2016 02 25 - loinc - panels forms assess

8/19/2019 2016 02 25 - LOINC - Panels Forms Assess

1/85

Daniel J. Vreeman, PT, DPT, MScAssociate Research Professor

, Indiana University School of Medicine

Associate Director for Terminology Services, Regenstrief Institute, Inc

@djvreeman

© 2016

Panels, Forms, Assessment

Instruments

Clinical LOINC Meeting - Salt Lake City, UT USA


2/85


3/85

Base Model for Panels inLOINC


4/85

Panels in LOINC

Collector terms that contain links to anenumerated set of discrete child elements

We use the word “panel” a generic concept

that synonymous with battery, form, dataset, etc in other domains


5/85


6/85

Panels can themselves be children,which allows nesting


7/85

Define elements as Required,Optional, or Conditionally Present


8/85

Categorizing Panel Elements

Required (R)

Always expected to be present

Required with alternatives (R-a)

Always expected to be present, but with alternatives. (Typically a pair)

Optional (O)

May not be reported with panel depending on policy or capabilities ofreporting institution

Conditional (C)

A key part of the panel, and should be assumed to be negative or notpresent if results do not contain it

Reflex (Rflx)

Included if it satisfies a reflex condition based on other results in the panel

Null ()

Undeclared. Typically used in “convenience” panels


9/85

Categorizing Panel Elements

Required (R)

Always expected to be present

Required with alternatives (R-a)

Always expected to be present, but with alternatives. (Typically a pair)

Optional (O)

May not be reported with panel depending on policy or capabilities ofreporting institution

Conditional (C)

A key part of the panel, and should be assumed to be negative or notpresent if results do not contain it

Reflex (Rflx)

Included if it satisfies a reflex condition based on other results in the panel

Null ()

Undeclared. Typically used in “convenience” panels

see User’s Guide section 8.7 “Representing conditionality”


10/85

Naming Conventions for Panels

Many (most) include panel in the Component

If defined by an authoritative body, we tend touse the official name

If elements vary on axis values (e.g. Property), thepanel term name uses a dash “-“ in that field

Timing, Scale, and Method are typically specified


11/85

Naming Conventions for Panels

Many (most) include panel in the Component

If defined by an authoritative body, we tend touse the official name

If elements vary on axis values (e.g. Property), thepanel term name uses a dash “-“ in that field

Timing, Scale, and Method are typically specified

see massively revised Section 8 in LOINC Users’ Guide


12/85

What Defines a Panel?

Or, when can I map my local one to a LOINC one?

With help from the S&I Framework Initiative, wedeveloped a set of business rules for panels

The following is a brief summary


13/85

What Defines a Panel?

Or, when can I map my local one to a LOINC one?

With help from the S&I Framework Initiative, wedeveloped a set of business rules for panels

The following is a brief summary

see Section 13 in User Guide for full rules and examples


14/85

Business Rules for Panels

1. Must contain all of the required elements2. No extra primary measurements

3. Optional elements are optional

4. Substitutions of a method-specific code for amethodless one are allowed, but not viceversa

5. Substitutions for mass versus substanceProperties are allowed (newest rule)


15/85

Business Rules for Panels

5. No substitutions of quantitative forqualitative (and vice versa)

6. Pay attention to reflex components

7. Panels with only narrative definitions of theelements they should contain


16/85

Advanced model of panel

attributes in LOINCAn expansion that grew out of our work to representstandardized assessment instruments


17/85

LOINC could be a

master question fileand

uniform representation


18/85

Iterative Refinement

Started about 10 years ago

Informing ideas:

Survey instruments have psychometric propertiesQuestion meaning tightly coupled with answers

Many collaboratorsesp Tom White, Susan Bakken

CHI Functioning and Disability workgroup

ASPE, AHIMA, CMS, RTI, HL7, HITSP


19/85

Standardized Assessments and Collections

Vreeman DJ, McDonald CJ, Huff SM. Representing patient assessments in LOINC®. AMIA Annu Symp Proc. 2010;8 32-836. 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.


20/85

Assessment Instruments

Widely used…

…and not unlike other kinds of observations


21/85


22/85


23/85

Attributes of Items in a Panel Instance

Display name overrideCoding instructions

Cardinality

Local code on that form

Skip logic

Data type in form

Answer sequence override

Consistency/validation checksImages


24/85


25/85


26/85


27/85

Panels Available as Separate DownloadLook for the “Panels and Forms File”


28/85

LOINC Answers


29/85

LOINC Answers

LOINC is focused on “questions”, but…

Sometimes, questions are best understood by

knowing the set of allowed answer choices

Many answer choices are highly specialized

and not present in vocabulary standards


30/85

LOINC Answers

Many answer choices are highly specializedand not present in vocabulary standards

LOINC has a structured representation ofanswer lists

Classify them as “Example”, “Normative”, or“Preferred”


31/85


32/85

Example => Starter set, but you could use more/less


33/85

MAPPING CAUTION


34/85


35/85

Normative => This is it. Don’t mess with it!


