2015 12 02 - loinc introduction
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7/23/2019 2015 12 02 - LOINC Introduction
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Daniel J. Vreeman, PT, DPT, MScAssociate Research Professor
, Indiana University School of Medicine
Associate Director for Terminology Services, Regenstrief Institute, Inc
@djvreeman
© 2015
An Introduction to LOINC
Laboratory LOINC Workshop - Indianapolis, IN USA
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Acknowledgements
LOINC Development TeamClem McDonald, Jami Deckard, David Baorto, Katy Holck,Swapna Abhyankar, Theresa Pritchard, Sara Armson
RELMA Development TeamJohn Hook, Shahid Khokhar
LOINC Committee
Supporters
NLM, Regenstrief Institute, Regenstrief Foundation, APTA,RSNA, the LOINC Premium Members and Donors
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Overview
1. Origins and purpose of LOINC
2. The LOINC way
3. LOINC in action today
4. Overview of implementation resources
photo via Vernio77
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Origins of LOINC
McDonald et al. Canopy Computing: using the Web in Clinical Practice. JAMA
. 1998;280(15):1325-1329.
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Informatics Pioneers
40 years of EMR work
Indiana Network for Patient Care
Regenstrief serves as neutral 3rd party
convener
Most comprehensive and longest tenured Health Information Exchange (HIE) in USA
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Informatics Pioneers
40 years of EMR work
Indiana Network for Patient Care
Regenstrief serves as neutral 3rd party
convener
Most comprehensive and longest tenured Health Information Exchange (HIE) in USA
Crash Test Dummies
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Forrey AW, McDonald CJ, et al. Logical observation identifier names and codes (LOINC) database: a public use set of codes and names for electronicreporting of clinical laboratory test results. Clin Chem. 1996 Jan;42(1):81-90. PubMed PMID: 8565239.
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More than Meets the Eye
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Fundamental challenges:
Local systems have different ways of
identifying the same concept.
Things that look alike aren’t the same.
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Forrey AW, McDonald CJ, et al. Logical observation identifier names and codes (LOINC) database: a public use set of codes and names for electronicreporting of clinical laboratory test results. Clin Chem. 1996 Jan;42(1):81-90. PubMed PMID: 8565239.
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Logical
Observation
IdentifiersNames and
CodesA universal code system that facilitates exchange,
pooling, and processing of clinical data.
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A non-profit research organization in Indianapolis, USA
Established LOINC in 1994
Overall steward and owner of LOINC
Develops and licenses LOINC to promote widespread global
adoption
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LOINC is a universal code
system for tests, measurements,
and observations.
LOINC makes health data more
fluid and understandable todifferent computer systems.
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LOINC is like a bar code for
test data…
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photo via puuikibeach
WE DOMEASUREMENTS
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Laboratory LOINC
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Top 10 Lab Domain Overview
Microbiology 10,700
Chemistry 9,700
Drug/Toxicology 7,500
Allergy 3,800Chemistry - Challenge 3,700
Serology 2,400
Hematology 2,100Antibiotic Susceptibilities 1,700
