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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
© 2016
An Introduction to LOINC
Clinical LOINC Meeting - Salt Lake City, UT USA
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loinc.org/slideshows
http://loinc.org/slideshows
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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
http://www.flickr.com/photos/verino77/
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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
http://loinc.org/terms-of-use
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LOINC is a universal code
system for tests, measurements,
and observations.
LOINC makes health data
shareable and understandableto different computer systems.
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LOINC is like a bar code for
test data…
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WE DOMEASUREMENTS
http://www.flickr.com/photos/puuikibeach
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Laboratory LOINC
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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
https://www.flickr.com/photos/nihgov/20683459455/
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How fast does mypatient usually walk?41959-8:Walking speed:Vel:1W^mean:^Patient:Qn:Calculated
photo via Ed Yourdon
http://www.flickr.com/photos/yourdon/
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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
http://www.flickr.com/photos/striatic/
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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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79,000 codes…haven’tyou finished yet?
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Lots Cooking…Always more lab testsGenetic testing
Patient reported outcomes
Translational research data
Document titles
Radiology reportsphoto via liber
photo via liber
http://www.flickr.com/photos/liberhttp://www.flickr.com/photos/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.
http://www.ncbi.nlm.nih.gov/pubmed/25656513
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Legal Stuffhttp://loinc.org/terms-of-use
http://loinc.org/terms-of-use
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photo via 917press
http://www.flickr.com/photos/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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CANNOT use anyLicensed Material to
develop or promulgate
a different standard fororders or observations.
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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)
“
http://www.flickr.com/photos/iboy_daniel/
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Our vision is for
LOINC to be
integrated into every clinical information
system that shares or
aggregates data 42 000 i t d i 171 t i
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42,000+ registered users in 171 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
loinc.org registered users
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
loinc.org registered users
5,500 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.
http://www.ncbi.nlm.nih.gov/pubmed/22285984
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Australia
Austria
Belgium
Brazil
Canada
Cyprus
Estonia
Finland
France
Germany
Iceland
India
Italy
Malaysia
Mexico
Mongolia
The Netherlands
New Zealand
Philippines
Portugal
Qatar
Rwanda
Saudi Arabia
Slovakia
Slovenia
Spain
Thailand
Turkey
United States
Adopted as National Standard
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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)
Many re
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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 vendors
Instrument 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.
http://www.ncbi.nlm.nih.gov/pubmed/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.
http://www.ncbi.nlm.nih.gov/pubmed/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.
http://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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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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Support for LOINC in Ministry of Health Malaysia
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photo via Fishking_1
Upstream standardization.Ask your IVD vendor which LOINC codes
are appropriate for that test.
http://www.flickr.com/photos/fishking1/5304638016/sizes/o/in/photostream/
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In USA, major driver ofeHealth standards adoption is
EHR Incentive Program
a.k.a. “Meaningful Use”
Blumenthal D, Tavenner M. The "meaningful use" regulation for electronic health records. N Engl J Med. 2010 Aug 5;363(6):501-4. Epub 2010 Jul 13. PubMed PMID: 20647183.
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Stage 12011-2012
Data capture
and sharing
Stage 22014
Advance clinical
processes
Stage 32016
Improved care
outcomes
progressive requirements for data standards
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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
Use in Quality Measures
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Q y
LOINC Ad d F
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LOINC Adopted ForPatient Characteristics
[Non-lab] Diagnostics studies
Patient experience
Family history
Functional statusHealth record component
Interventions (that produce an assessment or measured results)
Laboratory tests
Physical examPatient preference
Risk evaluation
System resources (healthcare resources)
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i d i h i h i h
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Find Height in the EHR with LOINC
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Meaningful Use Stage 3
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87 mentions of LOINC.
2015 Edition Criteria NOT Adopted
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p
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 Messaging
Healthcare Provider Directory—Query Request
Healthcare Provider Directory—Query Response
Electronic Submission of Medical Documentation
2015 Edition Criteria NOT Adopted
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p
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 Messaging
Healthcare Provider Directory—Query Request
Healthcare Provider Directory—Query Response
Electronic Submission of Medical Documentation
2015 Edition Criteria Unchanged from 2014
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gComputerized Provider Order Entry (CPOE)—Medications
CPOE—Laboratory
CPOE—Diagnostic ImagingDrug-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-OutEmergency Access
End-User Device Encryption
Accounting of Disclosures
Transmission to Public Health Agencies—Reportable Laboratory Tests and Values/Results
2015 Edition Criteria Unchanged from 2014
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gComputerized Provider Order Entry (CPOE)—Medications
CPOE—Laboratory
CPOE—Diagnostic ImagingDrug-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-OutEmergency 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 andIncorporation
Electronic Prescribing
Data Export
Clinical Quality Measures—Record and
ExportClinical 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
Data
Data 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 PerformanceApplication Access—Patient Selection
Application Access—Data Category
Request
Application Access—All Data Request
Accessibility—centered Design
S i l P h l i l d B h i l D t
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Social, Psychological, and Behavioral Data
Financial resource strainEducation
Stress
DepressionPhysical activity
Alcohol use
Social connection and isolationExposure to violence
S i l P h l i l d B h i l D t
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Social, Psychological, and Behavioral Data
Financial resource strainEducation
Stress
DepressionPhysical activity
Alcohol use
Social connection and isolationExposure to violence
All have specific LOINC codes identified
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Comments due March 21, 2016
Send me any you want LOINC to consider
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FDA Adoption and
Promotion of LOINC2015 to 2016
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Collaboration with IEEEStandards for medical devices
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My friends think this is coolSo, what do you do for a living?
