LOINC(Logical Observation Identifier Names and

Codes)

Presentation to: NCVHS

May 17, 1999

Stan Huff - coshuff@ihc.com

3/18/1999 2

Stanley M. Huff, M.D.Intermountain Health Care (co-development partner with 3M HIS)

Senior Medical Informaticist (Data Dictionary and Interfaces)

University of UtahAssociate Professor (Clinical) - Medical Informatics

LOINCCo-chair, Clinical LOINC

HL7Chair-elect, HL7 BoardCo-chair, Vocabulary Committee

SNOMED Editorial BoardAdvisor

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LOINC Facts

• Initiated by Clem McDonald in 1995

• Contains 20,000+ names and codes

• Free for Use (Copyright Regenstrief Institute)

• FTP:– ftp://www.mcis.duke.edu/standards/termcode/

• WWW:– http://www.mcis.duke.edu/standards/termcode/loinc.htm– Readme - LOINRDME.TXT– LOINC Manual, Database files, Text files– RELMA - LOINC matching application

• Copy of LOINC slides: coshuff@ihc.com

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What are we trying to do?

• Communication of clinical data between independent computer systems– Intra-enterprise data sharing

• reduce redundant data entry

• better clinical care

– Inter-enterprise data sharing• public health reporting

• clinical studies– outcomes

– clinical trials

• patient administration– enrollment, claims, payments

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Why interface standards?

• Decrease the cost of interfaces– implementation time– implementation cost (resources)

• Enable component architecture– greater choice and flexibility

• Approach “plug-and-play”– we may not get all the way there for a while

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HL7 Messaging Paradigm

SystemSystemAA

SystemSystemAA

SystemSystemBB

SystemSystemBB

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ORU: The usual HL7 result message

Element Loop

Answer Part Loop

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Status

A code that identifies the units of numerical data

in OBX-5

A code that identifies the

datatypeof OBX-5

A code

that identifies the data in

OBX-5(Temp

Reading)

OBX-5: Data

OBX: the flexible segment

OBX||NM|11289-6^^LN||38|C^^ISO+|||||F

Other data fields include: date of observation, identity of provider giving observation, normal ranges, abnormal flags

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• Site 1:OBX|1|CE|ABO^ABO GROUP||O^Type O|

• Site 2:OBX|1|CE|BLDTYP^ABO GROUP||TYPEO^Type O|

• Site 3:OBX|1|CE|ABOTYPE^ABO GROUP||OPOS^Type O|

The problem

You and I may know that these are similar results, but our computers will not.

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The goal of the LOINC committee

Use LOINC as a universal coding system for clinical observations.

• Site 1:OBX|1|CE|883-9^ABO GROUP||F-D1250^Group O|

• Site 2:OBX|1|CE|883-9^ABO GROUP||F-D1250^Group O|

• Site 3:OBX|1|CE|883-9^ABO GROUP||F-D1250^Group O|

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The code isfrom SNOMED

The code isfrom LOINC

OBX-5: Data

A code for Group O

A code that identifies the datatype as a

coded element

OBX: with a coded value

A code that identifies the data in

OBX-5(ABO Blood Group)

OBX||CE|883-9^Blood Group^LN||F-D1250^Group O^SMI|

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OBX|1|CE|883-9^ABO GROUP^LN||F-D1250^Group O^SMI|

SNOMED International SNOMED International (Systematized Nomenclature of Medicine)(Systematized Nomenclature of Medicine)

F-D1111 Blood group AF-D1201 Blood group BF-D1250 Blood group OF-D1281 Blood group AB

OBX Using Standard Codes

LOINC 1.0L883-9 ABO GROUP:TYPE:PT:BLD^PATIENT:NOM

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Blood Types

Interface A (atomic)OBX|1|CE|883-9^ABO^LN|1|F-D1250^O^SNI|

OBX|1|CE|14906-2^RH^LN|1|G-A200^Positive^SNI|

Vocabulary and structure must be coordinated to achieve an integrated whole.

Interface B (molecular)OBX|1|CE|882-1^ABO+RH^LN|1|???^O Positive^SNI|

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Federal Initiatives Involving LOINC

• Proposal for use in Claims Attachments (HIPAA)

• DEEDS Database (Dan Pollock, CDC)

• Electronic Laboratory Reporting (CDC)

• Proposal for Cancer Registries (NAACCR, CDC)

• Included as part of UMLS Metathesaurus

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What should the government do?