Cell Markers 1,300
Molecular Pathology1,700
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Clinical LOINC
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If an observation is a question
and the observation value isan answer…
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LOINC provides codes for questions
Where needed, other vocabularies
provide codes for answers
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Does my patient have HIV?48345-3:HIV 1+O+2 Ab [Presence] in Serum or Plasma
Is my HIV patient’s immune
system responding well to ART?24467-3:CD3+CD4+ (T4 helper) cells [#/volume] in Blood
photo via nihgov
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How fast does mypatient usually walk?41959-8:Walking speed:Vel:1W^mean:^Patient:Qn:Calculated
photo via Ed Yourdon
di k f i
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MSH|^~\&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay||||||||||||||| PID|||$patientId$||$patientName$|||||||||||||||||||| PV1|||||||$attendingDoctor$||$consultingDoctor$||||||||
OBR|1|||012^CBC/Auto Diff^HSPA^57021-8^CBC W Auto Diff^LN||$reqDate||||||||| OBX|2|NM|123^WBC^HSP_A^26464-8^Leukocytes [#/volume] in Blood^LN||10.8|K/MM3|||||F| OBX|3|NM|234^RBC^HSP_A^26453-1^Erythrocytes [#/volume] in Blood^LN||4.82|MIL/MM3|||||F| OBX|4|NM|345^HGB^HSP_A^718-7^Hemoglobin [Mass/volume] in Blood^LN||15.7|GM/DL|||||F| OBX|5|NM|456^HCT^HSP_A^20570-8^Hematocrit [Volume Fraction] of Blood^LN||45|%|||||||F|
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MSH|^~\&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay||||||||||||||| PID|||$patientId$||$patientName$|||||||||||||||||||| PV1|||||||$attendingDoctor$||$consultingDoctor$||||||||
OBR|1|||012^CBC/Auto Diff^HSPA^57021-8^CBC W Auto Diff^LN||$reqDate||||||||| OBX|2|NM|123^WBC^HSP_A^26464-8^Leukocytes [#/volume] in Blood^LN||10.8|K/MM3|||||F| OBX|3|NM|234^RBC^HSP_A^26453-1^Erythrocytes [#/volume] in Blood^LN||4.82|MIL/MM3|||||F| OBX|4|NM|345^HGB^HSP_A^718-7^Hemoglobin [Mass/volume] in Blood^LN||15.7|GM/DL|||||F| OBX|5|NM|456^HCT^HSP_A^20570-8^Hematocrit [Volume Fraction] of Blood^LN||45|%|||||||F|
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MSH|^~\&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay||||||||||||||| PID|||$patientId$||$patientName$|||||||||||||||||||| PV1|||||||$attendingDoctor$||$consultingDoctor$||||||||
OBR|1|||012^CBC/Auto Diff^HSPA^57021-8^CBC W Auto Diff^LN||$reqDate||||||||| OBX|2|NM|123^WBC^HSP_A^26464-8^Leukocytes [#/volume] in Blood^LN||10.8|K/MM3|||||F| OBX|3|NM|234^RBC^HSP_A^26453-1^Erythrocytes [#/volume] in Blood^LN||4.82|MIL/MM3|||||F| OBX|4|NM|345^HGB^HSP_A^718-7^Hemoglobin [Mass/volume] in Blood^LN||15.7|GM/DL|||||F| OBX|5|NM|456^HCT^HSP_A^20570-8^Hematocrit [Volume Fraction] of Blood^LN||45|%|||||||F|
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MSH|^~\&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay||||||||||||||| PID|||$patientId$||$patientName$|||||||||||||||||||| PV1|||||||$attendingDoctor$||$consultingDoctor$||||||||
OBR|1|||012^CBC/Auto Diff^HSPA^57021-8^CBC W Auto Diff^LN||$reqDate||||||||| OBX|2|NM|123^WBC^HSP_A^26464-8^Leukocytes [#/volume] in Blood^LN||10.8|K/MM3|||||F| OBX|3|NM|234^RBC^HSP_A^26453-1^Erythrocytes [#/volume] in Blood^LN||4.82|MIL/MM3|||||F| OBX|4|NM|345^HGB^HSP_A^718-7^Hemoglobin [Mass/volume] in Blood^LN||15.7|GM/DL|||||F| OBX|5|NM|456^HCT^HSP_A^20570-8^Hematocrit [Volume Fraction] of Blood^LN||45|%|||||||F|
LocalCode^LocalName^CodeSystem^LOINCcode^LOINCname^CodeSystem
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MSH|^~\&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay||||||||||||||| PID|||$patientId$||$patientName$|||||||||||||||||||| PV1|||||||$attendingDoctor$||$consultingDoctor$||||||||
