2016 02 24 - loinc introduction

8/19/2019 2016 02 24 - LOINC Introduction

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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

@djvreeman

© 2016

An Introduction to LOINC

Clinical LOINC Meeting - Salt Lake City, UT USA


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loinc.org/slideshows

http://loinc.org/slideshows


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Acknowledgements

LOINC Development TeamClem McDonald, Jami Deckard, David Baorto, Katy Holck,Swapna Abhyankar, Theresa Pritchard, Sara Armson

RELMA Development TeamJohn Hook, Shahid Khokhar

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 in action today

4. Overview of implementation resources

photo via Vernio77

http://www.flickr.com/photos/verino77/


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A non-profit research organization in Indianapolis, USA

Established LOINC in 1994

Overall steward and owner of LOINC

Develops and licenses LOINC to promote widespread global

adoption

http://loinc.org/terms-of-use


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LOINC is a universal code

system for tests, measurements,

and observations.

LOINC makes health data

shareable and understandableto different computer systems.


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LOINC is like a bar code for

test data…


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WE DOMEASUREMENTS

http://www.flickr.com/photos/puuikibeach


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Laboratory LOINC


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Clinical LOINC


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If an observation is a question

and the observation value isan answer…


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LOINC provides codes for questions

Where needed, other vocabularies

provide codes for answers


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Does my patient have HIV?48345-3:HIV 1+O+2 Ab [Presence] in Serum or Plasma

Is my HIV patient’s immune

system responding well to ART?24467-3:CD3+CD4+ (T4 helper) cells [#/volume] in Blood

photo via nihgov

https://www.flickr.com/photos/nihgov/20683459455/


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How fast does mypatient usually walk?41959-8:Walking speed:Vel:1W^mean:^Patient:Qn:Calculated

photo via Ed Yourdon

http://www.flickr.com/photos/yourdon/


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The LOINC WayOpen. Nimble. Pragmatic.


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Development Approach

Worldwide distribution at no cost

New terms requested by end-users

Welcome all comers Committees are volunteers


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It’s free, but invaluable


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Financial Support

Many sourcesAHCPR, 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

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


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0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000LOINC Codes

Only Lab LOINC Codes

LOINC Codes Over Time by Release

laboratory terms only


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79,000 codes…haven’tyou finished yet?


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Lots Cooking…Always more lab testsGenetic testing

Patient reported outcomes

Translational research data

Document titles

Radiology reportsphoto via liber

photo via liber

http://www.flickr.com/photos/liberhttp://www.flickr.com/photos/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.

http://www.ncbi.nlm.nih.gov/pubmed/25656513


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Legal Stuffhttp://loinc.org/terms-of-use

http://loinc.org/terms-of-use


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photo via 917press

http://www.flickr.com/photos/917press/


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Just kidding.

Copyright is a good thing for

standards.

It’s the licensing part that issometimes 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 anyLicensed Material to

develop or promulgate

a different standard fororders 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 usersbefore they become useful.

~ Clem McDonald, MD (1998)

“

http://www.flickr.com/photos/iboy_daniel/


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Our vision is for

LOINC to be

integrated into every clinical information

system that shares or

aggregates data 42 000 i t d i 171 t i


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42,000+ registered users in 171 countries

loinc org registered users


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0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

loinc.org registered users

loinc org registered users


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0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

loinc.org registered users

5,500 new users per year


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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

Italy

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 Implementations

SIGA Saúde project7+ Provincial systems in Canada

8+ Regional Health Information Exchanges in Spain

ePSOSAssistance publique - Hôpitaux de Paris

Hong Kong Hospital Authority

Philippine Health Insurance CorporationInFSE Project in 5 regions in Italy (LOINC Italia)

Many re


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Other Key Adoptions

Many “big” labsAll health-related federal agencies in USA

Lots of care organizations

Professional societiesHealth information exchange networks

Insurance companies

EHR vendors

Instrument manufacturers (nascent)


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Vandenbussche PY, Cormont S, André C, et al. Implementation and management of a biomedical observation dictionary in a large healthcare information sy stem.

J Am Med Inform Assoc. 2013 May 1. PMID: 23635601.



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The results of our workvalidate the choice made to

develop a local dictionaryaligned with LOINC.



