2014 09 14 - loinc tutorial - documents

8/11/2019 2014 09 14 - LOINC Tutorial - Documents

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Daniel J. Vreeman, PT, DPT, MScAssociate Research Professor

, Indiana University School of Medicine

Associate Director for Terminology Services, Regenstrief Institute, Inc

2014

Documents

Clinical LOINC Meeting

2014 09 04


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Overview

1. Origins of a Document Ontology

2. HL7/LOINC Model

3. Evaluation and Ongoing Development

4. Future Directions

photo via Vernio77
http://www.flickr.com/photos/verino77/


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http://loinc.org/slideshows
http://loinc.org/slideshows


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Origins of a DocumentOntology


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Local systems have idiosyncratic names

need a common, controlled vocabulary

OutpatientPain

Note

Dr.SmithsTues

PainClinic

ChronicPain

Clinic


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Development Milestones


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Document Type Codes

Provide consistent semantics for names of documentsexchanged between systems for any purpose

Frazier P, Rossi-Mori A, Dolin RH, Alschuler L, Huff SM. The creation of an ontology of clinical document names. Stud Health Technol Inform. 2001;84(Pt 1):94-8.

Display Retrieval Organization Templates


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What is a Document?a collection of information

photo via striatic
http://www.flickr.com/photos/striatic/


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an information collection

Title

Sections

Sentences

Sentences

Other content
http://www.flickr.com/photos/karenhorton/http://www.flickr.com/photos/karenhorton/http://www.flickr.com/photos/karenhorton/



Different than a panelenumerated, discrete elements

an information collection

Title

Sections

Sentences

Sentences

Other content
http://www.flickr.com/photos/karenhorton/http://www.flickr.com/photos/karenhorton/http://www.flickr.com/photos/karenhorton/


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Clinical Notes

Clinical Note

Aclinicaldocument,producedbycliniciansspontaneouslyorinresponsetoarequestforconsultation.

Clinical Report

Aclinicaldocument,producedinresponsetoanorderforaprocedure.

Formal Document Ontology model and rules apply

to clinical notes, but not (yet) to reports.(although non-intuitively they are in CLASS:DOC.CLINRPT)


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ApproachEmpiric analysis of >2000 documentnames

Mayo, 3M/Intermountain, VA in SLC, VA in Nashville

Find the level of granularity that best

meets exchange use case

Photo via Jeffrey Beall
http://www.flickr.com/photos/denverjeffrey/


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Ultra-specific local

names Dr. Evils Friday Afternoon Pain

Clinic Note

Commonly understood

elements

Outpatient Pain Clinic Note


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Local Codes and Names

Still probably neededCan send both in HL7

Mapping to a standard enables:Interoperability

Aggregation


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Document Ontology Model



Names are based on

expected informationcontent

NOTdocument format
http://www.flickr.com/photos/karenhorton/http://www.flickr.com/photos/karenhorton/http://www.flickr.com/photos/karenhorton/http://www.flickr.com/photos/karenhorton/http://www.flickr.com/photos/karenhorton/http://www.flickr.com/photos/karenhorton/


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Names Based on Content

Same LOINC code for

if information content is the same


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Not Part of the Name

AuthorLocation of service

Date of service

Status (e.g. signed, unsigned)

Security/privacy flags (e.g. protected)

Updates or amendments to a document


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Assume that these other

important attributes wouldbe sent in different fields of

the message (e.g. metadata)


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Domainofthecontentinthedocumente.g. Cardiology, Pediatric Cardiology, Physical Therapy

Subject Matter Domain

Authortraining/professionalclassification(not@subspecialty)e.g. Physician, Nurse, Case Manager, Therapist, Patient

Role

ModestextensionofCMSsdefinition(notequivalenttolocation)e.g. Hospital, Outpatient, Emergency Department

Setting

Serviceoractivityprovidedtopatiente.g. Consultation, History and Physical, Discharge Summary

Type of Service

Generalstructureofthedocumente.g. Note, Letter, Consent

Kind of Document


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Rules for

constructing

namesphoto via Robert S Donovan
http://www.flickr.com/photos/booleansplit/


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1. Enumerated List

Documentnamesareconstructedfromenumeratedlists of values for each axis.


