption
- 25. Existing Translations • Spanish – BiTAC (Spain); 39,000 terms – Conceptum Medical Terminology Center; 38,000 terms, Users’ Guide – Mexican Institute of Social Security; Users’ Guide • French – Canada Health Infoway; 38,000 terms, Documentation – Société Française d'Informatique de Laboratoires; 4,000 terms • Simpliiied Chinese – Bethune International Peace Hospital; 38,000 terms, Users’ Guide, tutorial • Korean – Korean Ministry for Health, Welfare and Family Affairs; 27,000 terms • German – DIMDI; Companion website, Users’ Guide
- 26. New Translations (this release) • Estonian – Estonian LOINC working group of the Estonian Society for Clinical Chemistry; Users’ Guide, Tutorial • Portuguese – Brazilian Federal Agency for Health Plans and Insurance, Brazilian Clinical Analysis Society, Brazilian Clinical Pathology Society, and Diagnóstico das Américas (DASA); 2,800 terms • German, French, Italian, Spanish – CUMUL (Switzerland); 5000 common terms
- 28. In-‐progress Translations • French – Assistance Publique-‐Paris Hospitals (PMID: 18999107) • Estonian – University of Tartu; Lab terms • Dutch – SKML (the Dutch Foundation for Quality Assessment in Medical Laboratories); Lab terms • Catalan – BiTAC; Lab terms • Russian – Donetsk National Medical University, corTTex
- 29. How do you say “glucose?” Component Linguistic Variant Glukose German (Switzerland) Glucose French (Switzerland) Glucosio Italian (Switzerland) Glucosa Spanish (Switzerland) Simpliiied Chinese (China) Glucosa Spanish (Argentina) Glükoos Estonian (Estonia) Glicose Portuguese (Brazil) -‐ Draft Glucosa Spanish (Spain) Korean (Korea, South)
- 31. New Translation Approach • Prior Method – Translate whole name as one string • New Method – Break LOINC terms into their constituent Parts – Remove duplicate strings in Part list – Translate the Part strings – Reassemble the full LOINC name • Beneiits – Reduced translation work – Enables multilingual searches in RELMA
- 32. US Adoption a few recent highlights
- 33. Consolidated Health Informatics Initiative • CHI Goal: – Adopting interoperability standards to enable all agencies in the federal health enterprise to “speak the same language” • In 2006, adopted LOINC as standard: – Laboratory test order names – Medications: Structured Product Labeling Sections
- 34. Consolidated Health Informatics Initiative • In 2007, CHI adopted LOINC as standard for federally-‐required assessments: – questions and answers – assessment forms that include functioning and disability content
- 35. Other Key US Adoptions • UMLS • VA • CDC PHIN Initiatives – Implement CHI standards • IHS – Embarking on ~250 facility mapping process • NCQA/HEDIS – Healthcare Effectiveness Data and Information Set – Used 90% of health plans to measure quality
- 36. Other Key US Adoptions • ARRA “Meaningful Use” • HITSP – C80: vital signs, lab results, lab orders, genetic results, other results – IS92: newborn screening • eLINCS – Standard for results delivery from LIS to an EHR • NAACCR • CDISC – Pharmaceutical research specs • NCI – caBIG – Lab portion adopted as caBIG vocab standard
- 37. Other Key US Adoptions • HL7 – many implementation guides, CDA, etc • HIPAA Claims Attachments • Many Regional HIEs