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Members of the Korean National StandardsCommittee 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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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.

http://www.flickr.com/photos/fishking1/5304638016/sizes/o/in/photostream/


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In USA, major driver ofeHealth 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 12011-2012

Data capture

and sharing

Stage 22014

Advance clinical

processes

Stage 32016

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 inambulatory settings

4.Provide a care summary at care transition

5.Provide clinical summaries for patients 6.Submit reportable lab results to public health

Use in Quality Measures


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Q y

LOINC Ad d F


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LOINC Adopted ForPatient Characteristics

[Non-lab] Diagnostics studies

Patient experience

Family history

Functional statusHealth record component

Interventions (that produce an assessment or measured results)

Laboratory tests

Physical examPatient preference

Risk evaluation

System resources (healthcare resources)


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i d i h i h i h


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Find Height in the EHR with LOINC


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Meaningful Use Stage 3


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87 mentions of LOINC.

2015 Edition Criteria NOT Adopted


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p

Vital Signs

Image Results

Family Health History—Pedigree

Patient List Creation

Electronic Medication Administration Record

Decision Support—Knowledge Artifact

Decision Support—Service

Incorporate Laboratory Tests and Values/Results

Transmission of Laboratory Test Reports

Accessibility Technology

SOAP Transport and Security Specification and XDR/XDM for Direct Messaging

Healthcare Provider Directory—Query Request

Healthcare Provider Directory—Query Response

Electronic Submission of Medical Documentation

2015 Edition Criteria NOT Adopted


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p

Vital Signs

Image Results

Family Health History—Pedigree

Patient List Creation

Electronic Medication Administration Record

Decision Support—Knowledge Artifact

Decision Support—Service

Incorporate Laboratory Tests and Values/Results

Transmission of Laboratory Test Reports

Accessibility Technology

SOAP Transport and Security Specification and XDR/XDM for Direct Messaging

Healthcare Provider Directory—Query Request

Healthcare Provider Directory—Query Response

Electronic Submission of Medical Documentation

2015 Edition Criteria Unchanged from 2014


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gComputerized Provider Order Entry (CPOE)—Medications

CPOE—Laboratory

CPOE—Diagnostic ImagingDrug-Drug, Drug-Allergy Interaction Checks for CPOE

Medication List

Medication Allergy List

Drug-Formulary and Preferred Drug List Checks

Smoking Status

Authentication, Access Control, Authorization

Audit Report(s)

Amendments

Automatic Access Time-OutEmergency Access

End-User Device Encryption

Accounting of Disclosures

Transmission to Public Health Agencies—Reportable Laboratory Tests and Values/Results

2015 Edition Criteria Unchanged from 2014


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gComputerized Provider Order Entry (CPOE)—Medications

CPOE—Laboratory

CPOE—Diagnostic ImagingDrug-Drug, Drug-Allergy Interaction Checks for CPOE

Medication List

Medication Allergy List

Drug-Formulary and Preferred Drug List Checks

Smoking Status

Authentication, Access Control, Authorization

Audit Report(s)

Amendments

Automatic Access Time-OutEmergency Access

End-User Device Encryption

Accounting of Disclosures

Transmission to Public Health Agencies—Reportable Laboratory Tests and Values/Results

No standards adopted

2015 Edition Criteria Revised from 2014


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Demographics

Problem List

Clinical Decision Support

Family Health History

Patient-Specific Education Resources

Transitions of Care

Clinical Information Reconciliation andIncorporation

Electronic Prescribing

Data Export

Clinical Quality Measures—Record and

ExportClinical Quality Measures—Import and

Calculate

Clinical Quality Measures—Report

View, Download, and Transmit to 3rd

Party

Transmission to Immunization RegistriesTransmission to Public Health Agencies—

Syndromic Surveillance

Transmission to Cancer Registries

Automated Numerator Recording

Automated Measure Calculation

Safety-enhanced Design

Quality Management System

Auditable Events and Tamper-Resistance*

Integrity*Secure Messaging*

Direct Project*

Direct Project, Edge Protocol, and XDR/

XDM*

2015 Edition Criteria New Since 2014


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Implantable Device List

Social, Psychological, and Behavioral

Data

Data Segmentation for Privacy—Send

Data Segmentation for Privacy—Receive

Care Plan

Common Clinical Data Set Summary

Record—Create

Common Clinical Data Set Summary

Record—Receive

Clinical Quality Measures—Filter

Trusted Connection

API approach

Auditing Actions on Health Information

Patient Health Information Capture

Transmission to Public Health Agencies

—Electronic Case Reporting

Transmission to Public Health Agencies—Antimicrobial Use and Resistance

Reporting

Transmission to Public Health Agencies

—Health Care Surveys

Consolidated CDA Creation PerformanceApplication Access—Patient Selection

Application Access—Data Category

Request

Application Access—All Data Request

Accessibility—centered Design

S i l P h l i l d B h i l D t


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Social, Psychological, and Behavioral Data

Financial resource strainEducation

Stress

DepressionPhysical activity

Alcohol use

Social connection and isolationExposure to violence

S i l P h l i l d B h i l D t


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Social, Psychological, and Behavioral Data

Financial resource strainEducation

Stress

DepressionPhysical activity

Alcohol use

Social connection and isolationExposure to violence

All have specific LOINC codes identified


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Comments due March 21, 2016

Send me any you want LOINC to consider


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FDA Adoption and

Promotion of LOINC2015 to 2016


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Collaboration with IEEEStandards for medical devices


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My friends think this is coolSo, what do you do for a living?

photo via DieselDemon

https://www.flickr.com/photos/28096801@N05/4298600063/


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Apple Health Export in C-CDA Format

LOINC codes! Oh snap!


