1. LOINC Committee Meeting June 4, 2015 LOINC Challenges and Recommendations Raymond D. Aller, MD, FCAP Carolyn A. Knapik, BS, MT(ASCP) June 4, 2015

2. LOINC Encoded Results to EHRs Fundamental mismatch: most specific vs. generalized Principle concern voiced by CAP members Recommend “roll-up” from detailed LOINCs to more inclusive/generalized LOINCs First step: roll-up method specific LOINCs to method-less LOINCs, providing results are not clinically different –Is there an available list of analytes whose methods yield markedly different result values? © 2015 College of American Pathologists. All rights reserved. 2

3. LOINC Encoded Results to EHRs - continued –Consider deprecating some method distinctions where they are clearly not contributory to clinical interpretation. –Examples: ALBUMIN in Serum – Bromocresol green vs. Bromocresol purple vs. method-less HEMOGLOBIN (qualitative) in Urine – Test strip vs. automated Test strip vs. method-less Use LOINC part hierarchies to group together (“lump”) results that should be reported as a more generic reporting code (in the same line/column in a clinician’s flowsheet). © 2015 College of American Pathologists. All rights reserved. 3

4. LOINC Encoding Orders General Rule: Use method-less codes with OrderObs flag of either “Order” or “Both” –If no method-less code available, use method-specific code This code will not generally dictate what testing methodology will be employed These “double-duty” method specific codes should be flagged as such (generic order code use) –Is there an available short list of those method-specific codes that actually do require a particular methodology? Hepatitis serologies? © 2015 College of American Pathologists. All rights reserved. 4

5. LOINC Encoding Orders - continued – Can LOINC hierarchy tables be used? If a laboratory order matches a common laboratory order with associated LOINC code, then the matching LOINC code should be used (regardless of vocabulary variations). The absence of a LOINC order code should not prevent the use of a local code for orders LOINC codes can be requested for orders lacking an existing LOINC code © 2015 College of American Pathologists. All rights reserved. 5