2013 06 06 - laboratory loinc and relma workshop

7/28/2019 2013 06 06 - Laboratory LOINC and RELMA Workshop

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2013 Regenstrief Institute and James Case

UsingRELMAOrInSearchoftheMissingLOINC

JamesT.CaseMS,DVM,PhD,FHL7,FACMIHealthProgramSpecialist,SNOMEDCT

NationalLibraryofMedicine

LaboratoryLOINCMeetingJune2013


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Acknowledgements

LOINCDevelopmentTeam ClemMcDonald,DanVreeman,JamiDeckard,

DavidBaorto,KellyMalo8

RELMADevelopmentTeam JohnHook,AnandhiSowmyan,JamesDennis

LOINCCommi7ee Supporters:NLM,RegenstriefInsEtute,

RegenstriefFoundaEon


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Whatwillwecovertoday?

OverviewofLOINC ReviewingnewRLMAfeatures! InstallingRLMA Sengpersonalpreferences LoadingaLocalObservaEonFile(LMOF)

SearchingforaLOINCTerm PreparingLMOFforMapping ReviewofMapScreenFuncEons SengSearchLimits MappingLocalTermstoLOINC ViewingLOINCTermDetails Proposing/SubmingNewLOINCTerms xporEng/PrinEngMappedTerms MappingyourownLMOFdata


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Whyarewedoingthis?GoalsofHealthInformation

Standards

InteroperabilitytheabilitytoexchangeinformaEonbetweenorganizaEons

Comparabilitytheabilitytoascertaintheequivalenceofdatafromdifferentsources

DataQualitythemeasurementofaccessibility,completeness,accuracyandprecision(andmore)


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LevelsofInteroperability

Basicallowsdatatobeexchangedbetweencomputersystems Wordprocessingdocuments,textmessages

Funconaldescribesthestandardsyntax(format)ofthedata

Documenttemplates,forms,datastructures Messagestandards

Semancrequiresuseofstandardizedcontent(vocabularies)withinthedata

structure


7/2382013 Regenstrief Institute and James Case

Comparability

MeaningofthedataisconsistentwhensharedamongdifferentparEes rysipelasHumanskindisease;StreptococcusGrpA rysipelasAnimalSepEcemia/dermaEEs;Erysipelothrixrhusiopathiae

Commonterminologyrequired Shouldworkinthebackground

Wordsarenotenough CodesuniquelyidenEfyterms Vocabularyspecialized,precisetermsthatremove

ambiguity

OntologydescribesnatureofenEEesandtheirrelaEons ClassificaEongroupsrelatedterms



PotentialUsesofHealthDataare

ConstrainedbyDataQualityFactors

Dataqualityissues Differentforclient/paEentcommunicaEonsvs.

clinicaldecisionsupportvs.epidemiological

analysis O]enconstrainedbyexternalforces

e.g.criteriafordiagnosiso]endiffersfromthecriteriaforreporEng

UnidirecEonaleffectofdataconsolidaEon DetailedGeneral GeneralDetailed



TheProblemIna8empEngtoarriveatthetruth,Ihaveapplied

everywhereforinformaEon,butinscarcelyan

instancehaveIbeenabletoobtainhospital

recordsfitforanypurposeofcomparison.Iftheycouldbeobtained,theywouldenableusto

decidemanyotherquesEonsTheywouldshow

[subscribershowtheirmoneywasbeingspent

[andwhatamountofgoodwasreallybeingdonewithit

FlorenceNightingale-NotesonaHospital,1873



Testcomparisons

LabATestName:LymeDiseaseSerology

Measures:B.burgdorferiAbIgG

Method:ELISA

Scale:quantave

e.g.:Titer1:40

LabBTestName:LymeDiseaseAnbody

Measures:B.burgdorferiAbIgM

Method:Immuneblot

Scale:qualitave

e.g.:Posive

LOINC Code = 5062-5 LOINC Code = 6321-4

Whatyouseeintheorderlist



WhyLOINC?Withinonelaboratory,localjargonterms

maybeusedwhichareusuallywell

understoodbetweencolleagues,but

wouldnotbesufficientlywidelyknownfor

communicaEonwiththeoutsideworld.