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Apple Health Export in C-CDA Format

p


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American Nurses

AssociationMarch 19, 2015


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Know LOINC? Get Hired!Dec 1, 2015


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Many unexpected

successes along the way

photo via heyyu

http://www.flickr.com/photos/heyyu/


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Everyone loves LOINC

photo via mccaughan

http://www.flickr.com/photos/mccaughan/3484111996/


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The LOINC DistributionLOINC Table, Accessory Files, and Tools and

Resources for Implementers

loinc org/downloads

http://loinc.org/downloads


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loinc.org/downloads

http://loinc.org/downloads


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LOINC TableThe main LOINC database content

One Record Per Term


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One Record Per Term

Long Common Name Cholesterol in LDL [Mass/volume] in Serumor Plasma b Direct assa

Short Name LDLc SerPl Direct Assay-mCnc

Class Type Lab

Class Chem

Example Units (local) mg/dL

Example Units mg/dL

Order/Obs Both

A Rich Encyclopedia


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A Rich Encyclopedia

Cells.HPV E6+E7 mRNA/cells [Presence] inCervix 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 infunction. E6 and E7 genes in high-risk HPV genotypes are known as oncogenes becauseof their continuous expression, which leads to disruption of cell-cycle check points andcell genome instability through alteration of cellular p53 and retinoblastoma proteinfunctions. This test identifies cervical cells containing HPV E6 and E7 polycistronic mRNAusing in situ hybridization with oligonucleotides specific for the mRNA transcripts. The

cells remain intact, and following fixation and permeabilization, the probes enter thecells. The flow cytometer measures two things: 1. Quantification of E6 and E7 mRNA ineach cell and 2. The percentage of cells over-expressing E6 and E7 mRNA.


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LOINC Accessory FilesSpecial representations of LOINC content

Accessory Files


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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 Document Ontology FileSpecial file for the detailed naming conventions for clinical document titles.

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

LOINC/IEEE Medical Device Code Mapping FileLinkages between LOINC terms and content from IEEE EMB/11073 standard.

LOINC/RSNA Radiology Playbook FileSpecial file for the detailed naming conventions for radiology procedure titles.

LOINC/SNOMED CT Expression Association and Map SetsDraft status (Technology Preview) file containing a) mappings between LOINC parts and

SNOMED CT concepts and b) SNOMED CT expressions linked to LOINC codes.


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Tools for

Implementers

photo via Robert S Donovan

http://www.flickr.com/photos/booleansplit/


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loinc.org/mailing-lists

http://loinc.org/mailing-lists


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g g

search.loinc.org

http://loinc.org/mailing-lists


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Alternate Language Search


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I !Alternate Language Search


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Everything in Italian!

forum.loinc.org


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loinc.org/usage

http://loinc.org/usage


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@LOINC

loinc.org/adopters

http://loinc.org/adopters


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loinc.org/adopters

List yo r organization Free!

http://loinc.org/adopters


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List your organization. Free!


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RELMA®REgenstrief LOINC Mapping Assistant

RELMA Features


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Browse LOINC content

Map local terms to LOINCimport/exporttranslate local words to LOINC-speak

manual/automated mapping


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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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Vreeman DJ, Hook J, Dixon BE. Learning from the crowd while mapping to LOINC. J Am Med Inform Assoc. 2015 Nov;22(6):1205-11. Epub 2015 Jul 29. PubMed PMID:

26224334.


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Individual Memberships

Donations (Sponsorships)


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Share the love.


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Donate to LOINC.members.loinc.org/donate

members.loinc.org/donate


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Glad you’re here to at least


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photo via gmayster01 on & off ...

get your feet wet...

Jump in!

http://www.flickr.com/photos/10422334@N08/6175595309


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photo via Justin Ornellas

The Race is On!

http://www.flickr.com/photos/ornellas/http://www.flickr.com/photos/ornellas/


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Happy LOINCing!photo via ryarwood

http://www.flickr.com/photos/yarwood/


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2016 02 24 - loinc introduction

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