LOINC ( Logical Observatio by cwu19101


(Logical Observation Identifier Names and Codes)
                Presentation to:
                  May 17, 1999
                            Stan Huff - coshuff@ihc.com
Stanley M. Huff, M.D.
Intermountain Health Care (co-development partner with 3M HIS)
    Senior Medical Informaticist (Data Dictionary and Interfaces)
University of Utah
    Associate Professor (Clinical) - Medical Informatics
    Co-chair, Clinical LOINC
    Chair-elect, HL7 Board
    Co-chair, Vocabulary Committee
SNOMED Editorial Board

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 • 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

         System          System
           A               B

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ORU: The usual HL7 result message

ORU                   Observational Results (Unsolicited)
MSH                   Message Header
PID                   Patient Identification
 {OBR                 Observations Report ID
              {OBX}   Observation/Result
  }                   Answer Part Loop
                                 Element Loop

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OBX: the flexible segment
                     Other data fields include: date of
   A code that       observation, identity of provider
                     giving observation, normal ranges,
  identifies the
                     abnormal flags
    of OBX-5               OBX-5: Data           Status
                A code that
               identifies the
               data in OBX-5        A code that
                   (Temp        identifies the units
                 Reading)        of numerical data
                                     in OBX-5

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The problem

• Site 1:

• Site 2:

• Site 3:

   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

• 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|

   Use LOINC as a universal coding system for
   clinical observations.

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OBX: with a coded value

  A code that
 identifies the
                      The code is       The code is
 datatype as a
                      from LOINC      from SNOMED
coded element
OBX||CE|883-9^Blood Group^LN||F-D1250^Group O^SMI|

      A code that
                             OBX-5: Data
 identifies the data in
                          A code for Group O
  (ABO Blood Group)

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OBX Using Standard Codes

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

                LOINC 1.0L

           SNOMED International
      (Systematized Nomenclature of Medicine)
            F-D1111 Blood group A
            F-D1201 Blood group B
            F-D1250 Blood group O
            F-D1281 Blood group AB
Blood Types

 Interface A (atomic)

 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.

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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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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
               • Urinalysis
               • Toxicology
               • Hematology
               • Microbiology
               • Antibiotic Susceptibilties
               • Immunology/Serology
               • Genetic testing

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Clinical LOINC Subject Areas
  • Vital Signs            • EKG (ECG)
  • Hemodynamics           • Cardiac Ultrasound
  • Fluid Intake/Output    • Obstetrical Ultrasound
  • Body Measurements      • Discharge Summary
  • Operative Notes        • History & Physical
  • Emergency Department   • Pathology Findings
  • Respiratory Therapy    • Colonoscopy/Endoscopy

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   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 and Future Activities
 • 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, 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,
  • 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.
    3/18/1999                                                             23

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