Download - 2015 06 - LOINC Introduction
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Daniel J. Vreeman, PT, DPT, MSc Associate 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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AcknowledgementsLOINC Development Team
Clem McDonald, Jami Deckard, David Baorto, Katy Holck, Swapna Abhyankar, Theresa Pritchard, Rachel Fuhr, Sara Armson
RELMA Development Team
John Hook, Anandhi Sowmyan, James Dennis
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 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 Pioneers40 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 Pioneers40 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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photo via nosha McDonald et al. Canopy Computing: using the Web in Clinical Practice. JAMA. 1998;280(15):1325-1329.
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photo via nosha McDonald et al. Canopy Computing: using the Web in Clinical Practice. JAMA. 1998;280(15):1325-1329.
The rain forest canopy is a seamless web through which arboreal creatures efficiently
move to reach the edible fruits without any attention
to the individual trees.
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In each case, the goals are stymied or delayed by the work and
expense of translating the Babel-like proliferation of different codes used by different sources for the
same tests even when the sources comply with existing electronic
message standards.Forrey AW, McDonald CJ, et al. Logical observation identifier names and codes (LOINC) database: a public use set of codes and names for electronic reporting of clinical laboratory test results. Clin Chem. 1996 Jan;42(1):81-90. PubMed PMID: 8565239.
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photo via chadlewis
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 arent the same.
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This problem would not exist if all laboratories used the same universal set of
test identifiers when electronically transmitting
test results.
Forrey AW, McDonald CJ, et al. Logical observation identifier names and codes (LOINC) database: a public use set of codes and names for electronic reporting of clinical laboratory test results. Clin Chem. 1996 Jan;42(1):81-90. PubMed PMID: 8565239.
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LogicalObservationIdentifiersNames andCodes
A universal code system that facilitates exchange, pooling, and processing of clinical data.
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Established in 1994 by Regenstrief Institute.
Vocabulary standard for observation identifiers.
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LOINC is like a bar code for test data
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photo via puuikibeach
WE DO MEASUREMENTS
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Laboratory LOINC
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Top 10 Lab Domain Overview
Microbiology 10,700Chemistry 9,200Drug/Toxicology 7,200Allergy 3,900Chemistry - Challenge 3,700Serology 2,500Hematology 2,100Antibiotic Susceptibilities 1,700Cell Markers 1,500Molecular Pathology 900
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Clinical LOINC
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If an observation is a question and the observation value is an answer
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LOINC provides codes for questionsWhere needed, other vocabularies provide codes for answers
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What is my patients hemoglobin level? 718-7:Hemoglobin:MCnc:Pt:Bld:Qn
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How fast does my patient usually walk? 41959-8:Walking speed:Vel:1W^mean:^Patient:Qn:Calculated
photo via Ed Yourdon
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Indiana Network for Patient Care
HL7 v2.x Message
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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|
Indiana Network for Patient Care
HL7 v2.x Message
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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|
Indiana Network for Patient Care
HL7 v2.x Message
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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|
Indiana Network for Patient Care
HL7 v2.x Message
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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
Indiana Network for Patient Care
HL7 v2.x Message
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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
Indiana Network for Patient Care
HL7 v2.x Message
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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
Indiana Network for Patient Care
HL7 v2.x Message
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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
Indiana Network for Patient Care
HL7 v2.x Message
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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
Indiana Network for Patient Care
HL7 v2.x Message
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Codes for individual observations
Leukocytes [#/volume] in Blood by Automated count
Erythrocytes [#/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 with other data standards
photo via Temari 09
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The LOINC WayOpen. Nimble. Pragmatic.
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Development ApproachWorldwide distribution at no cost
New terms requested by end-users
Welcome all comers
Committees are volunteers
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Development ApproachWorldwide distribution at no cost
New terms requested by end-users
Welcome all comers
Committees are volunteers
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Development ApproachWorldwide distribution at no cost
New terms requested by end-users
Welcome all comers
Committees are volunteers
Its free, but invaluable
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Financial SupportMany sources AHCPR, 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
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010,000
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0
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0a
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5 | 1.
0c
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0d
9/15
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5 | 1.
0e
12/2
1/19
95 | 1
.0f
4/28
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0g
8/29
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0h(2
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6 | 1.
0h(3
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0j-a
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k
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0l
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0m
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ma
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n
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LOINC Codes
Only Lab LOINC Codes
LOINC Codes Over Time by Release
laboratory terms only
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75,000 codeshavent you finished yet?
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Lots CookingAlways 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.Its the licensing part that is sometimes 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 any Licensed Material to develop or promulgate a different standard for orders 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 users before 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 or aggregates data.
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38,300+ registered users in 167 countries
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loinc.org registered users
6,000 new users per year
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LOINC Translators
22 organizations. Currently 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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Australia
Austria
Belgium
Brazil
Canada
Cyprus
Estonia
Finland
France
Germany
Iceland
India
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 ImplementationsSIGA Sade project
7+ Provincial systems in Canada
8+ Regional Health Information Exchanges in Spain
ePSOS
Assistance publique - Hpitaux de Paris
Hong Kong Hospital Authority
Philippine Health Insurance Corporation
InFSE Project in 5 regions in Italy (LOINC Italia)
Many more...