U.Forsumetal.,PureAppl.Chem72:555-745,2000 Proper3esandUnitsintheClinical



LOINC

101EmphasisonLaboratoryLOINC



5193-8:HepatitisBvirussurfaceAb:ACnc:Pt:Ser:Qn:EIA

5193-8 LOINCCode

HepasBvirussurfaceAb

ACnc

Pt

Ser

Qn

EIA

Component

PropertyMeasured

Timing

System

Scale

Method

TherearesixmajorLOINCaxes

AnatomyofaLOINCTerm



NOTpartofaLOINCName

Reasonforthetest(whyitwasorderedorthediseaseitdiagnoses)

TesEnginstrument Specificdetailsaboutthespecimen Priority(e.g.STAT) WheretesEngwasdone Whodidthetest

TestinterpretaEon Pricingorcost Anythingnotpartofnamingthetest ThingsfromotherfieldsinanHL7message



ThesubstanceorenEtythatismeasured,evaluated,orobserved

Component/Analyte

- Sodium

- Glucose- Brucellasp.organism

- InfluenzaAVirusanEgen

CytomegalovirusVirusanEbody Lipids.Total




ComponentStructure

Analyte Name^Challenge^Adjustments

Formal analyte nameSpecify subanalytesMay have subclassesChallengeTwo parts separated by

postAdjustments

CalciumCoronavirus Ag

Calcium.ionized

1H post 100 g Glucose POpost

Adjusted to pH 7.4



Mass:ObservaEonsreportedwithmass(milligrams,grams,etc.)inthenumeratoroftheirunitsofmeasure Substance:ObservaEonsreportedwithmolesormilliequivalents

inthenumeratoroftheirunitsofmeasure

Catalycacvity:ObservaEonsthatreportenzymaEcacEvity

Arbitrary:Resultsthatreportarbitraryunitsinthenumeratoroftheirunitsofmeasure

Number:Counts

Property


ThecharacterisEcora8ributeoftheanalytethatismeasured,evaluated,orobserved

themostdifficultLOINCaxis

MajorCategories



MCncmassconcentraEon(mass/unitvol;e.g.mg/dL) MCntmasscontent(mass/unitmass;e.g.umol/L) NCncnumberconcentraEon(number/unitvol;e.g.mg/g) TmStpEme CCnccatalyEcconcentraEon(acEvity;e.g.) PridpresenceoridenEty Impimpression/interpretaEon FindsubjecEveorobjecEveobservaEon TypeKind-of

Property


themostdifficultLOINCaxis

CombineMajorCategorieswithSubtypesforFull

Property



CommonPropertyIssues

Fracon=Part/Whole

NFr:%osinophils/leukocytes

SFr:%HGBwhichisA2

Rao=mulEpleanalytesfromsamesystem

MCrto:BUN/CreaEnineinurine

RelaveRao=measuresfromdifferentsystem

RelRto:Albumin.pericardfld/Albumin.SerPl

Fraction versus Ratio



Pt-atapointinEme 12H-atwelvehourcollecEon 24H-atwentyfourhourcollecEon

Timing*

*non-PtEmingsareusuallyassociatedwithRateProperty

TheintervalofEmeoverwhichtheobservaEonormeasurementwasmade




SystemThe system (context) or specimen type upon

which the observation was made.

Ser

Ser/PlasBld

UrFlu

TissXXX

serum

serum or plasmawhole blood

urinebodyfluid

tissuespecified elsewhere

photo via AlishaV




SystemStructure

SuperSystem PaEentisthedefault Usedtoindicate

bloodproductunit bonemarrowdonor 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


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ScaleQn

Ord

Nom

Nar

Quantitativecontinuous numericcan have operators ()OrdinalRanked set (1+, 2+, 3+)Nominalunranked collectionTaxonomy (e.g. bacteria)Narrative

photo via puuikibeach



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Scale(Special)

OrdQnOrdinalorQuanEtaEve PrimarilyusedforanEmicrobialobservaEonse.g.

MICreportedasresistant,intermediate,suscepEbleorasthemmdiameteroftheinhibiEonzone

Useisdiscouragedinothercontexts MulEstructuredtextglobs

e.g.chromatographyoutput Useisdiscouraged

DocClinicaldocuments SetClinicala8achments(headers)


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Method

OnlyneededifinterpretaEonaffected Differentnormalranges TestsensiEvity/specificity

Listedatthegenericlevel AggluEnaEon nzymeImmunoassay ProbewithtargetamplificaEon



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HierarchiesLOINCClassOneforeachLOINCaxisMulE-axial

Component|System Separatedownload


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LOINCCOLLECTIONS

Panels,forms,surveys,andotherpaEent

assessments

photo via LuzA

St d di d A t d


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StandardizedAssessmentsand

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, HuffSM. LOINC - A Universal Catalog of Individual Clinical Observations and Uniform Representation of EnumeratedCollections. Int J Funct Inform Personal Med. 2010;3(4):273-291.