OBR|1|||012^CBC/Auto Diff^HSPA^57021-8^CBC W Auto Diff^LN||$reqDate||||||||| OBX|2|NM|123^WBC^HSP_A^26464-8^Leukocytes [#/volume] in Blood^LN||10.8|K/MM3|||||F| OBX|3|NM|234^RBC^HSP_A^26453-1^Erythrocytes [#/volume] in Blood^LN||4.82|MIL/MM3|||||F| OBX|4|NM|345^HGB^HSP_A^718-7^Hemoglobin [Mass/volume] in Blood^LN||15.7|GM/DL|||||F| OBX|5|NM|456^HCT^HSP_A^20570-8^Hematocrit [Volume Fraction] of Blood^LN||45|%|||||||F|
LocalCode^LocalName^CodeSystem^LOINCcode^LOINCname^CodeSystem
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MSH|^~\&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay||||||||||||||| PID|||$patientId$||$patientName$|||||||||||||||||||| PV1|||||||$attendingDoctor$||$consultingDoctor$||||||||
OBR|1|||012^CBC/Auto Diff^HSPA^57021-8^CBC W Auto Diff^LN||$reqDate||||||||| OBX|2|NM|123^WBC^HSP_A^26464-8^Leukocytes [#/volume] in Blood^LN||10.8|K/MM3|||||F| OBX|3|NM|234^RBC^HSP_A^26453-1^Erythrocytes [#/volume] in Blood^LN||4.82|MIL/MM3|||||F| OBX|4|NM|345^HGB^HSP_A^718-7^Hemoglobin [Mass/volume] in Blood^LN||15.7|GM/DL|||||F| OBX|5|NM|456^HCT^HSP_A^20570-8^Hematocrit [Volume Fraction] of Blood^LN||45|%|||||||F|
LocalCode^LocalName^CodeSystem^LOINCcode^LOINCname^CodeSystem
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MSH|^~\&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay||||||||||||||| PID|||$patientId$||$patientName$|||||||||||||||||||| PV1|||||||$attendingDoctor$||$consultingDoctor$||||||||
OBR|1|||012^CBC/Auto Diff^HSPA^57021-8^CBC W Auto Diff^LN||$reqDate||||||||| OBX|2|NM|123^WBC^HSP_A^26464-8^Leukocytes [#/volume] in Blood^LN||10.8|K/MM3|||||F| OBX|3|NM|234^RBC^HSP_A^26453-1^Erythrocytes [#/volume] in Blood^LN||4.82|MIL/MM3|||||F| OBX|4|NM|345^HGB^HSP_A^718-7^Hemoglobin [Mass/volume] in Blood^LN||15.7|GM/DL|||||F| OBX|5|NM|456^HCT^HSP_A^20570-8^Hematocrit [Volume Fraction] of Blood^LN||45|%|||||||F|
LocalCode^LocalName^CodeSystem^LOINCcode^LOINCname^CodeSystem
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MSH|^~\&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay||||||||||||||| PID|||$patientId$||$patientName$|||||||||||||||||||| PV1|||||||$attendingDoctor$||$consultingDoctor$||||||||
OBR|1|||012^CBC/Auto Diff^HSPA^57021-8^CBC W Auto Diff^LN||$reqDate||||||||| OBX|2|NM|123^WBC^HSP_A^26464-8^Leukocytes [#/volume] in Blood^LN||10.8|K/MM3|||||F| OBX|3|NM|234^RBC^HSP_A^26453-1^Erythrocytes [#/volume] in Blood^LN||4.82|MIL/MM3|||||F| OBX|4|NM|345^HGB^HSP_A^718-7^Hemoglobin [Mass/volume] in Blood^LN||15.7|GM/DL|||||F| OBX|5|NM|456^HCT^HSP_A^20570-8^Hematocrit [Volume Fraction] of Blood^LN||45|%|||||||F|
LocalCode^LocalName^CodeSystem^LOINCcode^LOINCname^CodeSystem
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Codes for individual observations
Leukocytes [#/volume] in Blood by Automated countErythrocytes [#/volume] in Blood by Automated count
Hematocrit [Volume Fraction] of Blood by Automated count
and collections of observations
CBC W Auto Differential panel - Blood
Vital signs, weight and height panel
PHQ-9 quick depression assessment panel
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OBX||CE|600-7^Bacteria Bld Cult^LN||56415008^Klebsiella pneumoniae^SCT
Result with a Coded Value
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OBX||CE|600-7^Bacteria Bld Cult^LN||56415008^Klebsiella pneumoniae^SCT
Result with a Coded Value
Data type of result
(OBX-5) is a coded
element
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OBX||CE|600-7^Bacteria Bld Cult^LN||56415008^Klebsiella pneumoniae^SCT
Result with a Coded Value
This code is from
LOINC
Code identifying this
observation
(what are these results?
