LOINC (Logical Observation Identifier Names and Codes) Original Presentation By: NCVHS May 17, 1999
LOINC Facts • LOINC資料庫包括化學，毒物學，血清學，微生物學 和一些臨床變數的實驗室觀察報告的記錄。 • 此專案的目標是産生一個用於 ASTM E 1238和 HL 7第 2. 2版實驗室結果和觀察資訊前後關聯通用的檢驗代 碼系統。 • 目前資料庫中大約包含 32, 000 觀察術語（observation terms），其中 20, 000條於實驗室試驗相關。 • Initiated by Clem Mc. Donald in 1995 • Contains 20, 000+ names and codes • Free for Use (Copyright Regenstrief Institute) • http: //loinc. org/ 3/18/1999 1
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 3/18/1999 2
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 3/18/1999 3
HL 7 Messaging Paradigm System A 3/18/1999 System B 4
ORU: The usual HL 7 result message Answ er Part Loop Element Loop • OBX-5 (Observation value) Definition: This field contains the value observed by the observation producer. • OBX-2 -value type contains the data type for this field according to which observation value is formatted. 3/18/1999 5
OBX: the flexible segment A code that identifies the datatype of OBX-5 Other data fields include: date of observation, identity of provider giving observation, normal ranges, abnormal flags OBX-5: Data Status OBX||NM|11289 -6^^LN||38|C^^ISO+|||||F A code that identifies the data in OBX-5 (Temp Reading) 3/18/1999 A code that identifies the units of numerical data in OBX-5 6
The problem • 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| You and I may know that these are similar results, but our computers will not. 3/18/1999 7
The goal of the LOINC committee • Site 1: OBX|1|CE|883 -9^ABO GROUP||F-D 1250^Group O| • Site 2: OBX|1|CE|883 -9^ABO GROUP||F-D 1250^Group O| • Site 3: OBX|1|CE|883 -9^ABO GROUP||F-D 1250^Group O| Use LOINC as a universal coding system for clinical observations. 3/18/1999 8
OBX: with a coded value A code that identifies the datatype as a coded element The code is from LOINC The code is from SNOMED OBX||CE|883 -9^Blood Group^LN||F-D 1250^Group O^SMI| A code that identifies the data in OBX-5 (ABO Blood Group) 3/18/1999 OBX-5: Data A code for Group O 9
OBX Using Standard Codes OBX|1|CE|883 -9^ABO GROUP^LN||F-D 1250^Group O^SMI| LOINC 1. 0 L 883 -9 ABO GROUP: TYPE: PT: BLD^PATIENT: NOM SNOMED International (Systematized Nomenclature of Medicine) F-D 1111 Blood group A F-D 1201 Blood group B F-D 1250 Blood group O F-D 1281 Blood group AB
Blood Types Interface A (atomic) OBX|1|CE|883 -9^ABO^LN|1|F-D 1250^O^SNI| OBX|1|CE|14906 -2^RH^LN|1|G-A 200^Positive^SNI| Interface B (molecular) OBX|1|CE|882 -1^ABO+RH^LN|1|? ? ? ^O Positive^SNI| Vocabulary and structure must be coordinated to achieve an integrated whole. 3/18/1999 11
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 3/18/1999 12
What should the government do? • Use HL 7 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 3/18/1999 13
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-9 CM, ICD-10 CM • Billing: CPT? 3/18/1999 14
General Form of LOINC Names LOINC codes are created systematically using a six axis model <component> : <property> : <timing> : <system> : <scale> : <method>
Laboratory LOINC Subject Areas • Chemistry(化學 ) • Urinalysis(尿分析) • Toxicology(毒理學) • Hematology(血液學) • Microbiology(微生物學 ) • Antibiotic Susceptibilties(抗菌敏感性) • Immunology/Serology(免疫學/血清學 ) • Genetic testing(遺傳學的測試 ) 3/18/1999 16
Clinical LOINC Subject Areas • Vital Signs(脈搏、呼吸、體 溫、血壓等數據 ) • Hemodynamics(血液動力學 ) • EKG (ECG) • Cardiac Ultrasound(心臟超 音波 ) • Fluid Intake/Output(流體 進 • Obstetrical Ultrasound(產科 • Body Measurements • Discharge Summary • Operative Notes • History & Physical • Emergency Department • Pathology Findings(病理學 ) • Respiratory Therapy(呼吸 • Colonoscopy/Endoscopy(結 入 /流出 ) 治療 ) 3/18/1999 超音波 ) 腸鏡檢查 /內視鏡檢查 ) 17
Organizations 3 M, 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, Life. Chem 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, Smith. Kline Beecham Clinical Laboratories, Space. Labs 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 3/18/1999 18
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 Mc. Donald, Bill Meilahn, Karen Sieber, Frank Stalling, John Stelling, Bill Thurston, Dan Yokota 3/18/1999 19
Clinical LOINC Committee James Barthel , Dean Bidgood, Bruce Bray, Bill Francis, Alan Golichowski, Brian Griffin, Karl Hammermeister, Stan Huff, Kathy Hutchins, Doug Martin, Clem Mc. Donald, Dan Pollock, Angelo Rossi Mori, Karen Sieber, Blaine Takesue, Anders Thurin, Wayne Tracy 3/18/1999 20
Future and Future Activities Current • Inclusion in SNOMED (in progress) • Addition of Orderables (in progress) • Expand Clinical Content • Create Short names • Physical Exam Findings
Literature References • Huff SM, Rocha RA, Mc. Donald 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, Mc. Donald CJ, De. Moor 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. 3/18/1999 22
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