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2. Document + One Other

NamesneedtospecifyaKind of Documentvalueandatleastone of the other four axes.

Component

Property

Find

System

Scale

Doc

Method

.


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3. Combinations

Combinationsfromwithinanaxisare allowedwheretheyarereasonable(SMD,Service).

Only a few examples currently:

Assessment+Plan note

Treatment plan+summary note

Hematology+Medical oncology


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Example LOINC Names

{Curly Braces} notation:sendthatcontentasaseparateiteminthemessage(fieldorsegment).


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LOINC Accessory FilesSpecial representations of LOINC content


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Accessory Files

LOINC Panels and Forms FileAn export of key panels, survey instruments, and forms in a

detailed data structure.

LOINC Multiaxial Hierarchy FileHierarchical organization of LOINC terms based on their axes.

DocOnt terms are organized by Component (Type of Service)

LOINC Document Ontology FileSpecial file for the detailed naming conventions for clinical

document titles (e.g. Discharge Summary, Progress Note, etc).


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Hierarchy in RELMA


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Document Ontology File

Links all Document Ontology terms to theirconstituent axis values

Axis values given unique Part identifierscategorized by axis

Available now!Downloads -> Accessory Files


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Evolution + EvaluationWere not done yet


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Iterative Evaluation

Case StudyNYPH-CUMC


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1. Expanded CDO is better

2. Many local documents map to 1 LOINC

3. Inter-rater reliability was good

Case Study

98.5%

Hyun S, Shapiro JS, Melton G, Schlegel C, Stetson PD, Johnson SB, Bakken S. Iterative evaluation of the Health Level 7--Logical Observation Identifiers Names and Codes Clinical

Document Ontology for representing clinical document names: a case report. J Am Med Inform Assoc. 2009 May-Jun;16(3):395-9.


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Cross-site Mapping Study of DO AxesTerms whose titles specified this axis

1. Majority of titles map to at least one axis

2. Sites varied in how they specified titles; createsgranularity issues in cross-site aggregation

Li L, Morrey CP, Baorto D. Cross-mapping clinical notes between hospitals: An application of the LOINC Document Ontology. AMIA Symp Proc; 2011:;777-783 .


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The LOINC document ontology modelcan provide a robust representation of

clinical documents. This can beexploited to assist in common namingconventions, finding notes by

traversing the axis categories ofSubject, Setting, Role and Type ofService. However, the granularity of

representation can be an issue inmapping across sites.


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Other Evaluations


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Other Evaluations

Dugas M, Thun S, Frankewitsch T, Heitmann KU.LOINC codes for hospital information systems documentsJ Am Med Inform Assoc. 2009 May-Jun;16(3):400-3.

PMID: 19261942.

Hyrinen K, Mykknen J.

Mapping the Finnish National EHR to the LOINC.Stud Health Technol Inform. 2011;165:161-6.

PMID: 21685603.

Reeves RM, FitzHenry F, Brown SH, et al.

Who said it? Establishing professional attribution among authorsof Veterans' Electronic Health Records.

AMIA Annu Symp Proc. 2012;2012:753-62. Epub 2012 Nov 3.PMID: 23304349.
http://www.ncbi.nlm.nih.gov/pubmed/23304349http://www.ncbi.nlm.nih.gov/pubmed/21685603http://www.ncbi.nlm.nih.gov/pubmed/19261942


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Still ongoing development

photo via shutterrunner
http://www.flickr.com/photos/shutterrunner/5266319924


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The FutureGreat Scott!


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Future Directions

More v1 and v2 axis value harmonizationIdentifiers for the axis values

Axis definitions

Computable hierarchyExtension to other Kind of Documents

Empiric analysis of document contents


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