1. LOINC ( Logical Observation Identifier Names and Codes) Presentation to: NCVHS May 17, 1999 Stan Huff - coshuff@ihc.com

2. 3/18/19991 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 LOINC Co-chair, Clinical LOINC HL7 Chair-elect, HL7 Board Co-chair, Vocabulary Committee SNOMED Editorial Board Advisor

3. 3/18/19992 LOINC Facts 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

4. 3/18/19993 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

5. 3/18/19994 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

6. 3/18/19995 HL7 Messaging ParadigmSystemASystemASystemBSystemB

7. 3/18/19996 ORU: The usual HL7 result message Element Loop Answer Part Loop

8. 3/18/19997 Status A code that identifies the units of numerical data in OBX-5 A code that identifies the datatype of OBX-5 A code that identifies the data in OBX-5 (Temp Reading) OBX-5: Data OBX: the flexible segment OBX||NM|11289-6^^LN||38|C^^ISO+|||||F Other data fields include: date of observation, identity of provider giving observation, normal ranges, abnormal flags

9. 3/18/19998 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| The problem You and I may know that these are similar results, but our computers will not.

10. 3/18/19999 The goal of the LOINC committee Use LOINC as a universal coding system for clinical observations. 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|

11. 3/18/199910 The code is from SNOMED The code is from LOINC OBX-5: Data A code for Group O A code that identifies the datatype as a coded element OBX: with a coded value A code that identifies the data in OBX-5 (ABO Blood Group) OBX||CE|883-9^Blood Group^LN||F-D1250^Group O^SMI|

12. OBX|1|CE|883-9^ABO GROUP^LN||F-D1250^Group O^SMI| 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 OBX Using Standard Codes LOINC 1.0L 883-9 ABO GROUP:TYPE:PT:BLD^PATIENT:NOM

13. 3/18/199912 Blood Types Interface A (atomic) OBX|1|CE|883-9^ABO^LN|1|F-D1250^O^SNI| OBX|1|CE|14906-2^RH^LN|1|G-A200^Positive^SNI| Vocabulary and structure must be coordinated to achieve an integrated whole. Interface B (molecular) OBX|1|CE|882-1^ABO+RH^LN|1|???^O Positive^SNI|

14. 3/18/199913 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

15. 3/18/199914 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

16. 3/18/199915 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?

17. LOINC codes are created systematically using a six axis model : : : : : : General Form of LOINC Names

18. 3/18/199917 Laboratory LOINC Subject Areas Chemistry Urinalysis Toxicology Hematology Microbiology Antibiotic Susceptibilties Immunology/Serology Genetic testing

19. 3/18/199918 Clinical LOINC Subject Areas Vital Signs Hemodynamics Fluid Intake/Output Body Measurements Operative Notes Emergency Department Respiratory Therapy EKG (ECG) Cardiac Ultrasound Obstetrical Ultrasound Discharge Summary History & Physical Pathology Findings Colonoscopy/Endoscopy

20. 3/18/199919 Organizations 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

21. 3/18/199920 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

22. 3/18/199921 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

23. Future Inclusion in SNOMED (in progress) Addition of Orderables (in progress) Expand Clinical Content Create Short names Physical Exam Findings Current and Future Activities

24. 3/18/199923 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, 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, 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.