2014 12 03 - laboratory loinc and relma workshop

8/10/2019 2014 12 03 - Laboratory LOINC and RELMA Workshop

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2014 Regenstrief Institute and James Case

Using RELMA

Or In Search of the Missing LOINC

James T. Case MS, DVM, PhD, FHL7, FACMIHealth Program Specialist, SNOMED CT

National Library of Medicine

Laboratory LOINC Meeting

December 2014


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Acknowledgements

LOINC Development Team Clem McDonald, Dan Vreeman, Jami Deckard,

David Baorto, Rachel Fuhr, Katy Holck, Swapna

Abhyankar RELMA Development Team John Hook, Anandhi Sowmyan, James Dennis

LOINC Committee Supporters: NLM, Regenstrief Institute,

Regenstrief Foundation


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What will we cover today? Overview of LOINC

Reviewing new RELMA features! Installing RELMA Setting personal preferences Loading a Local Observation File (LMOF)

Searching for a LOINC Term Preparing LMOF for Mapping Review of Map Screen Functions Setting Search Limits

Mapping Local Terms to LOINC Viewing LOINC Term Details Proposing/Submitting New LOINC Terms Exporting/Printing Mapped Terms

Mapping your own LMOF data


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Why are we doing this?Goals of Health Information Standards

Interoperability the ability to exchangeinformation between organizations

Comparability the ability to ascertain theequivalence of data from different sources

Data Quality the measurement ofaccessibility, completeness, accuracy andprecision (and more)


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Levels of Interoperability

Basic allows data to be exchanged betweencomputer systems Word processing documents, text messages

Functional describes the standard syntax(format) of the data Document templates, forms, data structures

Message standards

Semantic requires use of standardizedcontent (vocabularies) within the datastructure


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Comparability Meaning of the data is consistent when sharedamong different parties

Erysipelas Human skin disease; Streptococcus Grp A Erysipelas Animal Septicemia/dermatitis; Erysipelothrix

rhusiopathiae Common terminology required Should work in the background

Words are not enough Codes uniquely identify terms Vocabulary specialized, precise terms that remove

ambiguity Ontology describes nature of entities and their relations Classification groups related terms by category



Potential Uses of Health Data areConstrained by Data Quality Factors Data quality issues

Different for client/patient communications vs.clinical decision support vs. epidemiological

analysis Often constrained by external forces

e.g. criteria for diagnosis often differs from the criteriafor reporting

Unidirectional effect of data consolidation Detailed General

General Detailed

This is a problem evenwhen standard

terminologies are used



The ProblemIn attempting to arrive at the truth, I have applied

everywhere for information, but in scarcely aninstance have I been able to obtain hospital

records fit for any purpose of comparison. If theycould be obtained, they would enable us todecide many other questions They would show[subscribers] how their money was being spent

[and] what amount of good was really being donewith it

Florence Nightingale - Notes on a Hospital, 1873



Test comparisons

Lab A Test 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

LOINC Code = 5062 5 LOINC Code = 6321 4

What you see in the order list



Why LOINC?Within one laboratory, local jargon termsmay be used which are usually well

understood between colleagues, butwould not be sufficiently widely known forcommunication with the outside world.

U. Forsum et al., Pure Appl. Chem 72:555-745, 2000 Properties and Units in the ClinicalLaboratory Sciences Part VII. Properties and Units in Clinical Microbiology



LOINC 101Emphasis on Laboratory

LOINC



5193-8:Hepatitis B virus surface Ab:ACnc:Pt:Ser:Qn:EIA

5193-8 LOINC Code

Hepatitis B virus surface Ab

ACnc

Pt

Ser

Qn

EIA

Component

Property Measured

Timing

System

Scale

Method

There are six major LOINC axes

Anatomy of a LOINC Term



NOT part of a LOINC Name Reason for the test (why it was ordered or the disease it

diagnoses)

Testing instrument Specific details about the specimen

Priority (e.g. STAT) Where testing was done Who did the test

Test interpretation Pricing or cost Anything not part of naming the test

Things from other fields in an HL7 artifact



The substance or entity that is measured,evaluated, or observed

Component/Analyte

- Sodium

- Glucose- Brucella sp. organism- Influenza A Virus antigen- Cytomegalovirus Virus antibody- Lipids.Total