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IteraEvelyexpandedthe

baselabpanelmodeltoaccommodatemore

complexa8ributes


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HierarchyofaPanelinLOINC


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Assessmentinstrumentsarewidelyused

and not unlike other clinicalobservations

Purpose


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LOINCcouldsupporta

master question file

anduniform representation


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P l /F A il bl


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Panels/FormsAvailableas

SeparateDownload


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LOINC.ORG/USAGE

i l


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AFewTestsGiveMostResults

C

umulative

Labora

tory

O

bserv

ation

V

olume(%)

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

loinc org/usage


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loinc.org/usage

Top 2000 Results


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a.k.a. Top 300 Orders

http://loinc.org/downloads/usage/

orders


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a.k.a. Common Units of Measure

http://loinc.org/downloads/usage/units


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M i T


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MappingTermsto

LOINCThingstoRemember

Thethingorderedisnotalwaysthethingmeasured: BloodCultureliveorganism(s)idenEfied VDRLTreponemapallidumAb Urinalysislotsofdifferentthings

ThequesEon(whatamImeasuring?e.g.Glucose)isnottheanswer(e.g.90mg/dl) YouaremappingthequesEon,nottheanswer!

Youmustknowthespecificsofthecomponentbeingtestedfor(whatisthistestactuallymeasuring?)


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WhatisinLOINC?Content

Termstructures Submi8edunits,xampleUCUMunits

aimingtowardpreferredunitssorEng

Synonyms Answerlists(increasingnumber) TextdescripEonslinkstoinfosources

aboutindividualtests Panelstructures ForeignlanguagetranslaEons


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RELMARegenstriefLOINCMappingAssistant


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PurposeofTutorial

liminateneedtoreadtheUsersManual BecomefamiliarwithRLMAfeatures ProvidesomeinsightintomappingEps/pialls Helpbeginthemappingprocessforyour

insEtuEon

Hangwithsomereallycoolfolks


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LOINCfilesandindexes ManualandautomatedmappingfuncEons SamefreeuseasLOINC(seelicense) RLMAtoolstransformlocalwordsinlocalfile

Usercreatesfileoflocalterm/nameandcodes AssignsLOINCtermtolocaltest/ba8erycode Commontestssubsettospeedmapping ContextsensiEvehierarchiesforlocaluse. FlexibleGoogle-likesearchfuncEons

RELMAFunctions


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NewinThisVersion(Rel.6.1) Bugfixes

Fixedaccessibilityissueswherelargetextdidnotdisplaycorrectly.

FixedissuewheretheuserwasnotreturnedtotheMainMenua]erclosingthesearchscreen.

FixedissuewheremulEpleformsweredisplayingwhentheuserselected"ReviewHIPAAA8achments"fromthetop

menu.

Fixedissuewherethe"CommonTests"dropdownlistonthemappingformdidnotshowallfouropEonswithouttheneedforscrolling.

FixedissuewherethesearchresultslanguageheaderdidnotproperlyshowtheRLMAdefinedpreferredlanguage.


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AbilitytodeleteaLocalTermFilefromwithintheformEtled"SelectLocalTermFile".

RLMAwillnotallowtheusertodeletetheprovidedSAMPLfile.

Willnota8empttoconnecttotheinternetifuserhaschosentoNOTshowthelog-inscreen

onRLMAstart-up.

RLMAnowtemporarilydisplaysawarningtextwithinthesearchtextboxwhenasearch

doesnotreturnsearchresults.

NewinThisVersion(Rel.6.1)


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Providesamoreuser-friendlymessageforLMOF3.mdbprivilegeerrormessages.

Provideanexpandedsetofsearchexclusioncriteriaintheformofcheckboxes,whichallows

formulEple-selecEon. moredetailedinformaEonaboutthesenew

restricEonsintheusermanual.

TheOrder/Obsconstraintshavebeenexpandedwithtwonewitems: Includesubset Includeunclassified



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TheLucene"descripEon"fieldhasbeenexpandedtoincludedatafromreferencesources.

ResultsinasubstanEalincreaseintheamountofdiskspaceusedbytheapplicaEon.

The"xportLocalTermFile"screennowsupportsdirectexporttoaMicroso]xcelspreadsheet.



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LOINCWebSite


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Whatsavailabletodownload?

RLMA-mappingandbrowsingtool HL7messageconverter-Makesadatabasesuitablefor

mapping

HL7lint(findsbadmessages) LOINCdatabaseandspreadsheets Accessoryfiles(panels,forms,top2000,etc.) LOINCUserguide;RLMAUserGuide ToolstoassistlanguagetranslaEonsbypart ToolsforbuildingdatabasestomapfromHL7

messages

Newguidancedocumentsformappers

RELMA Hi hli h


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RELMAHighlights Browse-ablehierarchiesofLOINCparts Displaysearchresultsintreeview nhanceddetailsviewofterms/parts

References DescripEons Sampleunits

mpirically-derivedcommontestlist mpirically-derivedcommonorderlist Specialfeaturesforpanels/forms nhancedexport/copy-pasteopEons


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Installing RELMA

Installation Steps


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InstallationSteps

RequiresWindows(orVMonaMac) Makesureyouhaveenoughfreediskspace!

