Laboratory LOINC Workshop - Indianapolis, IN

LOINC
Introduction and Overview

Daniel J. Vreeman, PT, DPT, MSc

Assistant Research Professor, Indiana University School of Medicine
Research Scientist, Regenstrief Institute, Inc

2012.06.07 dvreeman@regenstrief.org © 2012

loinc.org/slideshows
 Acknowledgements
LOINC Development Team
Kathy Mercer, Jaci Phillips, Jami Deckard, Kelly Malott,
David Baorto, Clem McDonald

RELMA Development Team

John Hook, Anandhi Sowmyan, James Dennis

LOINC Committee

Sandy Poremba
Origins of LOINC
The lingua franca of clinical observation exchange
 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.
McDonald et al. Canopy Computing: using the Web in Clinical Practice. JAMA. 1998;280(15):1325-1329. photo via nosha
photo via beckstei
Arboreal Informatics Pioneers
40 years of EMR work
Indiana Network for Patient Care
Nation’s  most  comprehensive  and  longest  tenured  HIE

Regenstrief
– the “Data Switzerland”
Fundamental challenge:
Local systems have different ways of
identifying the same concept.
 Only way to corral the
infinite indiosyncracies is
with standards

photo via pfarrell95

A vocabulary standard
would serve as the
Rosetta Stone.

Image © Hans Hillewaert / CC-BY-SA-3.0

 Logical
Observation
Identifiers
Names and
Codes
A universal code system that facilitates exchange,
pooling, and processing of results
Established in 1994 by
Regenstrief Institute.

Vocabulary standard for

observation identifiers.
Similar name, different meaning…

photo via Caption Time

meerkat meerkat mere cat meerkat

 MEASUREMENTS
”R“
US
photo via puuikibeach
If an observation is a question and
the observation value is
an answer…

LOINC provides codes for

questions

Where needed, other

vocabularies provide codes for
answers
What is my patient’s
hemoglobin level?
718-7:Hemoglobin:MCnc:Pt:Bld:Qn
How fast does my patient
usually walk?
41959-8:Walking speed:Vel:1W^mean:^Patient:Qn:Calculated

photo via Ed Yourdon

 Indiana Network for Patient Care

HL7 v2.x Message

LocalCode^LocalName^CodeSystem^LOINCcode^LOINCname^CodeSystem
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|
 Result with a Coded Value

Data type of result

(OBX-5) is a coded This code is This code is from
element from LOINC SNOMED

OBX||CE|57131-5^Newborn conditions with pos markers^LN||7573000^PKU^SCT

Code identifying this

observation
(what are these results? Code identifying the result
Conditions identified by (Phenylketonuria )
newborn screening )
A  brief  aside  about  
terminology…

photo via eye of einstein

LOINC Terminology
LOINC  (noun)

To  LOINC,  LOINCing,  LOINCed  (verb)

[Chief,  Head,  etc]  LOINCer  (noun)

LOINCification  (noun)

SNOMED Terminology
SNOMED  (noun)

SNOMEDicated???  
Different standards for different
parts of the elephant.

photo via Ludovic Hirlimann

 We now return to your
regularly scheduled
program…

photo via x-ray delta one

Laboratory LOINC
Clinical LOINC
LOINC Collections
Panels, forms, surveys, and other patient
assessments

photo via LuzA

 Standardized Assessments and Collections

Vreeman DJ, McDonald CJ, Huff SM. Representing patient assessments in LOINC®. AMIA Annu Symp Proc. 2010;832-836. PMID: 21347095 .
Vreeman DJ, McDonald CJ, Huff SM. LOINC® - A Universal Catalog of Individual Clinical Observations and Uniform Representation of Enumerated Collections. Int J Funct Inform
Personal Med. 2010;3(4):273-291.
Laboratory LOINC Committee Chair:
Clem McDonald, MD

Clinical LOINC Committee Chair:

Stan Huff, MD
The LOINC Community
Open. Nimble. Pragmatic.
 Open Development
It’s  free,  but  invaluable
Worldwide distribution at no cost
New terms from end-users
Welcome all comers
Committees are volunteers
 Funding Support
Main current sources are:
U.S. National Library of Medicine
Regenstrief Foundation

Prior support from

Several other U.S. federal agencies,
John A. Hartford Foundation
 Regenstrief Institute
Steward
Developer of content
Developer of tools
Developer of community
Distributor
Voice
 4/
5/ 24
2 /
6/ 4/ 199

10,000
20,000
30,000
40,000
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80,000

0
2 1 5
6/ 3/1 995 | 1
2
7/ 8/ 995 | 1. .0
1 1 0
9/ 4/1 995 | 1. a
12 15 99 | 1 0b
/2 /19 5 | .0
1 c
8/ 4/2 /1 95 1.0
2 8 9 | d
12 9/1 /19 95 1.0
/3 99 96 | 1 e
/1 6 .0
Lab Codes