5193-8: Hepatitis B virus surface Ab :ACnc:Pt:Ser:Qn:EIA


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Mass: Observations reported with mass (milligrams, grams, etc.) in the

numerator of their units of measure Substance: Observations reported with moles or milliequivalents in the

numerator of their units of measure

Catalytic activity: Observations that report enzymatic activity

Arbitrary: Results that report arbitrary units in the numerator of their unitsof measure (slowly being retired) Threshold: Results that represent the relation between a value and some

established limit or cut -off

Number: Counts

Property

5193-8:Hepatitis B virus surface Ab: ACnc :Pt:Ser:Qn:EIA

The characteristic or attribute of the analyte that ismeasured, evaluated, or observed

the most difficult LOINC axis

Major Categories



MCnc mass concentration (mass/unit vol; e.g. mg/dL) MCnt mass content (mass/unit mass; e.g. mg/Kg)

NCnc number concentration (number/unit vol; e.g. num/mL) TmStp time CCnc catalytic concentration (activity; e.g. kat/L) Prid presence or identity Imp impression/interpretation Find subjective or objective observation Type Kind-of

Property

5193-8:Hepatitis B virus surface Ab: ACnc :Pt:Ser:Qn:EIA

the most difficult LOINC axis

Combine Major Categories with Subtypes for Full Property



Common Property Issues

Fraction = Part/WholeNFr: % Eosinophils / leukocytes

SFr: % HGB which is A2

Ratio = multiple analytes from same system

MCrto: BUN/Creatinine in serum

Relative Ratio = measures from different system

RelRto: Albumin.pericard fld/Albumin.SerPl

F r ac t i o n v e r s u s R a t io



Important property changes

ACNC was always a placeholder For P/N results, changed to Threshold

Additional migrations occurring gradually

LOINC IDs being retained

Flavors of Threshold Property ThrSCnc Threshold Substance Concentration

ThrMCnc Threshold Mass Concentration

ThrACnc Threshold Arbitrary Concentration

PR vs PRID Presence or absence of an analyte now represented as

PR (presence)

For nominal results, property is still PRID



Pt - at a point in time 12H - a twelve hour collection 24H - a twenty four hour collection

Timing*

*non-Pt timings are usually associated with Rate Property

The interval of time over which the observation ormeasurement was made

5193-8:Hepatitis B virus surface Ab:ACnc: Pt: Ser:Qn:EIA



SystemThe system (context) or specimen type upon

which the observation was made.

Ser

Ser/PlasBldUrFluTissXXX

serum

serum or plasmawhole bloodurinebody fluidtissuespecified elsewhere

photo via AlishaV

5193-8:Hepatitis B virus surface Ab:ACnc:Pt: Ser: Qn:EIA
http://www.flickr.com/photos/AlishaV/http://www.flickr.com/photos/AlishaV/



System Structure

Super System Patient is the default

Used to indicate blood product unit

bone marrow donor fetus

818-5:A Ag:ACnc:Pt: RBC^BPU :Ord:54417-1:ABO+Rh group:Type:Pt: Bld^fetus :Nom:

System^Super System

photo via Xurble
http://www.flickr.com/photos/xurble/http://www.flickr.com/photos/xurble/


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ScaleQn

OrdNom

Nar

Quantitativecontinuous numericcan have operators ()

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

unranked collectionTaxonomy (e.g. bacteria)

Narrative

photo via puuikibeach

5193-8:Hepatitis B virus surface Ab:ACnc:Pt:Ser: Qn: EIA
http://www.flickr.com/photos/puuikibeach/http://www.flickr.com/photos/puuikibeach/


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Scale (Special) OrdQn Ordinal or Quantitative Primarily used for antimicrobial observations e.g.