2Gbisrecommended FromCD-StartRun:\RLMA\Setup SpecifyinstallaEondirectory

Lifewillbeeasierifyouacceptthedefault Twodatabasefilesinstalled

RLMA.MDBLOINCTermsDatabase LMOF3.MDBLocalMasterObservaEonFile

Twosamplefilesincluded RunfromStart(All)ProgramsRegenstriefRLMA

Fil L i


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FileLocations

DatabaseandAncillaryFiles WindowsXP=C:\DocumentsandSengs\AllUsers\Documents

\RLMA\

WindowsVista=C:\Users\Public\Documents\RLMA\ Windows7=C:\Users\Public\PublicDocuments\RLMA\

Samplefiles WindowsXP=C:\DocumentsandSengs\AllUsers\Documents

\RLMA\Samples\

WindowsVista=C:\Users\Public\Documents\RLMA\Samples\ Windows7=C:\Users\Public\PublicDocuments\RLMA

\Samples\


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Running RELMAVersion 6.1

Copyright Screen


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CopyrightScreen

New Feature! Join the LOINC


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NewFeature!JointheLOINC

Community


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LOINCcrowdsourcing

M i M /W l S


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MainMenu/WelcomeScreen

Set Preferred Language


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SetPreferredLanguage

ClickFile,SetPreferred

Language

Select Linguistic Variant(s)


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SelectLinguisticVariant(s)

Selectingatranslationmayrequireindexestobebuilt

LOINCTermswithS

panishLinguisticVariant


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p g

AllSpanish!


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SettingUserPreferences

Set User Preferences


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SelectUserPreferences

FromtheFileMenu

SetUserPreferences

...orfromWelcomeScreen

Set User Preference Dialog


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SetUserPreferenceDialog

StartupScreenPreference

NewFileLocations:

(Seepriorslideforlocation)

User Map Screen Preferences


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UserMapScreenPreferences

ClickMapScreenTab

Include/ExcludeBattery

Terms

AddcommentsonMappings

Autocreatesearchterms

User Detail Pages Preferences


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UserDetailPagesPreferences

DownloaddetailpagesfromLOINC.org


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ImportingLocal

TermsintoRELMA

4W L d LMOF Fil


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4WaystoLoadLMOFFiles

DirectentryintoLMOFfromwithinRLMA(painful) Handyforindividualentries/edits

CreateanAccesstablethatmimicstheLMOFstructure(lesspainfulbuttedious)

AppendixA:RLMAManual CreateadelimitedASCIIfilefromyourlocaltest

catalog(goodchoice)

LoaddirectlyfromHL7v2.xmessages PullsdatafromOBRandOBXsegments StoresNTsegmentdata

Constr cting a Local Dataset


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ConstructingaLocalDataset

Createextractofyourtestcatalogwith: Ba8ery/PanelCode Ba8ery/PanelDescripEonorName *LocalCode *TestDescripEonorName

IncludeMethodifImportant Units xampleValues LaboratorySecEon

Creating Delimited ASCII File


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CreatingDelimitedASCIIFile

RLMAcantparsefreetext Needtocreateseparatefields

Canuseanyofthesedelimiters Tab,Semicolon,Comma,Space Candefineyourown

Fieldscanbeinanyorder Minimumrequiredfields

LocalCode LocalDescripEon Units(highlyrecommended)


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EnteringNewLocalTerms

intoRELMA

ManualEnter/Edit


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/

View/Add/EditLocalTerms

EditTermDialo

g


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d t e a og

Edit\Add\DeleteTerms

ExportTerms

PrintPreviewListTextalignmentoption

Export Local Term File


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ExportLocalTermFile

Delimiterssupported:

Tab,comma,bar(|)

New!Directexportto

MicrosoftExcel

AddLocalTerm


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ClicktoAddtoCurrentWorkingFile

MICRO

BUBPLAG

BUBONIC PLAGUE RRT PCR

SearchLocalTermFile


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EnterKeywordfromanyField

Calcium

ReturntoFullList

Print Preview Local Term File


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PrintPreviewLocalTermFile

Onlyprintsselectedrows

Steps to Import Local Terms


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StepstoImportLocalTerms

1. ClickImport Local TermsBu8onfromMainMenua) File>Import Local Terms from Delimited File

2. Locateyourlocaltermstextfile3. NameyourWorkingSet(Mandatory)

a. LMOFdatabasecancontainmulEpleworksets4. DefinedefaultsecEon(OpEonal)5. IdenEfyfiledelimiter6. AssignfieldstoLMOFa8ributes

a. Ignorefieldsyoudontneedb. Combinefieldsifneeded

7. CheckCase-sensiEveifneeded. ClickImport.

ExampleTab-DelimitedFile


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p

ImportingLocalFiles


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p g

SelectImportLocalTerms

fromDelimitedFile

Navigate to File Location


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NavigatetoFileLocation

SelectFileandClickOpenSamplejilesstoredin

RELMADirectory

OpenFileinRELMA


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p

Nameyourworkingset.