1/ 99 | 1 | 1.0 f
LOINC Codes

10 8/ 6 .0 g
/9 19 | 1. h(2
/ 9 0 )
5/ 199 97 h(3
2/ 1/1 7 | | 1. )
7/ 12 99 1.0 0i
2 / 8 j
8/ 3/1199 | 1 -a
6/ 9 9 .0k
9 |
2/ 199 9 | 1.0
6/ 4/ 9 | 1.0 l
13 20 1 m
1/ /20 00 .0m
1/ 1/2 00 | 1. a
31 0 | 0n
7/ /2001 1.0
1 | 0
1/ /2001 2.0
1 | 0
2/ /2001 2.0
2/ 1/2 02 | 2. 1
19 0 | 03
8/ /2002 2.0
1 | 4
Slope = 600

9/ /2002 2.0
1 | 5
5/ /2002 2.0
10 1/2 02 | 2. 6
/1 00 | 07
1/ /20 3 2.0
1 | 8
2/ /2003 2.0
12 1/2 04 | 2. 9
1
12/1/2004 | 2. 0
/1 00 | 11
6/ /20 4 2.1
12 1/2 04 | 2. 2
/1 00 | 13
6/ /20 5 2.1
12 1/ 0 | 2 4
/2 20 5 | .15
6/ 1/2 06 2.1
Slope = 2200

12 21 00 | 2 6
/0 /20 6| .17
7/ 3/2 07 2.1
1 9
1/ 0/2007|2.2
07 10 00 |2 1
/ .2
12/06 2008|2 2
/3 /20 9| .24
2/ 0/2 09 2.2
2 6
6/ 6/2009|2.2
12 15 01 |2 7
/ .2
laboratory terms only

06/29 2010|2 9
/ .3
12/30 2010|2 0
/3 /20 0| .32
0/ 1 2.
20 1| 34
LOINC Codes Over Time by Release

11 2.3
|2 6
.3
8
Lots Cooking…
Always more lab tests
Genetic reporting
Flow cytometry
Lots of survey instruments, forms, and assessments
More radiology reports
Structured document titles
…

photo via liber

18,300+ users in 146 countries
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Everything  in  Italian!

forum.loinc.org
loinc.org/usage
loinc.org/terms-of-use
photo via 917press
Just kidding.

Copyright is a good thing for

standards.

It’s the licensing part that is

interesting.
No cost
Worldwide
In perpetuity
Use
Copy
Distribute
Any purpose:
commercial
non-commercial
photo via Refracted Moments™
CANNOT use any
Licensed Material to
develop or promulgate a
different standard for
orders or observations.
That would defeat
the purpose of
having a standard!
International Adoption
participation, translation, implementation
 LOINC Submitters

Since  2009:
79  organizations  from  14  countries
LOINC Translators
19  organizations
Vreeman DJ et al. Enabling international adoption of LOINC through translation. J Biomed Inform (2012), doi:10.1016/j.jbi.2012.01.005
 Adopted as National Standard
Brazil
Canada
France
Germany
The Netherlands
Mexico
Rwanda
Thailand
 Large Implementations
SIGA Saúde project
Canada Health Infoway
ePSOS
Assistance publique - Hôpitaux de Paris
Red Agrolab
BiTAC
Hong Kong Hospital Authority

Many  more...
 Members  of  the  Korean  National  Standards  
Committee  have  enthusiastically  embraced  LOINC
Some  serious  LOINCing  in  Hong  Kong
Some  not-­so-­serious  LOINCing
Talking  about  LOINC  at  the  Thai  Ministry  of  
Information  and  Communication  Technology
US Adoption
A few key highlights
 Some Key US Adoptions
All the “big” labs
All health-related federal agencies
Lots of care organizations
HIE’s
Insurance companies
EHR vendors
Instrument manufacturers (nascent)
CMS EHR Incentive
Program
a.k.a. “Meaningful Use”
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
Key Lessons
for Today

photo via IMLS DCC

Not  just  an  I.T.  problem
If Murky, Don’t Assume
Units of measure are critical.

Sample results can help identify the

correct LOINC Scale.

Local experts, package inserts can be

very informative.
 Clean water act

Upstream standardization.
Ask instrument or test kit
manufacturers.
photo via Fishking_1
ivdconnectivity.org
A journey.
Not a destination.
 Ongoing Journey

Plan for updating as your testing

changes (less common), or your local
code identifiers change (more common).
 Ongoing Journey

Replace mappings to deprecated

terms with new LOINC releases.

(RELMA can help)

 Prioritization
Local or national policies may help
prioritize mapping subsets.

For example:
common results
+ panel elements
+ public health reportable tests
Propose New LOINC Terms
LOINC grows because you ask.

photo via NaSiUdUk

RELMA Can Help
loinc.org/submissions
Jump In!

photo via Justin Ornellas

The Race is On!

Happy LOINCing!
photo via ryarwood
photo via milos milosevic