Bacteria identified by
Blood Culture )
Data type of result
(OBX-5) is a coded
element
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OBX||CE|600-7^Bacteria Bld Cult^LN||56415008^Klebsiella pneumoniae^SCT
Result with a Coded Value
This code is from
LOINC
Code identifying this
observation
(what are these results?
Bacteria identified by
Blood Culture )
Data type of result
(OBX-5) is a coded
element
This code is from
SNOMED
Code identifying the result
(K. pneumoniae)
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LOINC fits well withother data standards
photo via Temari 09
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The LOINC WayOpen. Nimble. Pragmatic.
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Development Approach
Worldwide distribution at no cost
New terms requested by end-users
Welcome all comers Committees are volunteers
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Development Approach
Worldwide distribution at no cost
New terms requested by end-users
Welcome all comers Committees are volunteers
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Development Approach
Worldwide distribution at no cost
New terms requested by end-users
Welcome all comers Committees are volunteers
It’s free, but invaluable
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Financial Support
Many sourcesAHCPR, ASPE, CDC, CHCF, CMS, Hartford Foundation, IN
CTSA, Regenstrief Foundation*, Regenstrief Institute,
NCRR, NIBIB*, NLM*, LOINC User Community**active now
Today, the U.S. National Library of Medicine
(NLM) accounts for about 2/3 of our funding.
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Major releases
twice per year
(June and December)
photo via striatic
LOINC C d O Ti b R l
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0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
90,000LOINC Codes
Only Lab LOINC Codes
LOINC Codes Over Time by Release
laboratory terms only
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76,000 codes…haven’tyou finished yet?
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Lots Cooking…Always more lab tests
Genetic testing
Patient reported outcomes
Translational research data
Document titles
Radiology reportsphoto via liber
photo via liber
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Deckard J, McDonald CJ, Vreeman DJ. Supporting interoperability of genetic data with LOINC. J Am Med Inform Assoc. 2015 Feb 5. PMID: 25656513.
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Legal Stuffhttp://loinc.org/terms-of-use
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photo via 917press
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Just kidding.
Copyright is a good thing for
standards.
It’s the licensing part that issometimes interesting.
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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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Encourages
translation into
other languages
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That would defeat
the purpose of
having a standard!
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LOINC in action today
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photo via iboy_daniel
Data standards are like telephones.
They require a critical mass of usersbefore they become useful.
~ Clem McDonald, MD (1998)
“
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Our vision is for
LOINC to be
integrated into every clinical information
system that shares oraggregates data.
41,000+ registered users in 170 countries
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41,000+ registered users in 170 countries
loinc.org registered users
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0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
45,000
g g
loinc.org registered users
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0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
45,000
g g
6,000 new users per year
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Translations into 18 variants of 12 languages
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Vreeman DJ, Chiaravalloti MT, Hook J, McDonald CJ. Enabling international adoption of LOINC through translation. J Biomed Inform.2012 Aug;45(4):667-73. PMID: 22285984.
