2014 09 - loinc tutorial - panels, forms, and assessments

8/11/2019 2014 09 - LOINC Tutorial - Panels, Forms, and Assessments

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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

Panels, Forms, Assessment

Instruments

Clinical LOINC Meeting

2014 09 04


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Overview

1. Base model for panels

2. Advanced model of panel attributes

3. LOINC Answers4. Panel and Answer features in RELMA

5. Sample of the content

6. Key adoptions7. Lessons learned

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


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Base Model for Panels inLOINC


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Panels in LOINC

Collector terms that contain links to anenumerated set of discrete child elements

We use the word panel a generic conceptthat synonymous with battery, form, data

set, etc in other domains


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Panels can themselves be children,which allows nesting


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Define elements as Required,Optional, or Conditionally Present


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Categorizing Panel Elements

Required (R)Element is always expected to be present

Optional (O)

Element may not be reported with panel depending on policy

or capabilities of reporting institution

Conditional (C)Element is a key part of the panel, and should be assumed to be

negative or not present if results do not contain it

Null ()

Undeclared. Typically used in convenience panels


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Naming Conventions for Panels

Many (most) include panel in the Component

If defined by an authoritative body, we tend to

use the official name

If elements vary on axis values (e.g. Property), the

panel term name uses a dash - in that field

Timing, Scale, and Method are typically specified


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What Defines a Panel?

Or, when can I map my local one to a LOINC one?

With help from the S&I Framework Initiative, we

are developing a revised set of business rules forpanels

The following summarizes the draft rules


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Business Rules for Panels

1. Base definitions of Required, Optional,Conditional still hold.

2. If a panel is defined with methodless

elements, users could substitute any method-specific code that matched on the otherattributes

1. As a corollary, it is notacceptable to substitute

a qualitative term for a quantitative term

3. If a panel is defined with method-specificcodes, only that method (or equivalent) is

allowed


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Business Rules for Panels

4. Elements that are not measured evaluations(e.g. calculations, derived values, ask at orderentry questions, interpretations, etc) can be

included (or not)5. LOINC may define some panels (in rare cases)

where the exact elements are not enumeratedbut rather described in text. This will be used

only in rare complex cases (e.g. public health,lupus anticoagulant panels, etc).


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Advanced model of panel

attributes in LOINCAn expansion that grew out of our work to representstandardized assessment instruments


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LOINC could be a

master question fileand

uniform representation


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Iterative Refinement

Started about 10 years ago

Informing ideas:

Survey instruments have psychometric properties

Question meaning tightly coupled with answers

Many collaboratorsesp Tom White, Susan Bakken

CHI Functioning and Disability workgroup

ASPE, AHIMA, CMS, RTI, HL7, HITSP


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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.


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Assessment Instruments

Widely used

and not unlike other kinds of observations


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Item-level Attributes

Question TextQuestion Source

External Copyright

Terms of Use

Description/Definition

Units of Measure (UCUM)Data Types


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Structured Answer Lists

Answer List AttributesOID

External Link

Answer Item AttributesID (contains LA prefix)

String

Sequence

Local codeUniversal code (SNOMED CT)

Score


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Attributes of Items in a Panel Instance

Display name overrideCoding instructions

Cardinality

Local code on that form

Skip logic

Data type in form

Answer sequence override

Consistency/validation checksImages


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Panels Available as Separate DownloadLook for the Panels and Forms File


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LOINC Answers


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LOINC Answers

LOINC is focused on questions, but

Sometimes, questions are best understood by

knowing the set of allowed answer choices

Many answer choices are highly specializedand not present in vocabulary standards


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LOINC Answers

Many answer choices are highly specializedand not present in vocabulary standards

LOINC has a structured representation ofanswer lists

Classify them as Example or Normative


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30/71Example => Starter set, but you could use more/less


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MAPPING CAUTION


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Normative => This is it. Dont mess with it!


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Panel Features in RELMA


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A sample of the LOINC content

US Government Forms Neonatal Skin Risk Assessment Scale


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US Government Forms

CARE, MDSv2, MDSv3, OASIS B1,

OASIS C, RFC, US Surgeon

Generals Family Health Portrait,

End Stage Renal Disease forms

Borderline Symptom List - 23 Item

Brief Interview for Mental Status (BIMS)

CARE long term care hospital (LTCH)

Confusion Assessment Method (CAM)

Core behavioral health terms (SAMHSA)Edinburgh Postnatal Depression Scale

FACIT

Geriatric Depression Scale (GDS)

HIV Signs and Symptoms Checklist

Home Health Care Classification

howRU

Living with HIV (LIV-HIV)

Morse Fall Scale

My Mood Monitor

Neonatal Skin Risk Assessment Scale

Neuro-QOL

NIH Stroke Scale

OMAHA

OPTIMAL

PROMIS

PhenX

PHQ (9 and 2)

Quality Audit Marker (QAM)VR 12 and 36

US Government Forms Neonatal Skin Risk Assessment Scale


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US Government Forms

CARE, MDSv2, MDSv3, OASIS B1,

OASIS C, RFC, US Surgeon

Generals Family Health Portrait,

End Stage Renal Disease forms

Borderline Symptom List - 23 Item

Brief Interview for Mental Status (BIMS)

CARE long term care hospital (LTCH)

Confusion Assessment Method (CAM)

Core behavioral health terms (SAMHSA)Edinburgh Postnatal Depression Scale

FACIT

Geriatric Depression Scale (GDS)

HIV Signs and Symptoms Checklist

Home Health Care Classification

howRU

Living with HIV (LIV-HIV)

Morse Fall Scale

My Mood Monitor

Neonatal Skin Risk Assessment Scale

Neuro-QOL

NIH Stroke Scale

OMAHA

OPTIMAL

PROMIS

PhenX

PHQ (9 and 2)

Quality Audit Marker (QAM)VR 12 and 36

15,000+ variables

Oh snap!

Fi d P l d F i RELMA


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Find Panels and Forms in RELMA

Fi d P l d F i RELMA


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Find Panels and Forms in RELMA

Hit this!

Lab Panels


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Lab Panels

Clinical Panels


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Clinical Panels

Survey Instruments


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Survey Instruments

View Panel Children


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View Panel Children

View Panel Children


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View Panel Children

Select View Panel Children

from context menu


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Find Panels that Contain this Term


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Select Find Panels with All TheseLOINCs from context menu



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Also on Comprehensive Details Pages


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These panels all contain this Creatinine term


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LOINC adoption here isgaining some traction


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Lesson 1Variation abounds


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Despitesimilarit

y

in items,much

variatio! exist!

many differences might have been avoided

Original PHQ-9


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CARE

MDSv3


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Weigh the costof losing

comparability beforeinventingsomething new
http://www.flickr.com/photos/toddography/http://www.flickr.com/photos/toddography/


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Lesson 2IP issues present large

challenges


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Weigh the costof losing

comparability before inventingsomething new


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Lesson 3Not all use-cases need

everything


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Evolve gracefully.photo via Dawn Huczek

Q li M
http://www.flickr.com/photos/31064702@N05/http://www.flickr.com/photos/31064702@N05/


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Quality Measures

1. Name of some specific instrument used2. Total score from a particular instrument

G f l E l ti


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Graceful Evolution

1. Create "panel" codes that represent thenamed instrument

2. Create a total score term (as a child) for the

instruments where score is needed

3. When they are needed, fully model the

instrument as a complete set of questions

(with answers where appropriate)


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2014 09 - loinc tutorial - panels, forms, and assessments

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