1. Laboratory LOINC Workshop – Indianapolis, IN
LOINC
Introduction and Overview
Daniel J. Vreeman, PT, DPT, MSc
Assistant Research Professor, Indiana University School of Medicine
Research Scientist, Regenstrief Institute, Inc
12.08.2011
dvreeman@regenstrief.org
© 2011

2. http://loinc.org/slideshows

3. Origins of LOINC
The lingua franca of clinical observation exchange

4. Regenstrief’s 40+ Years of
Canopy Computing
making a forest out of individual trees of data
McDonald et al. Canopy Computing: using the Web in Clinical Practice. JAMA. 1998;280(15):1325-1329.

5. photo via nosha

6. Arboreal Informatics Pioneers
40 years of EMR work
Indiana Network for Patient Care
Nation’s most comprehensive and longest tenured HIE
Regenstrief
– the neutral 3rd party convener

9. Fundamental challenge:
local systems have
idiosyncratic ways of
identifying similar concepts

10. Vocabulary standards
provide the linuga franca.

11. Logical
Observation
Identifiers
Names and
Codes
A universal code system that facilitates exchange,
pooling, and processing of results

12. Similar name, different meaning…
photo via Caption Time
meerkat
meerkat
mere cat
meerkat

14. If an observation is a question
and the observation value is
an answer…
LOINC provides codes for
questions
Other vocabularies provide
codes for the answers

15. What is my patient’s
hemoglobin level?
718-7:Hemoglobin:MCnc:Pt:Bld:Qn

16. How fast does my
patient usually walk?
41959-8:Walking speed:Vel:1W^mean:^Patient:Qn:Calculated

17. Indiana Network for Patient Care
HL7 v.2.X Message
MSH|^~&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay|||||||||||||||
PID|||$patientId$||$patientName$||||||||||||||||||||
LocalCode^LocalName^CodeSystem^LOINCcode^LOINCname^CodeSystem
PV1|||||||$attendingDoctor$||$consultingDoctor$||||||||
OBR|1|||012^CBC/Auto Diff^HSPA^57021-8^CBC W Auto Diff^LN||$reqDate|||||||||
OBX|2|NM|123^WBC^HSP_A^26464-8^Leukocytes [#/volume] in Blood^LN||10.8|K/MM3|||||F|
OBX|3|NM|234^RBC^HSP_A^26453-1^Erythrocytes [#/volume] in Blood^LN||4.82|MIL/MM3|||||F|
OBX|4|NM|345^HGB^HSP_A^718-7^Hemoglobin [Mass/volume] in Blood^LN||15.7|GM/DL|||||F|
OBX|5|NM|456^HCT^HSP_A^20570-8^Hematocrit [Volume Fraction] of Blood^LN||45|%|||||||F|
A
Message Processor
A
Institutional Repository

18. Result with a Coded Value
Data type of
result (OBX-5) is a This code is This code is
coded element
from LOINC
from SNOMED
OBX||CE|57131-5^Newborn conditions with pos markers^LN||7573000^PKU^SCT
Code identifying this
observation
(what are these results? Code identifying the
Conditions identified by result (Phenylketonuria )
newborn screening )

19. A brief aside about
terminology…
photo via eye of einstein

20. LOINC Terminology
LOINC (noun)
From “Standardizing the MDS with LOINC® and Vocabulary Matches”
Tohttp://aspe.hhs.gov/daltcp/reports/2007/MDS-LOINC.htm
LOINC, LOINCing, LOINCed (verb)
[Chief, Head, etc] LOINCer (noun)
LOINCification (noun)
SNOMED Terminology
SNOMED (noun)
SNOMEDicated???