MIC reported as resistant, intermediate, susceptibleor as the mm diameter of the inhibition zone

Use is discouraged in other contexts Multi structured text globs

e.g. chromatography output Use is discouraged

Doc Clinical documents Set Clinical attachments (headers)


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Method Only needed if interpretation affected

Different normal ranges Test sensitivity/specificity

Generally listed at the genericlevel Agglutination

Enzyme Immunoassay Probe with target amplification

5193-8:Hepatitis B virus surface Ab:ACnc:Pt:Ser:Qn: EIA


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Hierarchies LOINCClass

one per term

arbitrarily assigned One for each LOINC axis

Multi-axial Component | System

Separate download


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Mapping Terms to LOINCThings to Remember

The thing ordered is not always the thing measured: Blood Culture live organism(s) identified VDRL Treponema pallidum Ab Urinalysis lots of different things

You must know the specifics of the component beingtested for (what actually being measured?)

The question (what am I measuring? e.g. Glucose) isnot the answer (e.g. 90 mg/dl)

You are mapping the question, not the answer!

Need to get the observation/result boundary correct. Sample values help substantially


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What is in LOINC?Content

Term structures Submitted units, Example UCUM units

aiming toward preferred units sorting

Synonyms Answer lists (increasing number) Text descriptions links to info sources

about individual tests Panel structures Foreign language translations

And much more


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RELMARegenstrief LOINC Mapping Assistant


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Download of latest version

The latest version of the installation filemay be downloaded from:

https://iu.box.com/relma67


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Purpose of Tutorial

Eliminate need to read the Users Manual Become familiar with RELMA features Provide some insight into mapping tips/pitfalls Help begin the mapping process for your

institution Hang with some really cool folks


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LOINC files and indexes Manual and automated mapping functions RELMA tools transform local words in local file

User creates file of local term/name and codes

Assigns LOINC term to local test/battery code Common tests subset to speed mapping Context sensitive hierarchies for local use. Flexible Google -like search functions

RELMA Functions


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New in This Version (Rel. 6.7) LOINC Part CLASS values are available for searching on

the PART search screen using the new "ClassList" field. Cardinality representation changed.

Ex. optional with no upper bound is now displayed as "0..*"instead of "0..n."

LOINC CreatedOn and PART CreatedOn fields Now indexed and available for searching. See the advanced

search help topics of the user manual.

Have been added to the "BASIC ATTRIBUTES" section of thedetail pages.

"Export full panel structure to Excel" function includesthe LOINC answer list id ("LL" code) and answer list

name on the ANSWERS tab of the spreadsheet.


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New in This Version (Rel. 6.7) Added LMOF backup feature. Enhanced Local Term tagging feature.

Assign a tag to multiple local terms.

Assign a tag during the import process.

Exporting of local terms now includes the tag value(s). Answer list information now available via the main

search screen. A true/false field that indicates whether or not a term has an

associated answer list. (e.g. AnswerList: true) AnswerListId field - search by LOINC answer list number. (e.g.

AnswerListID: LL1919-1)

AnswerListName field - search by keywords in the answer listname. (e.g. AnswerListName: artificial)


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LOINC Web Site


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Whats available to download? RELMA - mapping and browsing tool

HL7 message converter- Makes a database suitable formapping

LOINC database and spreadsheets

Accessory files (panels, forms, top 2000, etc.) LOINC User guide; RELMA User Guide Tools to assist language translations by part Tools for building databases to map from HL7

messages Guidance documents for mappers


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RELMA Highlights Browse-able hierarchies of LOINC parts

Display search results in tree view Enhanced details view of terms/parts

References

Descriptions

Sample units

Empirically-derived common test list Empirically-derived common order list Special features for panels/forms Enhanced export/copy-paste options


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ll


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Installation Steps Requires Windows (or VM on a Mac)

Make sure you have enough free disk space! 2Gb is recommended

From CD - Start Run :\RELMA\Setup

Specify installation directory Life will be easier if you accept the default

Two database files installed RELMA.MDB LOINC Terms Database

LMOF3.MDB Local Master Observation File

Two sample files included Run from Start (All) Programs Regenstrief RELMA


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File Locations

Database and Ancillary Files Windows XP = C:\Documents and Settings\All

Users\Documents\RELMA\

Windows Vista = C:\Users\Public\Documents\RELMA\

Windows 7, 8 = C:\Users\Public\Public Documents\RELMA\ Sample files

Windows XP = C:\Documents and Settings\AllUsers\Documents\RELMA\Samples\

Windows Vista = C:\Users\Public\Documents\RELMA\Samples\ Windows 7, 8 = C:\Users\Public\Public

Documents\RELMA\Samples\


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Running RELMAVersion 6.7


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Join the LOINC Community


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LOINC crowdsourcing


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Main Menu/Welcome Screen

S P f d L


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Set Preferred Language

Click File, Set PreferredLanguage

S l Li i i V i ( )


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Select Linguistic Variant(s)

Selecting a translation mayrequire indexes to be built

LOINC Terms with Spanish Linguistic Variant


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LOINC Terms with Spanish Linguistic Variant

All Spanish!