photo via DieselDemon
https://www.flickr.com/photos/28096801@N05/4298600063/
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Apple Health Export in C-CDA Format
LOINC codes! Oh snap!
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Apple Health Export in C-CDA Format
p
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American Nurses
AssociationMarch 19, 2015
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Know LOINC? Get Hired!Dec 1, 2015
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Many unexpected
successes along the way
photo via heyyu
http://www.flickr.com/photos/heyyu/
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Everyone loves LOINC
photo via mccaughan
http://www.flickr.com/photos/mccaughan/3484111996/
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The LOINC DistributionLOINC Table, Accessory Files, and Tools and
Resources for Implementers
loinc org/downloads
http://loinc.org/downloads
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loinc.org/downloads
http://loinc.org/downloads
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LOINC TableThe main LOINC database content
One Record Per Term
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One Record Per Term
Long Common Name Cholesterol in LDL [Mass/volume] in Serumor Plasma b Direct assa
Short Name LDLc SerPl Direct Assay-mCnc
Class Type Lab
Class Chem
Example Units (local) mg/dL
Example Units mg/dL
Order/Obs Both
A Rich Encyclopedia
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A Rich Encyclopedia
Cells.HPV E6+E7 mRNA/cells [Presence] inCervix by Flow cytometry (FC)
Most human papilloma virus (HPV) genomes encode for eight major proteins, six"early" (E1, E2, E3, E4, E6, and E7) and two "late" (L1 and L2). The "early" are regulatory infunction. E6 and E7 genes in high-risk HPV genotypes are known as oncogenes becauseof their continuous expression, which leads to disruption of cell-cycle check points andcell genome instability through alteration of cellular p53 and retinoblastoma proteinfunctions. This test identifies cervical cells containing HPV E6 and E7 polycistronic mRNAusing in situ hybridization with oligonucleotides specific for the mRNA transcripts. The
cells remain intact, and following fixation and permeabilization, the probes enter thecells. The flow cytometer measures two things: 1. Quantification of E6 and E7 mRNA ineach cell and 2. The percentage of cells over-expressing E6 and E7 mRNA.
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LOINC Accessory FilesSpecial representations of LOINC content
Accessory Files
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Accessory FilesLOINC Panels and Forms File
An export of key panels, survey instruments, and forms in a detailed data structure.
LOINC Document Ontology FileSpecial file for the detailed naming conventions for clinical document titles.
LOINC Multiaxial Hierarchy FileHierarchical organization of LOINC terms based on their axes.
LOINC/IEEE Medical Device Code Mapping FileLinkages between LOINC terms and content from IEEE EMB/11073 standard.
LOINC/RSNA Radiology Playbook FileSpecial file for the detailed naming conventions for radiology procedure titles.
LOINC/SNOMED CT Expression Association and Map SetsDraft status (Technology Preview) file containing a) mappings between LOINC parts and
SNOMED CT concepts and b) SNOMED CT expressions linked to LOINC codes.
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Tools for
Implementers
photo via Robert S Donovan
http://www.flickr.com/photos/booleansplit/
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loinc.org/mailing-lists
http://loinc.org/mailing-lists
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g g
search.loinc.org
http://loinc.org/mailing-lists
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Alternate Language Search
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I !Alternate Language Search
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Everything in Italian!
forum.loinc.org
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loinc.org/usage
http://loinc.org/usage
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@LOINC
loinc.org/adopters
http://loinc.org/adopters
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loinc.org/adopters
List yo r organization Free!
http://loinc.org/adopters
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List your organization. Free!
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RELMA®REgenstrief LOINC Mapping Assistant
RELMA Features
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Browse LOINC content
Map local terms to LOINCimport/exporttranslate 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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Vreeman DJ, Hook J, Dixon BE. Learning from the crowd while mapping to LOINC. J Am Med Inform Assoc. 2015 Nov;22(6):1205-11. Epub 2015 Jul 29. PubMed PMID:
26224334.
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Individual Memberships
Donations (Sponsorships)
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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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Glad you’re here to at least
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photo via gmayster01 on & off ...
get your feet wet...
Jump in!
http://www.flickr.com/photos/10422334@N08/6175595309
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photo via Justin Ornellas
The Race is On!
http://www.flickr.com/photos/ornellas/http://www.flickr.com/photos/ornellas/
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Happy LOINCing!photo via ryarwood
http://www.flickr.com/photos/yarwood/
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