21. Different standards for different
parts of the elephant.
photo via Ludovic Hirlimann

22. SNOMED CT
Systematized Nomenclature of Medicine - Clinical Terms
photo via Bruce McKay~YSP

23. LOINC + SNOMED?

24. International Classification of
Diseases (ICD)
and the rest of the family
photo via Esparta

25. RxNorm
normalized names for clinical drugs
photo via e-MagineArt.com

26. We now return to our
regularly scheduled
program…
photo via x-ray delta one

27. Laboratory LOINC

28. Clinical LOINC

29. The LOINC Community
Open. Nimble. Pragmatic.

30. Open Development
Worldwide distribution at no cost
End-user content additions
Welcome all comers
Volunteers

32. Regenstrief Institute
Steward
Developer of content
Developer of tools
Developer of community
Distributor
Voice

33. LOINC Codes Over Time By Release
70,000
LOINC Codes
Lab Codes
60,000
Slope = 2200
50,000
Slope = 600
40,000
30,000
20,000
10,000
laboratory terms only
0

35. 16,000
loinc.org members
14,000
12,000
10,000
8,000
6,000
4,000
2,000
14 new members per day
410 new members per month
0

36. 14,420+ users in 145 countries

37. @LOINC

38. Downloads: ~1400/month

39. The LOINC Distribution

40. http://search.loinc.org

41. http://search.loinc.org

44. http://forum.loinc.org

45. loinc.org/usage
“Top 2000 Results”

46. a.k.a. “Top 300 Orders”

47. a.k.a. “Common Units of Measure”

48. International Adoption
participation, translation, implementation

49. LOINC Submitters
2009 to April 2011
84 organizations from 14 countries

50. LOINC Translators
18 organizations

52. Chinese
(CHINA)
Dra$
Portuguese
(BRAZIL)
English
(UNITED
STATES)
Estonian
(ESTONIA)
French
(CANADA)
French
(FRANCE)
French
(SWITZERLAND)
German
(GERMANY)
German
(SWITZERLAND)
Greek
(GREECE)
Italian
(ITALY)
Italian
(SWITZERLAND)
Korean
(KOREA,
REPUBLIC
OF)
Spanish
(ARGENTINA)
Spanish
(SPAIN)
Spanish
(SWITZERLAND)

53. In-progress
Catalan
Dutch
French
Russian

54. Large Implementations
SIGA Saúde project
Canada Health Infoway
ePSOS
Assistance publique - Hôpitaux de Paris
Hong Kong Hospital Authority
Red Agrolab
BiTAC
Lots more…success is often silent

55. US Adoption
A few key highlights

56. US Federal Agencies
NLM
VA
DoD
IHS
NCI
CDC

57. Other Key US Adoptions
HITSP
eLINCS
NAACCR
CDISC
NCQA/HEDIS, NQF
HL7
HIPAA
HIE’s

58. EHR Incentive
Program
a.k.a. “Meaningful Use”

61. St a n da rds
^

63. New Frontiers in
Content Modeling

64. LOINC Collections
Panels, forms, surveys, and other patient
assessments
photo via LuzA

65. Standardized Assessments
Vreeman DJ, McDonald CJ, Huff SM. Representing patient assessments in LOINC®. AMIA Annu Symp Proc. 2010;832-836. PMID: 21347095 .
Vreeman DJ, McDonald CJ, Huff SM. LOINC® - A Universal Catalog of Individual Clinical Observations and Uniform Representation of Enumerated Collections.
Int J Funct Inform Personal Med. 2010;3(4):273-291.

66. Purpose
Assessments are widely used…
…and not unlike other clinical observations

67. LOINC could be a
master question file
and
uniform representation

68. Hierarchy of a Panel in LOINC

70. Panels/Forms Available as
Separate Download

71. Sample of Assessments in LOINC
US Government Forms
CARE, MDSv2, MDSv3, OASIS B1, OASIS C, RFC
US Surgeon General’s Family Health Portrait
Brief Interview for Mental Status (BIMS)
Confusion Assessment Method (CAM)
Geriatric Depression Scale (GDS)
HIV Signs and Symptoms Checklist
Home Health Care Classification
howRU
Living with HIV (LIV-HIV)
Morse Fall Scale
OMAHA
PHQ (9 and 2)
Quality Audit Marker (QAM)

72. Translational Research Variables
11,000+ variables
Oh snap!

75. Lots More Cooking…
Lots of forms and assessments
More radiology reports
Structured document titles
Genetic testing
…
photo via liber

76. Key Lessons
for Today
photo via IMLS DCC

77. photo via wakefielddavid
Not just an IT problem

78. Get real.
units, results, experts

79. Don’t be a
one hit
wonder.
photo via gsz

80. A journey.
Not a destination.

81. Clean water act
photo via Fishking_1

82. photo via milos milosevic

83. The Race is On!
Get LOINCing!
photo via ryarwood