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S t U P f


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Select User PreferencesFrom the File Menu

Set User Preferences

...or from Welcome Screen


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Set User Preference Dialog

Startup Screen Preference

File Locations:(See prior slide for location)

New Local Term Backup Tab

U M S P f


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User Map Screen PreferencesClick Map Screen Tab

Include/Exclude Battery Terms

Add comments on Mappings

Auto create search terms

U D t il P g P f


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User Detail Pages Preferences

Download detail pages from LOINC.org


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Request Submission Preference

Preferred method of request submission


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New! Local Backup Preferences


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Importing LocalTerms into RELMA


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5 Ways to Load LMOF Files

Direct entry into LMOF from within RELMA (painful) Handy for individual entries/edits

Create an Access table that mimics the LMOF structure(less painful but tedious)

Appendix A: RELMA Manual

Create a delimited ASCII file from your local testcatalog (good choice)

Import Excel file Load directly from HL7 v2.x messages

Pulls data from OBR and OBX segments

Stores NTE segment data


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Constructing a Local DatasetCreate extract of your test catalog with:

Battery/Panel Code Battery/Panel Description or Name *Local Code *Test Description or Name

Include Method if Important Units

Example Values Laboratory Section

C i D li i d ASCII Fil


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Creating Delimited ASCII File RELMA cant parse free text

Need to create separate fields

Can use any of these delimiters Tab, Semicolon, Comma, Space

Can define your own Fields can be in any order Minimum required fields

Local Code Local Description Units (highly recommended)


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Entering New Local Terms

into RELMA

Manual Enter/Edit


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Manual Enter/Edit

View/Add/Edit Local Terms

Edit Term Dialo

g


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Edit Term Dialo g

Edit\Add\Delete TermsExport Terms

Print Preview ListText alignment option

User assigned tags

E L l T Fil


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Export Local Term File

Delimiters supported:Tab, comma, bar (|)

Export to Microsoft Excelor Text File

New feature! Exportassigned tags

Add Local Term


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Add Local Term

Click to Add to CurrentWorking File

MICRO

BUBPLAG

BUBONIC PLAGUE RRT PCR

Add tags

Search Local Term File


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Search Local Term File

Enter Keyword from anyField

Calcium

Return to Full List

Tags panel only appears iftags have been assigned

Open or close tag list

Using tags to filter local terms


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Using tags to filter local terms

Print preview local termfile

Configure output prior toviewing and printing

Print Preview Local Term File


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Print Preview Local Term File

Only prints selected rows

Steps to Import Local Terms


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Steps to Import Local Terms1. Click Import Local Terms Button from Main Menu

a) File>Import Local Terms from Delimited File 2. Locate your local terms text file3. Name your Working Set (Mandatory)

a) LMOF database can contain multiple work sets4. Define default section (Optional)5. Identify file delimiter6. Assign fields to LMOF attributes

a) Ignore fields you dont need b) Combine fields if needed

7. Check Case -sensitive if needed 8. Click Import .

Example Tab-Delimited File


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Example Tab-Delimited File

Importing Local Files


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Importing Local Files

Select Import Local Termsfrom Delimited File orExcel Spreadsheet

Navigate to File Location


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Navigate to File LocationSelect File and Click OpenSample files stored in

RELMA Directory

Open File in RELMA


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Open File in RELMA

Name your working set.RELMA allows multiple sets in

LMOF database

Select your delimiter

Import Button

Fields Segregated


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Fields Segregated

Assign LMOF Attribute

Assign working set name

Working set import


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Working set importLOINC Workshop OBR


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New feature import tags

You can include tags in your import filethat allow you to categorize your local

terms New fields in import function allow

assignment of Tag with

Local term file with added tags


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Local term file with added tags