• Use HL7 standards for clinical data that is sent to government agencies (others will follow)– standardization of communication

• Select and support “free for use” medical terminologies with public money via contracts with existing terminology providers– could be a public-private partnership– use good maintenance tools and technology

• Manage contracts and make the terminologies available through a publicly funded support/service center– NLM– UMLS Metathesaurus

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Which terminologies

• Make the most cost effective choices

• Don’t study it to death

• My picks– Observation Identifiers (LOINC)– Clinical Findings (SNOMED/Read, Medcin?, others?)– Drugs

• Clinical Drugs in UMLS Metathesaurus

• NDC codes (assuming improvements in maintenance)

– Classifications (as needed)• Diagnosis: ICD-9CM, ICD-10CM

• Billing: CPT?

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LOINC codes are created systematically using a six axis model

<component> : <property> :<component> : <property> :<timing> : <system> :<timing> : <system> :<scale> : <scale> : <method><method>

General Form of LOINC Names

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Laboratory LOINC Subject Areas

• Chemistry

• Urinalysis

• Toxicology

• Hematology

• Microbiology

• Antibiotic Susceptibilties

• Immunology/Serology

• Genetic testing

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Clinical LOINC Subject Areas

• Vital Signs

• Hemodynamics

• Fluid Intake/Output

• Body Measurements

• Operative Notes

• Emergency Department

• Respiratory Therapy

• EKG (ECG)

• Cardiac Ultrasound

• Obstetrical Ultrasound

• Discharge Summary

• History & Physical

• Pathology Findings

• Colonoscopy/Endoscopy

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Organizations

3M, ARUP Laboratories, California Veterinary Diagnostic Labs, Cerner Corporation, Columbia Presbyterian Medical Ctr, Dallas ISC, Dept of Veterans Affairs, Denver VA Medical Ctr, Duke

Medical Ctr, Hewlett Packard, Hospital for Sick Children, Toronto, Indiana University Hospital, Intermountain Health

Care, Laboratory Corporation of America, LifeChem Laboratory Services, Maryland Dept of Health & Mental Hygiene, Mayo

Medical Laboratories, National Center for Injury Prevention and Control, Quest Diagnostics Incorporated, Quintiles, Regenstrief

Institute for Health Care, Reparto Informatica Medica, Roudebush VA Medical Ctr, SmithKline Beecham Clinical Laboratories, SpaceLabs Medical, Inc, Univ of California

Veterinary Medicine, University Hospital, Indianapolis, IN, University Hospital, Linkoping Sweden, University of Missouri

Hospital and Clinics, University of Utah, University of Washington, World Health Organization

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Laboratory LOINC Committee

Ray Aller, John Baenziger, Pamela D. Banning, Jim Bristol, Tom Burgess, Jim Case, Linda Charles, Jim Cimino , Diane Dwyer, Arden

Forrey, Andy Gajda, Norbert Goldfield, Brian Griffin, Ed Hazell, Gil Hill, Stan Huff, Kathy Hutchins, Kathy Kammerer, Dennis Leavelle, Diane Leland, Pat Maloney, Doug

Martin, Clem McDonald, Bill Meilahn, Karen Sieber, Frank Stalling, John Stelling, Bill

Thurston, Dan Yokota

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Clinical LOINC Committee

James Barthel , Dean Bidgood, Bruce Bray, Bill Francis, Alan Golichowski, Brian Griffin, Karl Hammermeister, Stan Huff, Kathy

Hutchins, Doug Martin, Clem McDonald, Dan Pollock, Angelo Rossi Mori, Karen Sieber, Blaine Takesue, Anders Thurin,

Wayne Tracy

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Future

• Inclusion in SNOMED (in progress)

• Addition of Orderables (in progress)

• Expand Clinical Content

• Create Short names

• Physical Exam Findings

Current and Future Activities

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Literature References

• Huff SM, Rocha RA, McDonald CJ, De Moor GJE, etal. Development of the LOINC (Logical Observation Identifier Names and Codes) Vocabulary. Journal of American Medical Informatics Association, 1998, 5:276-292.

• Dolin RH, Huff SM, Rocha RA, Spackman KA, Campbell, KE. Evaluation of a “Lexically Assign, Logically Refine”Strategy for Semi-Automated Integration of Overlapping Terminologies. Journal of American Medical Informatics Association, 1998, 5:203-213.

• Rocha RA, Huff SM. Coupling Vocabularies and Data Structures: Lessons from LOINC. Journal of American Medical Informatics Association, AMIA Annual Fall Symposium Supplement, 1996, 90-4.

• Forrey AW, McDonald CJ, DeMoor G, Huff SM , Leavelle D, Leland Fiers DT, Charles L, Griffin B, Stalling F, Tullis A, Hutchins K, Baenziger J. Logical Observation Identifier Names and Codes (LOINC) Database: A public use set of codes and names for electronic reporting of clinical laboratory test results. Clinical Chemistry, 1995.