RELMAallowsmultiplesetsin

LMOFdatabase

Selectyourdelimiter

ImportButton

FieldsSegregated


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g g

Assign LMOF Attribute

Assignworkingsetname

Workingsetimport


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g p

LOINC Workshop OBR

ReadytoImport


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y

Minimumassignments

Nowyoucanclickthe

Importbutton!

Post-Processing of Local File


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Post ProcessingofLocalFile

A]erimport,RLMASearchesforterms(words)thatitdoesnotrecognize

StoredinafileforfuturereconciliaEon


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LocalTermFileOptions

ChangeLocalTermFile


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SelecttheWorkingSet

Currentmappingstatus

New!Candeletelocalterm

set;nottheactiveone

Alternative Pragmatic Way


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AlternativePragmaticWay

UselargesetofHL7messages AutomaEcallymakedatasetof:

OBRID OBRdescripEon

OBXID OBXdescripEon Sampleofresultswith

Realvalues Units Abnormalflags Normalranges

GenerateLocaltermjilefromHL7messages


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SelectImportTermsfromHL7File

SelectFiletoImport


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SelectHL7File

SpecifyHL7FileNameandSampleSize


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NametheLocalTerm

File(workingset)

Selectwhichcodestostore

Skipimportofsamplevalues

Selectthenumberof

samplevalues

HL7MessagesDataStatistics


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NewTermsaddedtoLMOF


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NewBatteryCode

ClickonEditTermtosee

SampleData

SampleResultsforObservation


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NewTestCode

SampleValuesfrom

Messages

LennyLOINCsays:


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y y

LoadtheSampleFiles

IntoRELMAnow!

Importthetwosamplefilesprovided Import_Sample_OBR.txt

Containsba8erycodeanddescripEon

Import_Sample_OBX.txt Containstestcodeand

descripEon

Create2workingsets Loadyourpersonaldataset


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Cleaningyourdata

PreparingyourDataforMapping


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Improvemappingsuccessby: xpandingabbreviaEons Standardizingcolloquialterms

IgnoringadministraEveterms StandardizingEmereferences

CanbedonepriortoimporEng Be8ertousetoolsbuiltintoRLMA

RELMACleanin

gTools


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g

Usethistooltoedit

unknownterms

ReviewUnknownLocalTerms


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MayRe-ScanFilefor

UnknownTerms

ReplaceLocalTerms


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p

AssignLMOFAttributeReplacementOptions

RELMACleanin

gTools


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g

Usethistooltomake

globalsubstitutions


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TermSubstitution

Savethisglobalsubstitution

foronlythisworkingset

LennyLOINCsays:


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Begintocleanyour

datanow!

UsingtheOBRorOBXsamplefiles,take15-20minutestocleanuptheseunrecognizedterms

Youmayuseyourowndataifyouwish.


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SearchingforLOINCTerms


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ComprehensiveSearch

OnlyTool

SearchWindow

H l Fil


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EnterSearch

Terms Limitto

SpecijicUnits

Usedifferent

logic

HelpFile

RestricttoCommon

Limits

SearchWindow


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CommonTestsselected

CommonTestsrank

RELMASearchHelpjile


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ContextMenu


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Rightclicktobring

upcontextmenu

ChangedsearchfunctionMaxwords


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Largenumberof

results

Keyword

ComponentWordCount

restrictswordcount

Mapping Local Terms


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MappingLocalTerms

MappingLocalTerms


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SelectyourWorkingSettoMap File>Select Local Term File to Process

SelectMap Local Terms to LOINCfromWelcomeScreen

Selectthesubsetoftermstoworkwith: All Mapped Unmapped

SetyourSearch Limits Set Search Limits Bu8on

StandardMappingWindowFeatures


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Customizablegrid ViewdetailsofLOINCterm Sortbycolumn

Clickcolumn CustomSort

Printorexportresultsgrid Spellchecksquigglylinetosignifywords

notknowntoRLMA

MappingScreen


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Vieworeditlocalterm

Quickselectbuttonlist

CustomGridConjiguration

Enterlocaltermnumber

ConjigureGrid


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Reordergridelements

Selectelementstodisplay

ResetDefaultConjiguration

Visuallyresizeelements

Quickchoicebuttons


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ViewingLOINCtermdetail

ViewLocalTermDetails


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Selectlevelofdetailto

displayCanscrollthrough

returnedsubsetofterms

Changetextsize

Canscrolldownasingle

formattedpage

DetailsTextSizeS l t t t i


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Selecttextsize

Selectdetaildisplaylevel


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Selectlevelofdetailto

display

StandardMappingScreen


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Beginasearch

(orhitenter)EEK!WhatllI

do?!