Tag terms

Assign tag values


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Assign tag values

New fieldassignment

Tagged local terms


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Tagged local terms

Imported tags

Post-Processing of Local File


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Post-Processing of Local File

After import, RELMA Searches for terms(words) that it does not recognize

Stored in a file for future reconciliation

Importing Excel file


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p g

Excel files now appear

along with text files

Excel format for import


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Excel format for import


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Local Term File Options

Change Local Term File


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Select the Working Set

Current mapping status

Can delete local term set; notthe active one

Alternative Pragmatic Way


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Alternative Pragmatic Way Use large set of HL7 messages

Automatically make dataset of: OBR ID OBR description

OBX ID OBX description Sample of results with

Real values Units Abnormal flags Normal ranges

Generate Local term file from HL7 messages


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Select Import Terms fromHL7 File

Select File to Import


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Select HL7 File

Specify HL7 File Name and Sample Size


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Name the Local TermFile (working set)

Select which codes to store

Skip import ofsample values

Select the number ofsample values

HL7 Messages Data Statistics


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New Terms added to LMOF


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New Battery Code

Click on Edit Term to seeSample Data

Sample Results for Observation


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pNew Test Code

Sample Values from

Messages


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RELMA Cleaning Tools


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gUse this tool to edit

unknown terms

Only available if nolanguage variant selected

Review Unknown Local Terms


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May Re-Scan File forUnknown Terms

Replace Local Terms


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p

Assign LMOF AttributeReplacement Options

RELMA Cleaning Tools


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gUse this tool to make

global substitutions


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Term Substitution

Save this global substitutionfor only this working set

Lenny LOINC says:


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y yBegin to clean your

data now!

Using the OBR sample file oryour own data, take 15-20minutes to clean up theseunrecognized terms


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Searching for LOINC Terms


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Search Window


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Enter Search Terms

Limit toSpecific Units

Use differentlogic

Help File

Restrict Limits

Search Window


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Common Tests selected Common Tests rank


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Changed search function Max words


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Large number ofresults

KeywordComponentWordCount

restricts word countRestricting to Commonlabs refines further

New search function - Answerlist


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Large number ofresults

Restricting to terms thathave answer lists

Answerlist details


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M i L l T


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Mapping Local Terms


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Standard Mapping Window Features


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Customizable grid View details of LOINC term New! Add searchable tags to local term Sort by column

Click column Custom Sort

Print or export results grid Spell check squiggly line to signify words

not known to RELMA


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Configure Grid


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Reorder grid elements

Select elements to display

Reset Default ConfigurationVisually resize elements


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View Local Term Details


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Select level of detail todisplay

Can scroll through

returned subset ofterms

Change text size

Can scroll down a singleformatted page

Details Text Size


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Select text size

Select detail display level


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Select level of detail todisplay

Standard Mapping Screen


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Begin a search

(or hit enter) EEK! Whatll

I do?!



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Click toshow words

used insearch

Initial Mapping Results


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Use termcheckbox

Number of LOINCterms containing

keyword Battery termsincluded in

search

Revised Mapping Results


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Number ofmatching

records found

Re-revised

Mapping Results


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Number ofmatching

records foundMatch units

selected



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Clear allinput fields

Enter keywords here

CANINE DISTEMPER VIRUS IF



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Navigate throughthe local terms

Tabbed Access to Functions


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Navigate to Functionsfrom Mapping Page

Switch between Grid andTree Views

Tree View


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Tree View


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Results displayed hierarchically Defined by the multi-axial hierarchy in search

restrictions (covered later)

Map to a term in tree by clicking Map button

or double clicking term Only to rows that have LOINC Codes

Tree View


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Cannot map toterms

representingLOINC parts

Can map to termswith LOINC Codes

Tree NavigationButtons

Assigning a LOINC Map


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Highlight correctterm

Click Map Button(or doubleclick)

Adding Mapping Comments


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If commentsoption is selected,prompt appears

Check with Frank in Chemistry

Assigning a LOINC Map


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LOINC Term Assigned

View Panel Children


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Select View Panel Childrenfrom context menu

Panel Children


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Excel Export Format


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New feature linked answer lists


