“Medically Ready Force…Ready Medical Force”

Use of the LOINC Document Ontology with the DoD Military Health System

Ms. Nancy Orvis MHS Director Business Architecture, Standards, and InteroperabilityMr. Russell Ott Deloitte Consulting

September 3, 2014

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“Medically Ready Force…Ready Medical Force”

What is the Health Artifact and Image Management Solution (HAIMS)?

• Provides Department of Defense (DoD) and Department of Veterans Affairs (VA) health care providers global visibility and access to artifacts and images (A&I) generated during the health care delivery process

• Integrates with DoD’s current electronic health record (EHR) and supports the exchange of A&I with the Department of Veterans Health Administration (VHA)

– As of 2 Dec 2013, HAIMS/VHA interface had shared over 26,345 A&I

• Designated as the system of record to store the digitized Service Treatment Record (STR) upon service member separation, and make it electronically retrievable by the Veterans Benefits Administration (VBA)

– As of June 2014, 60,000 STRs made available to the VA via HAIMS repository

• MHS has 9.6M beneficiaries potentially served by HAIMS– All Active Duty and recently separated Active Duty personnel will have their legal health

record stored in HAIMS

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“Medically Ready Force…Ready Medical Force”

HAIMS DocTypes: Current State

• HAIMS is an aggregator of information and hub for data sharing.– Some content is locally stored within HAIMS– Some content is stored as a metadata reference to other systems (e.g.,

PACS)

• Strategic direction is to attempt to standardize our Document Type framework using the LOINC Document Ontology and encourage other provider organizations to do the same.

• HAIMS Document Type schema:– 98 total current Document Types

• 56 Codes from LOINC Document Ontology• 32 LOINC codes not in the Ontology• 10 DoD-specific codes

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“Medically Ready Force…Ready Medical Force”

Addition of Reserve documents

• The Army Reserve has its own documentation repository• Recently we performed a mapping effort to the LOINC

Document Ontology with the following results:• Started with 150 unique forms• Mapped down to 37 Document Types

– 25 Codes from LOINC Document Ontology– 10 LOINC codes not in the Ontology– 2 Concepts where LOINC codes need to be requested – 0 MHS-specific codes (with examples)

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“Medically Ready Force…Ready Medical Force”

Requests for LOINC Clinical Committee

• Add new LOINC codes

• Add specified LOINC codes into the Document Ontology

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HAIMS DescriptionSummary - ProfileEncounter Note - E&M of Tuberculosis

HAIMS Description LOINC Code LOINC Long DescriptionDental - X-ray 52040-3 Dental X-rays and other images (not DICOM)Encounter Note - Immunization 11369-6 History of immunization NarrativeEncounter Note - Occupational Exposure 10161-8 History of occupational exposure NarrativeEncounter Note - Transfusions 56836-0 History of blood transfusion NarrativeProcedure Note - EEG 11523-8 EEG studyProcedure Note - EKG 11524-6 EKG studyProcedure Note - Gynecologic Cytology 33717-0 Cytology Cervical or vaginal smear or scraping studyProcedure Note - Laboratory 11502-2 Laboratory reportProcedure Note - Pathology 34122-2 Pathology Procedure NoteProcedure Note - Spirometry 18759-1 Spirometry study

“Medically Ready Force…Ready Medical Force”

Next Steps

• DoD is planning to perform a full review of LOINC codes in use within HAIMS and present additional requests at the next Clinical Committee Meeting– Specific focus is the 32 LOINC codes not in the Ontology and the 10

DoD-specific codes

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Questions/Discussion

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Nancy Orvis nancy.orvis@dha.milRussell Ott rott@deloitte.com