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LOINC AND SNOMED Tim Benson Abies Ltd Wellcome Trust Sintero Server Project Cardiff University Author: Principles of Health Interoperability HL7 and SNOMED,

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Presentation on theme: "LOINC AND SNOMED Tim Benson Abies Ltd Wellcome Trust Sintero Server Project Cardiff University Author: Principles of Health Interoperability HL7 and SNOMED,"— Presentation transcript:

1 LOINC AND SNOMED Tim Benson Abies Ltd Wellcome Trust Sintero Server Project Cardiff University Author: Principles of Health Interoperability HL7 and SNOMED, Springer 2010

2 O UTLINE Origins of LOINC Origins of SNOMED CT Complementary or Competitive

3 S COPE OF LOINC Clinical Laboratory Tests The test not the result Clinical observables “Eye colour”, not “Blue eyes” Form headings Document types Assessment scales

4 O RIGINS OF LOINC Logical Observation Identifiers Names and Codes Designed for use in interoperability Clem McDonald ASTM 1238:88 Standard Specification for Transferring Clinical Laboratory Data Between Independent Computer Systems HL7 V OBX Segment EU EUCLIDES and OpenLabs projects

5 HL7 V 2 OBX SEGMENT Turn-round document Observable Code Value Code Physical quantity

6 EUCLIDES European Clinical Laboratory Data Exchange Standard Georges De Moor, Gent 6 dimensional classification

7 LOINC C ODES LOINC Code Consecutive number + Check digit e.g Short convenient name Long common name All codes are pre-coordinated to common concept model Six dimensions slightly different from EUCLIDES

8 LOINC D IMENSIONS Component what is being measured Property kind of property measured Timing point in time or period System sample or body part Scale nominal, ordinal, interval or ratio Method procedure used to produce the result or other observation

9 RELMA Regenstrief LOINC Mapping Assistant LOINC database search Map local codes to LOINC codes

10 P ROBLEMS OF LOINC Complex Many similar codes with only small differences mass concentration v molecular concentration anatomical position of pulse or BP Dimensions are not hierarchical so limits subsumption testing

11 G OOD ASPECTS OF LOINC Completely free Does what it claims to do (but no more) Fit for purpose Easy and quick to add new codes

12 O RIGINS OF SNOMED CT (1) SNOMED CAP committee 1955 SNOP 1965 topography morphology etiology function (physiology) SNOMED 1975 SNOMED III 1993 SNOMED RT (Reference Terminology) 1997

13 O RIGINS OF SNOMED CT (2) Read Codes Coded terms in EHR e.g. “Blue Eyes” Developed by Abies and James Read for use in GP computer system Purchased by DH in 1990 V Version 3 (CTV3) 1996 Used by all GPs in UK (100%) Basis of payment Unsuccessful in other specialties

14 R EAD C ODE ( V 1,2) C HAPTERS Diagnoses ICD Chapters A-Z Medication BNF Chapters a-z History and physical Occupations (0), history and symptoms (1), physical examination findings (2) Procedures Diagnostic (3), lab (4), imaging (5), prevention (6), therapy (7), surgery (8), admin (9)

15 SNOMED CT Merger of Read Codes and SNOMED RT Reference Terminology All concepts are in hierarchies (19) Concepts Descriptions (terms) Relationships Defining, qualifying, sub-type, association Description Logic

16 P ROBLEMS OF SNOMED CT Much legacy baggage Lack of transparency Lack of free access Lack of good web-based tools Complexity Post-coordination is not yet a practical proposition Undefined boundaries Over-sold as answer to all terminology problems

17 B ENEFITS OF SNOMED CT Future-proof structure Inherently multi-lingual Broad coverage

18 E DUCATION P ROBLEM Few people are competent in both LOINC and SNOMED Clinical terminology is not taught well One of 186 topics in AMIA Core Curriculum for Clinical Informatics (JAMIA, 2009) Formal training is essential 93% of all those who rated themselves as competent had had more than 3 days formal training in SNOMED CT (Report for DH, unpublished)

19 E DUCATION – NEEDS A BLENDED APPROACH 1. Learn by doing (assignments and examples) 2. Face-to-face presentations 3. Web-based presentations and videos 4. User guides and books 5. Pick it up from colleagues

20 LOINC AND SNOMED CT TOGETHER Clinical statement consists of: Narrative text Context (who, when, where, etc) Observable Finding (Rector A. What’s in a code, MEDINFO 2007)

21 O BSERVABLE “Observables” are qualities of patients that are present in all patients and whose values or states are determined by observation This is what LOINC is designed to code and does it well

22 F INDING Information specific to a particular patient Finding = Observable + Value Value may be various data types Physical quantity, code, date, text etc SNOMED CT is good for Observation Value Codes

23 C ONCLUSIONS LOINC and SNOMED CT were originally designed to do different things They are complementary


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