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Adds answer list IDs to the answer tab of apanel export Allows linkage using the AnswerlistID with

the LOINC codes and the answer to seewhich answer go with a specific LOINC

Search for a panel


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Search for panel orLOINC code

Find the panelsassociated

Get panel details and export


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Export the full panelstructure


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More on SearchingSearch Screen


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Search Screen

Basic Search SyntaxSpecialCharacter(s)

Example Definition


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Character(s)

Influenza virus A Linked terms must appear together

AND Morphine ANDOpiates

Both terms must appear in the search resultterm

OR Influenza ORParainfluenza

Either or both terms must appear in thesearch result term

NOT Influenza NOT equine Excludes terms with the word following theNOT. Cannot be used alone.

? Gluc?se(glucose,glucase)

Substitutes a single character in the string.Cannot be used as the first character; cannotbe used in phrases

* Gluc*se(glucose,glucuronidase, etc.)

Substitute multiple characters in the string.Cannot be used as the first character; cannotbe used in phrases

Search Qualifiers


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Includes Glucuronidase,Glucosidase,Glucosylceramidase, etc.

Detailed help available

Combini

ng Search Terms


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Reduced number of terms

Exclude Glucosidase

Advanced Search Syntaxbased on Google-like search syntax


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g y

Parameter Description

+ Term must be included in search

- Term must be excluded from the search

( ) Group terms for subquery (i.e. A OR B; A AND B)

Fieldname: Limit term search to the associated field (e.g. Component: glucose)

Fieldname:() Group multiple terms in a single field

~ Fuzzy search (e.g. Hemofhilus~)

~ Proximity search for multiple terms (e.g. function panel~1) {}, [] Upper and lower bounds; {} exclusive, [] inclusive

\ Special character escape

Applying advanced search


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91 terms



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33 terms


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8 terms

Limiting Searches


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g

Setting Search Limits


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Narrows search to specific subset of LOINC terms Reduces number of candidate terms Limits can be applied to all components

Component attribute can be further restricted bynumber of words

Tree structure allows for hierarchical constraints

General Search Constraints


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Controls features including: Limit to LOINC terms compatible with submitted units Forced match with any specimen contained in name Method-less terms only

Restrict by class type Remove lateralized terms

Use carefully or search may not be successful(Note parallel control switches at bottom of screen)


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Setting search limits


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Can also set most of them by toggling

buttons at the bottom of the screen

Toggle Buttons

Search Constraints

Attribute trees


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Expanded predefined,general search constraints

Limit to LOINC termsconsistent with local units


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Specimenconstraints

Terms Consistent with Specimen


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CSF

Enter defaultSpecimen

Terms Consistent with Specimen


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Only CSF Terms arereturned



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Exclude laterality

Exclude laterality


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Laterality terms


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Restriction to common orders


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Large number ofcandidatesCommon orders

rank



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Methodless TermsRestriction

Override Methodless TermsRestriction

Limit to Methodless Terms


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Both method andmethod-less terms

Limit to Methodless Terms


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Only MethodlessTerms Appear

More on Methodless Terms


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Some LOINC categories do not havemethodless terms

Checking methodless only will remove thesefrom view on results grid

Checking additional box allows these to beseen

Methodless Only Unchecked


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All terms returned

Methodless Only Checked


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Only Methodlessterms returned

Differ in one or

more components

Conditional Methodless


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More terms

returned

No method-lessterm; all shown



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Include Trial, Deprecated orDiscouraged LOINC Codes with

Returned Terms

Include Deprecated LOINC Terms


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Deprecated LOINC Terms appear asStrikethrough Text with a Do Not

Symbol

You cannot map todeprecated LOINC terms

The map button is grayedout if one of these termsis selected

Discouraged LOINC Terms appear as an

inverted triangle

Favor Property Restriction


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Favor one type ofproperty over others

All other componentsbeing equal MCnconly will be displayed


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LOINC Hierarchies Class Tree


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Three top-levelbranches

Tree NavigationButtons


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Search Trees


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Restrict eligible teststo non-challenge

chemistry tests only

Following Class Restriction


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Only Non-ChallengeChemistry tests

returned

System Hierarchy


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Component Hierarchy

Click on details for morei f ti b t th


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Show the LOINC Codes

associated with thesecomponents

information about the

selection

Details Screen LOINC Part


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Show Associated LOINCs


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LOINC Term Details Screen


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Tree Export Tools


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Configure Export Format

Export according toConfiguration

Tree Export Configuration


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RELMA - Tree Features All trees operate the same way