36/85


37/85


38/85

Proper use of LOINC question

codes with assessmentinstrument methodsBlog post that answers the question “when is it ok to reuse

a LOINC question from an existing instrument?”

https://danielvreeman.com/proper-use-of-loinc-question-codes-with-assessment-instrument-methods/


39/85

Panel Features in RELMA


40/85

A sample of the LOINC content…

US Government Forms Neonatal Skin Risk Assessment Scale


41/85

US Government Forms

CARE, MDSv2, MDSv3, OASIS B1,

OASIS C, RFC, US Surgeon

General’s Family Health Portrait,

End Stage Renal Disease forms

Borderline Symptom List - 23 Item

Brief Interview for Mental Status (BIMS)

CARE long term care hospital (LTCH)

Confusion Assessment Method (CAM)

Core behavioral health terms (SAMHSA)Edinburgh Postnatal Depression Scale

FACIT

Geriatric Depression Scale (GDS)

HIV Signs and Symptoms Checklist

Home Health Care Classification

howRU

Living with HIV (LIV-HIV)

Morse Fall Scale

My Mood Monitor

Neonatal Skin Risk Assessment Scale

Neuro-QOL

NIH Stroke Scale

OMAHA

OPTIMAL

PROMIS

PhenX

PHQ (9 and 2)

Quality Audit Marker (QAM)VR 12 and 36



42/85

US Government Forms










FACIT




howRU


Morse Fall Scale

My Mood Monitor

Neonatal Skin Risk Assessment Scale

Neuro-QOL

NIH Stroke Scale

OMAHA

OPTIMAL

PROMIS

PhenX

PHQ (9 and 2)


15,000+ variables

Oh snap!



43/85

US Go e e t o s










FACIT




howRU


Morse Fall Scale

My Mood Monitor

eo ata S s ssess e t Sca e

Neuro-QOL

NIH Stroke Scale

OMAHA

OPTIMAL

PROMIS

PhenX

PHQ (9 and 2)


15,000+ variables

Oh snap!

Added about 230 survey-

related terms last release

Find Panels and Forms in RELMA


44/85




45/85


Hit this!

Lab Panels


46/85

Lab Panels

Clinical Assessments Scales Panels


47/85

Clinical Assessments, Scales, Panels

Panels for Clinical Documents


48/85

Panels for Clinical Documents

Non lab Diagnostic Studies


49/85

Non-lab Diagnostic Studies

Government


50/85

Government

Miscellaneous


51/85

Miscellaneous

Survey Instruments (Patient Reported)


52/85

Survey Instruments (Patient Reported)

View Panel Children


53/85

View Panel Children

View Panel Children


54/85

View Panel Children

Select “View Panel Children”

from context menu

Panel Children


55/85

Panel Children

Find Panels that Contain this Term


56/85




57/85


Select “Find Panels with All TheseLOINCs” from context menu



58/85


Also on Comprehensive Details Pages


59/85




60/85


These panels all contain this Creatinine term

Export the Full Panel Structure


61/85

Export the Full Panel Structure


62/85


63/85


64/85


65/85


66/85

DataElements in FHIR (work in progress)


67/85

DataElements in FHIR (work in progress)

CMS D El Lib


68/85

CMS Data Element Library4,600+ data elements from CARE, MDS, CARE-LTCH, OASIS

Responsive to IMPACT Act

Overall goals:• Uniformity across CMS assessments and quality measures

• Authoritative resource for patient assessment dataelements

• Promote the sharing of electronic patient assessment datasets and information standards

• Promote EHR interoperability and care coordination

Mapped to LOINC and other national vocabularies

CMS D El Lib


69/85

CMS Data Element Library

We are engaged as advisors governance

RAND earned contract for maintenance and

oversight of the Library and will work with usto resolve gaps


70/85

Pilot Apps demonstrating

LOINC form Power

NLM LForms tool

Merck ePRO toolpowered by OpenMRS


71/85


72/85


73/85

Lesson 1Variation abounds


74/85

Des

pi t e

similari t

y

in it ems,much

vari a

tio !

ex

i s t!

…many differences might have been avoided

Original PHQ-9


75/85

CARE

MDSv3

MDSv2


76/85

Frequencywithwhichresidentcomplainsorshowsevidenceofpain(inlast7days)?No pain, Pain less than daily, Pain daily

Howmuchofthetimehaveyouexperiencedpainorhurtingoverthelast5days? Almost constantly, Frequently, Occasionally, Rarely, Unable to answer

MDSv3

Haveyouhadpainorhurtingatanytimeduringthelast2days?Yes, no, unable to respond

CARE

FrequencyofPainInterferingwithpatient'sactivityormovement

Patient has no pain or pain does not interfere with activity or movement, Lessoften than daily, Daily but not constantly, All of the time

OASIS-B1

FrequencyofPainInterferingwithpatient'sactivityormovementPatient has no pain, Patient has pain that does not interfere with activity or

movement, Less often than daily, Daily but not constantly, All of the time

OASIS-B2


77/85


78/85

Lesson 2IP issues present largechallenges


79/85


80/85

Weigh the cost of losing

comparability before inventing something new


81/85

Lesson 3Not all use-cases needeverything


82/85

Evolve gracefully.photo via Dawn Huczek

http://www.flickr.com/photos/31064702@N05/http://www.flickr.com/photos/31064702@N05/


83/85

Graceful Evolution


84/85

Graceful Evolution

1. Create "panel" codes that represent thenamed instrument

2. Create a total score term (as a child) for theinstruments where score is needed

3. When they are needed, fully model theinstrument as a complete set of questions(with answers where appropriate)


85/85