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Clicktoshowwords

usedin

search

InitialMappingResults


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Useterm

checkbox

NumberofLOINCtermscontaining

keywordBatteryterms

includedin

search

RevisedMappingResults


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Numberof

matching

recordsfound

Re-revisedMappingResults


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Numberof

matching

recordsfoundMatchunits

selected



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Clearall

inputjields

Enterkeywordshere

CANINE DISTEMPER VIRUS IF



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Navigatethrough

thelocalterms

TabbedAccesstoFunctions


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NavigatetoFunctions

fromMappingPage

SwitchbetweenGridand

TreeViews

TreeView


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TreeView


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Resultsdisplayedhierarchically DefinedbythemulE-axialhierarchyinsearch

restricEons(coveredlater)

MaptoatermintreebyclickingMapbu8onordoubleclickingterm OnlytorowsthathaveLOINCCodes

TreeView


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Cannotmapto

terms

representing

LOINCparts

Canmaptoterms

withLOINCCodes

TreeNavigation

Buttons

AssigningaLOINCMap


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Highlightcorrect

term

ClickMapButton(ordoubleclick)

AddingMappingComments


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Ifcommentsoptionisselected,

promptappears

Check with Frank in Chemistry

AssigningaLOINCMap


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LOINCTerm

Assigned

ViewPanelChildren


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SelectViewPanelChildren

fromcontextmenu

PanelChildren


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ConjigureExportOptions


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OutputOptions

Include

columnheadersSaveConjiguration

and/orExport

ExcelExportFormat


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MoreonSearching

Search Screen


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SearchScreen

BasicSearchSyntaxSpecial Character(s) Example

Definition


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Influenza virus A Linked terms must appear together

AND Morphine AND Opiates Both terms must appear in the search result term

OR Influenza ORParainfluenza

Either or both terms must appear in the search resultterm

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

? Gluc?se(glucose,glucase)

Substitutes a single character in the string. Cannot beused as the first character; cannot be used in

phrases

* Gluc*se(glucose, glucuronidase,

etc.)

Substitute multiple characters in the string. Cannot beused as the first character; cannot be used in

phrases

SearchQualijiers


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IncludesGlucuronidase,Glucosidase,

Glucosylceramidase,etc.

Detailedhelpavailable

Combinin

gSearchTerms


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Reducednumberofterms

ExcludeGlucosidase

AdvancedSearchSyntaxbasedonGoogle-likesearchsyntax


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based o Goog e e sea c sy ta

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

Applyingadvancedsearch


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91terms



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33terms



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19terms



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8terms

LimitingSearches


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g

SettingSearchLimits


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NarrowssearchtospecificsubsetofLOINCterms Reducesnumberofcandidateterms Limitscanbeappliedtoallcomponents Componenta8ributecanbefurtherrestrictedbynumberofwords Treestructureallowsforhierarchicalconstraints

GeneralSearchConstraints


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Controlsfeaturesincluding: LimittoLOINCtermscompaEblewithsubmi8edunits Forcedmatchwithanyspecimencontainedinname Method-lesstermsonly

Limittocomponents/analyteswithNorfewerwordsintheirname

PopupsearchEmingstaEsEcsa]ereachsearch Usecarefullyorsearchmaynotbesuccessful

(Noteparallelcontrolswitchesatbo8omofscreen)

SettingSearchLimits


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ClickHierarchy&Search

LimitsTab

Settingsearchlimits


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Canalsosetmostofthembytogglingbu8ons

atthebo8omofthescreen

ToggleButtons

SearchConstraints

Attributetrees


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New!Expanded

predejined,generalsearch

constraints

LimittoLOINCterms

consistentwithlocalunits

TermsConsistentwithUnits


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Onlytermsconsistent

withmmol/Lappear

SettingSearchLimits


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Specimen

constraints

TermsConsistentwithSpecimen


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CSF

Enterdefault

Specimen

TermsConsistentwithSpecimen


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OnlyCSFTerms

arereturned

SettingSearchLimits


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Excludelaterality

Excludelaterality


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Lateralityterms

SettingSearchLimits


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Restrictto

commonorders

Restrictiontocommonorders


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LargenumberofcandidatesCommonorders

rank

SettingSearchLimits


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MethodlessTerms

Restriction

OverrideMethodlessTerms

Restriction

LimittoMethodlessTerms


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Bothmethodand

method-lessterms

LimittoMethodlessTerms


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OnlyMethodless

TermsAppear

MoreonMethodlessTerms


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SomeLOINCcategoriesdonothavemethodlessterms

Checkingmethodlessonlywillremovethesefromviewonresultsgrid

CheckingaddiEonalboxallowsthesetobeseen

MethodlessOnlyUnchecked


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Alltermsreturned

MethodlessOnlyChecked


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OnlyMethodless

termsreturned

Differinoneor

morecomponents

ConditionalMethodless


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Moreterms

returned

Nomethod-less

term;allshown

SettingSearchLimits


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IncludeTrial,Deprecatedor

DiscouragedLOINCCodeswith

ReturnedTerms

IncludeDeprecatedLOINCTerms


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DeprecatedLOINCTermsappearas

StrikethroughTextwithaDoNot

Symbol

YoucannotmaptodeprecatedLOINCterms

Themapbuttonisgrayedoutifoneofthesetermsisselected

DiscouragedLOINCTermsappearasan

invertedtriangle

FavorPropertyRestriction


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Favoronetypeof

propertyoverothers

AllothercomponentsbeingequalMCnc

onlywillbedisplayed

Order/ObservationRestriction


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OrderorObservation

preference

LOINCHierarchiesClassTree


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Threetop-level

branches

TreeNavigation

Buttons

BeforeClassRestriction


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Largenumberof

candidateterms

Manytermshaveclass

ofCHAL

SearchTrees


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Restricteligibletests

tonon-challenge

chemistrytestsonly

FollowingClassRestriction


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OnlyNon-ChallengeChemistrytests

returned

SystemHierarchy


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ComponentHierarchy

Clickondetailsformore

information about the


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ShowtheLOINCCodesassociatedwiththese

components

informationaboutthe

selection

DetailsScreenLOINCPart


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ShowAssociatedLOINCs


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LOINCTermDetailsScreen


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TreeExportTools


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ConjigureExportFormat

Exportaccordingto

Conjiguration

TreeExportConjiguration


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RELMA-TreeFeatures

Alltreesoperatethesameway


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p y

Showstermsspelledout Canexpandandcollapsepartsoralloftree. Treeisstringsearchable Searchcanbebasedononeormorebranchesofatreewithorwithoutother

criteria

UseClearMostLimitsbu8ononMappingScreentoremovealltreeselecEons

LOINCPartSearch


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Samelookastermsearch UsesGoogle-likequerylanguage

xtremelyfast Includeandexcludecriteria ParEalstringmatching(usingwildcards)

Demo Campylobacterfetus,notAb

LOINCAnswerListSearch


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NominalLOINCtermsarenowrequiredtobesubmi8edwithanswerlists.

FindinganswerlistsandtheuseofthemcanbedonewithAnswerListSearchtab

AnswerListSearch


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AnswerListsassociatedwith

LOINCterm

Navigatingthroughthe

Mapping Process


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MappingProcess

Li it ff t t l b E t E d

LOINCMappingTactics


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LimitefforttoonelabsecEonataEmeandfocusexperEse

Chemistryandhematologywillbeeasiest Formanufacturedassays,usepackageinsertas

sourceinformaEon Sampleresultsgivecluetopropertyandscale ConsiderprioriEzingbyfrequencyofuse


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VreemanDJ,FinnellJT,OverhageJM.ARationaleforParsimoniousLaboratoryTerm

MappingbyFrequency.AMIAAnnuSympProc.2007;:771-775.

MoreLOINCMappingTactics

Tryusingmethod-lesstermsfirstS ifi h d b i d i


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Specificmethodscanbetransmi8edin: OBX17(v2.x),ObservaEon.methodCode(v3.0)

xaminelocalunitsorrealresultstoverifycorrectpropertyandscale

ProperEesarerarelydisEnguishableintestnames Youdonthavetodoitallatonesing

UsetheUnmappedfuncEontoreturnwhereyoule]off

Witheveryrelease-UpdatepreviousmappingstoidenEfydeprecatedterms

CommonMappingIssues

Locally Defined Test Name Ambiguity


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LocallyDefinedTestNameAmbiguity Reuseoflocaltestcode

Analyte-freeLocalTestNames (Miscellaneousserology,PCR)

IncongruentValuesets(Scaleambiguity) Resultvs.InterpretaEon AvailableLOINCTermstooSpecific/General Panelvs.DiscreteTest CommoninMicrobiology

UsingyourMappedTerms


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PrintresultsofLOINCMapping xporttoFile

ConjigureExportFormat


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ContextSensitiveExport

Conjiguration

LMOFExportConjiguration


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SelectFieldstoExport

SelectExportFormat

SaveConjigurationand

Export

PrintMappedTermsfromView/Add/EditMenu


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Mayhighlighttermstobe

printed

ClickPrintbuttontoPreview

output

FormattedReportOutput


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ClickPrintbuttontooutput

formattedreport

ExcelExport


200/238


LabAutoMapper

R i b t h d t fi d N l t t


201/238


RuninbatchmodetofindN-closestterms

Canthenusethisoutputtodofinalmapping AgainunitsareVRYimportant Canpickalllimitsavailabletoregularmapping