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p y

Shows terms spelled out Can expand and collapse parts or all of tree. Tree is string searchable

Search can be based on one or morebranches of a tree with or without othercriteria

Use Clear Most Limits button on MappingScreen to remove all tree selections

LOINC Part Search

Same look as term search


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Same look as term search

Uses same Google -like query language Extremely fast

Include and exclude criteria

Partial string matching (using wildcards)

LOINC CLASS values may now be searchusing "ClassList:" field

Demo Campylobacter fetus, not Ab

LOINC Answer List Search


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Nominal LOINC terms are now requiredto be submitted with answer lists.

Finding answer lists and the use of themcan be done with Answer List Search tab

Answer List Search


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Answer Lists associated withLOINC term

Navigating through theMapping Process


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Mapping Process

Li it ff t t l b ti t ti d

LOINC Mapping Tactics


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Limit effort to one lab section at a time andfocus expertise

Chemistry and hematology will be easiest For manufactured assays, use package insert as

source information Sample results give clue to property and scale Consider prioritizing by frequency of use


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Vreeman DJ, Finnell JT, Overhage JM. A Rationale for Parsimonious Laboratory TermMapping by Frequency. AMIA Annu Symp Proc . 2007;:771-775.

More LOINC Mapping Tactics Try using method-less terms first

f h d b d


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Specific methods can be transmitted in: OBX 17 (v2.x), Observation.methodCode (v3.0)

Examine local units or real results to verifycorrect property and scale Properties are rarely distinguishable in test names

You dont have to do it all at one sitting Use the Unmapped function to return where you

left off With every release - Update previous mappings

to identify deprecated terms

Common Mapping Issues

Locally Defined Test Name Ambiguity


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Locally Defined Test Name Ambiguity Reuse of local test code

Analyte- free Local Test Names (Miscellaneous serology, PCR)

Incongruent Value sets (Scale ambiguity) Result vs. Interpretation Available LOINC Terms too Specific/General

Panel vs. Discrete Test Common in Microbiology

Using your Mapped Terms


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Print results of LOINC Mapping Export to File

Configure Export Format


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Context Sensitive ExportConfiguration

LMOF Export Configuration


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Select Fields to Export

Select Export Format

Save Configuration andExport

Print Mapped Terms from View/Add/Edit Menu


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May highlight terms to beprinted

Click Print button to Previewoutput

Formatted Report Output


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Click Print button to outputformatted report

Excel Export


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Picking the Lab Auto Mapper


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Lab Auto Mapper Start Screen


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Maximum number of termsto return

Can restrict search tocommon tests

Lab Auto Mapper Start Screen


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Terms used formapping

Local test code


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Exporting Mapped Terms


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Export Terms toDelimited File

Export Terms Dialog


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Check Fields youwish to export

Select Delimiter

Select Term Set

Direct export toExcel

Select file location


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Other RELMA Features

Panels, Forms and Survey Review

Review Panels, Forms andSurveys


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Review Panels, Forms andSurveys

Laboratory Panels


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Expand category tosee panels

Double-clickpanel test to seecomponents

Expanded Panel Detail


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Government Panels


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Form Category

Panel Codes

Government Panel Children


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Expanded Clinical Panel


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Clinical Panels


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Find where a term hasbeen used

35089-2, 35090-0

LOINC Term Panel Usage


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Other Survey Instruments


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HIPAA Attachments


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View Various HIPAA Attachments

HIPPA Attachment Tree


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Expanded Attachment Data


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Cant find the


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term youwant?

Search Hints and Tips Keywords with zero frequency are ignored

May need to rephrase use synonym


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May need to rephrase use synonym

Some causes for no returned terms Too many keywords in search uncheck some Limits applied that dont make sense

E.g. Method-less tests plus Method tree set to EIA Did not find and revise words not in RELMA

Local units not in RELMA

Units are GREAT discriminators You may have tests that need to be added toLOINC

Proposing New LOINC Terms


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Proposing New Terms Make sure the term is really needed

Think of other names for the same concept


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p Avoid detailed methods or localizations Is the distinction really important?

