2. Overview
• Origins
of
LOINC
– Background
– Growth
– Participation
• Successes
– International
– US
3. Origins
of
LOINC
The
Lingua
Franca
of
Clinical
Observation
Exchange
4. Introduction
• Regenstrief’s
30-‐year
history
• The
Indiana
Network
for
Patient
Care
– A
working
HIE
for
~15
years
– More
than
100
sources
– Regenstrief:
3rd
party
convener
• Local
systems
use
idiosyncratic
codes
• Vocabulary
standards
– LOINC
®
-‐
universal
code
system
for
clinical
observations
– The
lingua
franca
of
information
exchange
• Laboratory
and
Radiology
results*
– Often
unavailable
at
the
time
of
a
clinical
visit
(6%,
4%)
– Often
located
outside
of
their
clinical
system
*Smith
CP,
Araya-‐Guerra
R,
Bublitz
C,
et
al.
Missing
clinical
information
during
primary
care
visits.
JAMA.
2005;293(5):565-‐571
6. From
whence
comes
LOINC?
• LOINC®
– Logical
Observation
Identiiiers
Names
and
Codes
– A
universal
code
system
for
laboratory
and
other
clinical
observations
– The
lingua
franca
of
information
exchange
for
clinical
observations
McDonald
CJ,
Huff
SM,
Suico
JG,
et
al.
LOINC,
a
universal
standard
for
identifying
laboratory
observations:
a
5-‐year
update.
Clin
Chem.
2003;49(4):624-‐633.
7. Indiana Network for Patient Care
HL7 v.2.X Message
MSH|^~&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay|||||||||||||||
LocalCode^LocalName^CodeSystem^LOINCcode^LOINCname^CodeSystem
PID|||$patientId$||$patientName$||||||||||||||||||||
PV1|||||||$attendingDoctor$||$consultingDoctor$||||||||
OBR|1|||CBC^CBC/Auto Diff^HSPA^57021-8^CBC W Auto Diff^LN||$reqDate|||||||||
OBX|2|ST|WBC^WBC^HSP_A^26464-8^Leukocytes [#/volume] in Blood^LN||10.8|K/MM3|||||F|
OBX|3|ST|RBC^RBC^HSP_A^26453-1^Erythrocytes [#/volume] in Blood^LN||4.82|MIL/MM3|||||F|
OBX|4|ST|HGB^HGB^HSP_A^718-7^Hemoglobin [Mass/?volume] in Blood^LN||15.7|GM/DL|||||F|
OBX|5|CE|HCT^HCT^HSP_A^20570-8^Hematocrit [Volume Fraction] of Blood^LN||45|%|||||||F|
A
A
8. LOINC
Purpose
To
facilitate
the
exchange
and
pooling
of
results
for
clinical
care,
outcomes
management,
and
research
• Speciiically,
to
provide
a
universal
ID
for
the
OBX-‐3
iield
in
HL7
ORU
messages
• LOINC
codes
“questions”,
not
answers
– Orders/Panels
(OBR-‐4)
– Questions
(OBX-‐3)
– NOT
Values
(OBX-‐5)
• Numbers,
organisms
(E.
coli)
McDonald
CJ,
Huff
SM,
Suico
JG,
et
al.
LOINC,
a
universal
standard
for
identifying
laboratory
observations:
a
5-‐year
update.
Clin
Chem.
2003;49(4):624-‐633.
9. LOINC’s
General
Role
• If
an
observation
is
a
question,
and
the
observation
value
an
answer:
– LOINC
provides
codes
for
the
questions
{OBR-4,
OBX-3}
– Other
systems
(eg
SNOMED)
provide
codes
for
the
answers
What
is
my
patient’s
hemoglobin
level?
718-‐7:Hemoglobin:MCnc:Pt:Bld:Qn
How
fast
does
my
patient
usually
walk?