PickingtheLabAutoMapper


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LabAutoMapperStartScreen


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Maximumnumberofterms

toreturn

Canrestrictsearchto

commontests

LabAutoMapperStartScreen


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Termsusedfor

mapping

Localtestcode

LabAutoMapper-MappingScreen


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ExportingMappedTerms


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ExportTermsto

DelimitedFile

ExportTermsDialog


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CheckFieldsyou

wishtoexport

SelectDelimiter

SelectTermSet

New!Direct

exporttoExcel

Selectjilelocation


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OtherRELMA

Features

Panels,FormsandSurveyReview

ReviewPanels,Formsand

Surveys


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ReviewPanels,FormsandSurveys

LaboratoryPanels


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Expandcategoryto

seepanels

Double-clickpaneltesttosee

components

ExpandedPanelDetail


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GovernmentPanels


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FormCategory

PanelCodes

GovernmentPanelChildren


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ExpandedClinicalPanel


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ClinicalPanels


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Findwhereatermhas

beenused

35089-2, 35090-0

LOINCTermPanelUsage


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OtherSurveyInstruments


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HIPAAAttachments


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ViewVariousHIPAA

Attachments

HIPPAAttachmentTree


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ExpandedAttachmentData


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Cantjindthe


221/238


termyouwant?

SearchHintsandTips

Keywordswithzerofrequencyareignored May need to rephrase use synonym


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Mayneedtorephrase usesynonym Somecausesfornoreturnedterms

Toomanykeywordsinsearchunchecksome Limitsappliedthatdontmakesense

.g.Method-lesstestsplusMethodtreesettoIA DidnotfindandrevisewordsnotinRLMA

LocalunitsnotinRLMA UnitsareGRATdiscriminators Youmayhaveteststhatneedtobeaddedto

LOINC

ProposingNewLOINCTerms


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ProposingNewTerms

Makesurethetermisreallyneeded Thinkofothernamesforthesameconcept


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p

AvoiddetailedmethodsorlocalizaEons IsthedisEncEonreallyimportant?

SupplysufficientannotaEontojusEfythenewterm Packageinserts,samplereports(emailtoRegenstrief) Themorethebe8er!

ConstructnewtermswithinRLMA File>Propose a new LOINC Linkedtothetreestoallowbrowsing

CanreviewandsubmitthemtoLOINCfromwithinRLMA

ProposenewLOINCterms


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SelectProposea

newLOINC


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Requiredjieldsin

red

Navigatethrough

proposedterms

Createnewterm,

savecurrenttermorExitform

Advanced/Simple

toggle

PreviewProposedTerms


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Reviewyournew

terms

ReviewProposedTerms

James T. Case DVM, PhD

NIH/NLM

301-555-1314

301-555-1315


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Allproposedterms

fullyeditable

Choosewhetherto

sendorpostpone

X

X

X

[email protected]

SubmittingNewTerms

Mustsupplyname,organizaEon,phone


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andemailofsubmi8er Mustselectatleastoneproposedtermto

send

Configureexportdoesnotaffectsubmissionoutput

mailresulEngfiletoRegenstrief

UseExistingTermsasTemplate

ClickthePropose

Termbutton


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Selectyourclosest

match

UseExistin

gTermsasTemplate


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Allrequired

componentsjilledin

UsingLOINCandSNOMED

Together


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WheredoLOINCandSNOMEDFit?

Remember:


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LOINCrepresentsthequesEon: IsthereanyBotulismtoxininmyspecimen?

(3370-9)

OrganismsidenEfiedinspecimen?(634-6) SNOMDrepresentstheanswer:

NegaEve(SCTID26035009) E.coliO157:H7(SCTID10342900)

WheredoLOINCandSNOMEDFit?

InanHL7message,LOINCmaybeused:


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InOBR-4(UniversalServiceIdenEfier) InOBX-3(ObservaEonIdenEfier

SNOMDmaybeused: InOBX-5(wherenominalvaluesareneeded) AlmostanyplaceelseinanHL7messagewhere

codedvaluesareneeded

Acodethat

identijiesthe

OBX:WithaCodedValue


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Thecodeis

fromSNOMED

Thecodeis

fromLOINC

OBX-5:Data

AcodeforL.

monocytogenes

datatypeinOBX-5asa

codedelement

OBX-3:Acodethatidentijiesthedatain

OBX-5(Listeriaculture)

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

HL72.5Example(ER-7format)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

FirstOrderOBR

(CultureandID)

FirstResultValue


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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|| CA20837OBX|| CE|18967-7^Penicillin^LN||30714006^Resistant^SCT|||||| F||| 199812300934||

CA20837OBX|| CE|18928-2^Gentamicin^ LN||131196009^Susceptible^SCT|||||| F|||

199812300934|| CA20837

FirstResult

(CultureandID)

FirstResult

(CultureandID)

SecondResult(s)

OBXs

(SNOMED)

FirstResultDescription

OBX(LOINC)

SecondOrderOBR

(Susceptibility)

QandASession


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Exercise

Mapyourowndata


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