Supply sufficient annotation to justify the new term Package inserts, sample reports (email to Regenstrief) The more the better!

Construct new terms within RELMA File>Propose a new LOINC Linked to the trees to allow browsing

Can review and submit them to LOINC from withinRELMA

Propose new LOINC terms


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Select Propose anew LOINC


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Preview Proposed Terms


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Review your newterms

Review Proposed Terms

James T. Case DVM, PhD

NIH/NLM

301-555-1314

301-555-1315


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All proposed termsfully editable

Choose whether to

send or postpone

[email protected]

Direct submissionvia web

Submit Proposed Terms Add additionalinformation, if


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necessary Add attachments

Submitting New Terms Must supply name, organization, phone

and email of submitter


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and email of submitter

Must select at least one proposed term tosend

Configure export does not affectsubmission output Email resulting file to Regenstrief

Use Existing Terms as Template

Click the ProposeTerm button


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Select your closestmatch

Use Existing Terms as Template


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All requiredcomponents filled in


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Where do LOINC and SNOMED Fit?

Remember:


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LOINC represents the question: Is there any Botulism toxin in my specimen?

(33708-9)

Organisms identified in specimen? (634-6)

SNOMED represents the answer: Negative (SCTID 260385009)

E. coli O157:H7 (SCTID 103429008)

Where do LOINC and SNOMED Fit?

In an HL7 message, LOINC may be used:


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In OBR-4 (Universal Service Identifier) In OBX-3 (Observation Identifier

SNOMED may be used: In OBX-5 (where nominal values are needed)

Almost anyplace else in an HL7 message wherecoded values are needed

A code thatidentifies the

OBX: With a Coded Value


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The code isfrom SNOMED

The code isfrom LOINC

OBX-5: Data A code for L.

monocytogenes

data type inOBX-5 as a

coded element

OBX-3:A code thatidentifies the data in

OBX-5(Listeria culture)

OBX||CE|6609-2^Listeria ID^LN||36094007^L. monocytogenes^SCT

HL7 2.5 Example (ER-7 format)MSH|^~\&| LABGL1|| DMCRES|| 199812300100|| ORU^ R01|LABGL1199510221838581| P| 2.3||| NE| NE

PID||| 6910828^ Y^ C8|| Newman^ Alfred^ E|| 19720812| M|| W| 25 Centscheap Ave^^Whatmeworry^ UT^ 85201^^ P||( 555) 777- 6666|( 444) 677- 7777|| M|| 773789090

First Order OBR(Culture and ID)

First Result Value


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OBR|| 110801^ LABGL| 387209373^ DMCRES|634-6^Bacteria XXX Aerobe Cult^LN||| 199812292128||||||||Stool| IN2973^ Schadow^ Gunther^^^^ MD^

UPIN|||||||||||||||| CA20837^ Spinosa^ John^^^^ MD^ UPIN

OBX|| CE| 634-6^Bacteria XXX Aerobe Cult^ LN||50136005^Salmonella typhimurium^SCT|||||| F||| 199812292128|| CA20837

OBR|| 110801^ LABGL| 387209373^ DMCRES| 29567-9^Bacterial SusceptibilityPanel^ LN||| 199812300934||||||||Bacterial isolate| IN2973^ Schadow^Gunther^^^^ MD^ UPIN||||||||| Salmonella typhimurium ||||||| CA20837^ Spinosa^John^^^^ MD^ UPIN

OBX|| CE|23631-5^Trimethoprim/Sulfasoxazole^ LN||264841006^Intermediate^SCT|||||| F||| 199812300934|| CA20837

OBX|| CE|18967-7^Penicillin^LN||30714006^Resistant^SCT|||||| F||| 199812300934||CA20837

OBX|| CE|18928-2^Gentamicin^ LN||131196009^Susceptible^SCT|||||| F|||199812300934|| CA20837

First Result(Culture and ID)

First Result(Culture and ID)Second Result(s)

OBXs

(SNOMED)

First Result DescriptionOBX (LOINC)

Second Order OBR(Susceptibility)

Q and A Session


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ExerciseMap your own data


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