41959-‐8:Walking
speed:Vel:1W^mean:^Patient:Qn:Calculated
10. LOINC
Background
• Organized
by
Regenstrief
Institute
in
1994
– Ongoing
support
from
NLM
and
Regenstrief
– Guided
by
the
LOINC
Committee
(Lab
+
Clinical)
• Covers
domain
of
Clinical
Observations
– Laboratory
observations
(since
1995)
– Clinical
observations
(since
1996)
– HIPAA
Claims
Attachments
(NPRM
in
2005)
• LOINC
development
is
a
highly
‘open
source’
model
– Open,
nimble,
pragmatic
– LOINC
and
RELMA
program
are
freely
available
– Much
work
is
done
by
volunteers
– Additions
to
the
database
are
end-‐user
driven
25. Existing
Translations
• Spanish
– BiTAC
(Spain);
39,000
terms
– Conceptum
Medical
Terminology
Center;
38,000
terms,
Users’
Guide
– Mexican
Institute
of
Social
Security;
Users’
Guide
• French
– Canada
Health
Infoway;
38,000
terms,
Documentation
– Société
Française
d'Informatique
de
Laboratoires;
4,000
terms
• Simpliiied
Chinese
– Bethune
International
Peace
Hospital;
38,000
terms,
Users’
Guide,
tutorial
• Korean
– Korean
Ministry
for
Health,
Welfare
and
Family
Affairs;
27,000
terms
• German
– DIMDI;
Companion
website,
Users’
Guide
26. New
Translations
(this
release)
• Estonian
– Estonian
LOINC
working
group
of
the
Estonian
Society
for
Clinical
Chemistry;
Users’
Guide,
Tutorial
• Portuguese
– Brazilian
Federal
Agency
for
Health
Plans
and
Insurance,
Brazilian
Clinical
Analysis
Society,
Brazilian
Clinical
Pathology
Society,
and
Diagnóstico
das
Américas
(DASA);
2,800
terms
• German,
French,
Italian,
Spanish
– CUMUL
(Switzerland);
5000
common
terms
27.
28. In-‐progress
Translations
• French
– Assistance
Publique-‐Paris
Hospitals
(PMID:
18999107)
• Estonian
– University
of
Tartu;
Lab
terms
• Dutch
– SKML
(the
Dutch
Foundation
for
Quality
Assessment
in
Medical
Laboratories);
Lab
terms
• Catalan
– BiTAC;
Lab
terms
• Russian
– Donetsk
National
Medical
University,
corTTex
29. How
do
you
say
“glucose?”
Component
Linguistic
Variant
Glukose
German
(Switzerland)
Glucose
French
(Switzerland)
Glucosio
Italian
(Switzerland)
Glucosa
Spanish
(Switzerland)
Simpliiied
Chinese
(China)
Glucosa
Spanish
(Argentina)
Glükoos
Estonian
(Estonia)
Glicose
Portuguese
(Brazil)
-‐
Draft
Glucosa
Spanish
(Spain)
Korean
(Korea,
South)
30.
31. New
Translation
Approach
• Prior
Method
– Translate
whole
name
as
one
string
• New
Method
– Break
LOINC
terms
into
their
constituent
Parts
– Remove
duplicate
strings
in
Part
list
– Translate
the
Part
strings
– Reassemble
the
full
LOINC
name
• Beneiits
– Reduced
translation
work
– Enables
multilingual
searches
in
RELMA
33. Consolidated
Health
Informatics
Initiative
• CHI
Goal:
– Adopting
interoperability
standards
to
enable
all
agencies
in
the
federal
health
enterprise
to
“speak
the
same
language”
• In
2006,
adopted
LOINC
as
standard:
– Laboratory
test
order
names
– Medications:
Structured
Product
Labeling
Sections
34. Consolidated
Health
Informatics
Initiative
• In
2007,
CHI
adopted
LOINC
as
standard
for
federally-‐required
assessments:
– questions
and
answers
– assessment
forms
that
include
functioning
and
disability
content
35. Other
Key
US
Adoptions
• UMLS
• VA
• CDC
PHIN
Initiatives
– Implement
CHI
standards
• IHS
– Embarking
on
~250
facility
mapping
process
• NCQA/HEDIS
– Healthcare
Effectiveness
Data
and
Information
Set
– Used
90%
of
health
plans
to
measure
quality
36. Other
Key
US
Adoptions
• ARRA
“Meaningful
Use”
• HITSP
– C80:
vital
signs,
lab
results,
lab
orders,
genetic
results,
other
results
– IS92:
newborn
screening
• eLINCS
– Standard
for
results
delivery
from
LIS
to
an
EHR
• NAACCR
• CDISC
– Pharmaceutical
research
specs
• NCI
–
caBIG
– Lab
portion
adopted
as
caBIG
vocab
standard
37. Other
Key
US
Adoptions
• HL7
–
many
implementation
guides,
CDA,
etc
• HIPAA
Claims
Attachments
• Many
Regional
HIEs