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Other Key AdoptionsMany big labs
All health-related federal agencies in USA
Lots of care organizations
Professional societies
Health information exchange networks
Insurance companies
EHR vendors
Instrument manufacturers (nascent)
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For the last few years, the AP-HP has been using the LOINC international
nomenclature Thanks to this catalogue, the AP-HP is able to use the nomenclature in its
treatment processes, whenever biology analyses and test results are
requested.
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Vandenbussche PY, Cormont S, Andr C, et al. Implementation and management of a biomedical observation dictionary in a large healthcare information system. J Am Med Inform Assoc. 2013 May 1. PMID: 23635601.
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Vandenbussche PY, Cormont S, Andr C, et al. Implementation and management of a biomedical observation dictionary in a large healthcare information system. J Am Med Inform Assoc. 2013 May 1. PMID: 23635601.
The results of our work validate the choice made to develop a local dictionary
aligned with LOINC.
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Vandenbussche PY, Cormont S, Andr C, et al. Implementation and management of a biomedical observation dictionary in a large healthcare information system. J Am Med Inform Assoc. 2013 May 1. PMID: 23635601.
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Members of the Korean National Standards Committee 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 codes
are appropriate for that test.
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In USA, major driver of eHealth 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 1 2011-2012
Data capture and sharing
Stage 2 2014
Advance clinical processes
Stage 3 2016
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 in
ambulatory 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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Lab reporting to EHRs
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Use in Quality Measures
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LOINC Adopted ForPatient Characteristics
[Non-lab] Diagnostics studies
Patient experience
Family history
Functional status
Health record component
Interventions (that produce an assessment or measured results)
Laboratory tests
Physical exam
Patient preference
Risk evaluation
System resources (healthcare resources)
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An Example Quality MeasureNational Committee for Quality Assurance
Diabetes: Hemoglobin A1c Poor Control
Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period.
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Find HbA1c in the EHR with LOINC
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Proposed MU3ONC 2015 Standards and Certification Criteria Notice of Proposed Rule Making (NPRM)
March 30, 2015
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118 pages. 119 mentions of LOINC.
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Need LOINC for these CriteriaComputerized provider order entrylaboratory
Vital signs, body mass index, and growth charts
Clinical Decision Support
Patient-specific education
Social, psychological, and behavioral data
Transitions of care
Incorporate laboratory tests and values/results
Transmission of laboratory test reports
Data portability
Care Plan
Clinical Quality measures - record and export
Clinical Quality measures - import and calculate
View, download, transmit to 3rd party
Transmission to public health agencies - reportable lab tests and values
Transmission to cancer registries
Transmission to public health agencies - antimicrobial use and resistance reporting
Transmission to public health agencies - health care surveys
Consolidated CDA creation performance
Application access to Common Clinical Data Set
Electronic submission of medical documentation
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FDA Adoption and Promotion of LOINCJanuary 27, 2015 and May 14, 2015
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Know LOINC? Get Hired!June 1, 2015
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Many unexpected successes along the way
photo via heyyu
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Everyone loves LOINC
photo via mccaughan
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The LOINC DistributionLOINC Table, Accessory Files, and Tools and Resources for Implementers
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loinc.org/downloads
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LOINC TableThe main LOINC database content
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One Record Per Term
Long Common Name Cholesterol in LDL [Mass/volume] in Serum or Plasma by Direct assay
Short Name LDLc SerPl Direct Assay-mCnc
Class Type Lab
Class Chem
Example Units (local) mg/dL
Example Units mg/dL
Order/Obs Both
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A Rich Encyclopedia
Cells.HPV E6+E7 mRNA/cells [Presence] in Cervix 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 in function. E6 and E7 genes in high-risk HPV genotypes are known as oncogenes because of their continuous expression, which leads to disruption of cell-cycle check points and cell genome instability through alteration of cellular p53 and retinoblastoma protein functions. This test identifies cervical cells containing HPV E6 and E7 polycistronic mRNA using in situ hybridization with oligonucleotides specific for the mRNA transcripts. The cells remain intact, and following fixation and permeabilization, the probes enter the cells. The flow cytometer measures two things: 1. Quantification of E6 and E7 mRNA in each cell and 2. The percentage of cells over-expressing E6 and E7 mRNA.
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LOINC Accessory FilesSpecial representations of LOINC content
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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 Multiaxial Hierarchy File Hierarchical organization of LOINC terms based on their axes. Lab terms are organized first by Component, then by System.
LOINC Document Ontology File Special 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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loinc.org/mailing-lists
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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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forum.loinc.org
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loinc.org/usage
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@LOINC@LOINC
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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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In closing...
photo via janeandd
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photo via gmayster01 on & off ...
Glad youre here to at least get your feet wet...
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Jump in!
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The Race is On!
Happy LOINCing!photo via ryarwood
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photo via milos milosevic