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Ad d N i l S d d
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Australia
Austria
Belgium
Brazil
Canada
CyprusEstonia
Finland
France
Germany
Iceland
India
Italy
Malaysia
Mexico
Mongolia
The Netherlands
New Zealand
Philippines
Portugal
QatarRwanda
Saudi Arabia
Slovakia
Slovenia
Spain
Thailand
Turkey
United States
Adopted as National Standard
L I l t ti
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Large Implementations
SIGA Saúde project7+ Provincial systems in Canada
8+ Regional Health Information Exchanges in Spain
ePSOSAssistance publique - Hôpitaux de Paris
Hong Kong Hospital Authority
Philippine Health Insurance CorporationInFSE Project in 5 regions in Italy (LOINC Italia)
M ny
Oth K Ad ti
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Other Key Adoptions
Many “big” labsAll health-related federal agencies in USA
Lots of care organizations
Professional societiesHealth information exchange networks
Insurance companies
EHR vendorsInstrument manufacturers (nascent)
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Vandenbussche PY, Cormont S, André C, et al. Implementation and management of a biomedical observation dictionary in a large healthcare information sy stem.J Am Med Inform Assoc. 2013 May 1. PMID: 23635601.
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Vandenbussche PY, Cormont S, André C, et al. Implementation and management of a biomedical observation dictionary in a large healthcare information sy stem.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.
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Vandenbussche PY, Cormont S, André C, et al. Implementation and management of a biomedical observation dictionary in a large healthcare information sy stem.J Am Med Inform Assoc. 2013 May 1. PMID: 23635601.
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Members of the Korean National StandardsCommittee have enthusiastically embraced LOINC
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LOINCing in Hong Kong
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Some ad hoc 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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Support for LOINC in Ministry of Health Malaysia
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photo via Fishking_1
Upstream standardization.Ask your IVD vendor which LOINC codesare appropriate for that test.
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LOINC adopted for:
1. View, download, transmit data to third party
2.Cancer case reporting to state registry
3.Send/receive electronic lab results inambulatory settings
4.Provide a care summary at care transition
5.Provide clinical summaries for patients 6.Submit reportable lab results to public health
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Use in Quality Measures
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Find HbA1c in the EHR with LOINC
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Find HbA1c in the EHR with LOINC
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Meaningful Use Stage 3
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2015 Edition Criteria NOT Adopted
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Vital Signs
Image Results
Family Health History—Pedigree
Patient List Creation
Electronic Medication Administration Record
Decision Support—Knowledge Artifact
Decision Support—Service
Incorporate Laboratory Tests and Values/Results
Transmission of Laboratory Test Reports
Accessibility Technology
SOAP Transport and Security Specification and XDR/XDM for Direct MessagingHealthcare Provider Directory—Query Request
Healthcare Provider Directory—Query Response
Electronic Submission of Medical Documentation
2015 Edition Criteria NOT Adopted
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Vital Signs
Image Results
Family Health History—Pedigree
Patient List Creation
Electronic Medication Administration Record
Decision Support—Knowledge Artifact
Decision Support—Service
Incorporate Laboratory Tests and Values/Results
Transmission of Laboratory Test Reports
Accessibility Technology
SOAP Transport and Security Specification and XDR/XDM for Direct MessagingHealthcare Provider Directory—Query Request
Healthcare Provider Directory—Query Response
Electronic Submission of Medical Documentation
2015 Edition Criteria Unchanged from 2014C t i d P id O d E t (CPOE) M di ti
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Computerized Provider Order Entry (CPOE)—Medications
CPOE—Laboratory
CPOE—Diagnostic Imaging
Drug-Drug, Drug-Allergy Interaction Checks for CPOE
Medication List
Medication Allergy List
Drug-Formulary and Preferred Drug List Checks
Smoking Status
Authentication, Access Control, Authorization
Audit Report(s)
Amendments
Automatic Access Time-Out
Emergency Access
End-User Device Encryption
Accounting of Disclosures
Transmission to Public Health Agencies—Reportable Laboratory Tests and Values/Results
2015 Edition Criteria Unchanged from 2014Computerized Provider Order Entry (CPOE) Medications
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Computerized Provider Order Entry (CPOE)—Medications
CPOE—Laboratory
CPOE—Diagnostic Imaging
Drug-Drug, Drug-Allergy Interaction Checks for CPOE
Medication List
Medication Allergy List
Drug-Formulary and Preferred Drug List Checks
Smoking Status
Authentication, Access Control, Authorization
Audit Report(s)
Amendments
Automatic Access Time-Out
Emergency Access
End-User Device Encryption
Accounting of Disclosures
Transmission to Public Health Agencies—Reportable Laboratory Tests and Values/Results
No standards adopted
2015 Edition Criteria Revised from 2014
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Demographics
Problem List
Clinical Decision Support
Family Health History
Patient-Specific Education Resources
Transitions of Care
Clinical Information Reconciliation and
Incorporation
Electronic Prescribing
Data Export
Clinical Quality Measures—Record and
Export
Clinical Quality Measures—Import and
Calculate
Clinical Quality Measures—Report
View, Download, and Transmit to 3rd
Party
Transmission to Immunization RegistriesTransmission to Public Health Agencies—
Syndromic Surveillance
Transmission to Cancer Registries
Automated Numerator Recording
Automated Measure Calculation
Safety-enhanced Design
Quality Management System
Auditable Events and Tamper-Resistance*
Integrity*Secure Messaging*
Direct Project*
Direct Project, Edge Protocol, and XDR/
XDM*
2015 Edition Criteria New Since 2014
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Implantable Device List
Social, Psychological, and Behavioral
DataData Segmentation for Privacy—Send
Data Segmentation for Privacy—Receive
Care Plan
Common Clinical Data Set Summary
Record—Create
Common Clinical Data Set Summary
Record—Receive
Clinical Quality Measures—Filter
Trusted Connection
API approach
Auditing Actions on Health Information
Patient Health Information Capture
Transmission to Public Health Agencies
—Electronic Case Reporting
Transmission to Public Health Agencies—Antimicrobial Use and Resistance
Reporting
Transmission to Public Health Agencies
—Health Care Surveys
Consolidated CDA Creation Performance
Application Access—Patient Selection
Application Access—Data Category
Request
Application Access—All Data Request
Accessibility—centered Design
Social, Psychological, and Behavioral Data
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, y g ,
Financial resource strain
Education
Stress
DepressionPhysical activity
Alcohol use
Social connection and isolationExposure to violence
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Know LOINC? Get Hired!Dec 1, 2015
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Many unexpected
successes along the way
photo via heyyu
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The LOINC DistributionLOINC Table, Accessory Files, and Tools and
Resources for Implementers
loinc.org/downloads
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g
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LOINC Accessory FilesSpecial representations of LOINC content
Accessory Files
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LOINC Panels and Forms FileAn export of key panels, survey instruments, and forms in a
detailed data structure.
LOINC Multiaxial Hierarchy FileHierarchical organization of LOINC terms based on their axes.
Lab terms are organized first by Component, then by System.
LOINC Document Ontology FileSpecial file for the detailed naming conventions for clinical
document titles (e.g. Discharge Summary, Progress Note, etc).
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Tools for
Implementers
photo via Robert S Donovan
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search.loinc.org
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Alternate Language Search
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Everything in Italian!Alternate Language Search
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Everything in Italian!
forum.loinc.org
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loinc.org/usage
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@LOINC@LOINC
loinc.org/slideshows
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loinc.org/adopters
List your organization. Free!
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y g
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RELMA®REgenstrief LOINC Mapping Assistant
RELMA Features
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Browse LOINC content
Map local terms to LOINC
import/export
translate local words to LOINC-speak
manual/automated mapping
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22 organizations, 5 countries, 102,000 mappings
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Dixon BE, Hook J, Vreeman DJ. Learning From the Crowd in Terminology Mapping: The LOINC Experience. Lab Med. 2015 Spring;46(2):168-74. PMID: 25918199.
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LOINC PremiumMembership Programmembers.loinc.org
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Share the love.
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Donate to LOINC.members.loinc.org/donate
members.loinc.org/donate
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What’s still free?
All the Usual Awesomeness
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LOINC Table
Accessory Files
RELMA Program
Documentation
Web search app (search.loinc.org)
Participation in the LOINC Community
Access to submit new concepts to LOINC
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In closing...
photo via janeandd
Glad you’re here to at least
t f t t
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photo via gmayster01 on & off ...
get your feet wet...
Jump in!
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photo via Justin Ornellas
The Race is On!
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Happy LOINCing!photo via ryarwood
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