Clinical LOINC Meeting | Salt Lake City, UT USA

An Introduction to LOINC
Clinical LOINC Version

Daniel J. Vreeman, PT, DPT, MS

Regenstrief-McDonald Scholar in Data Standards
Indiana University School of Medicine

Director, LOINC and Health Data Standards

@djvreeman Regenstrief Center for Biomedical Informatics

2017
 Welcome to the
LOINC Community

photo via jamescridland | cc-by

 High Level Schedule
Tues
LOINC Overview (D Vreeman)
LOINC Foundations (J Deckard)
RELMA Overview (S Matney)
Wed - AM
Documents (D Vreeman)
Panels, Forms, and Patient Assessments (D Vreeman)
Radiology (D Vreeman)
Wed - Late AM to PM
Clinical LOINC Committee Meeting
Reception hosted by Dr. Huff
Thurs
Clinical LOINC Committee Meeting
 Workshop Webinar
Interaction
Attendees will be muted for the
workshop but you can still
interact with the LOINC team.

Have a question?
Use the Q&A section of the
webinar and the LOINC team will
respond.

Ask your question here

 meeting.loinc.org

Youll want to download RELMA if you havent already

loinc.org/slideshows
LOINCs superhero
origin story

McDonald et al. Canopy Computing: using the Web in Clinical Practice. JAMA. 1998;280(15):1325-1329.
 The rain forest canopy is a
seamless web through which
arboreal creatures efficiently
move to reach the edible
fruits without any attention
to the individual trees.
McDonald et al. Canopy Computing: using the Web in Clinical Practice. JAMA. 1998;280(15):1325-1329. photo via nosha | cc-by-sa
The big problem
 data
It's like, the more money
we come across
The more problems we see

MO DATA MO PROBLEMS
Problems
Health IT systems often lack
common mechanisms for MO DATA MO PROBLEMS

exchanging data.

Even when they do, they use

different ways of identifying the
same concept.

Only way to overcome these problems is

with data standards
 Variation Abounds
CODE NAME
34626D Arterial BP Diastolic
39312D ABP Diastolic
ARTDIASBP Arterial Diastolic BP
nvArtBPS Arterial Blood Pressure Systolic
DBP DBP
25284D BP (NIBP)
2737317 Diastolic Blood Pressure #1
6881D BP Diastolic
6881D BP
77934D BP Manual Diastolic
919109 Diastolic Blood Pressure
DiastBP DiastolicBP
PBPD PRE BLOOD PRESSURE DIASTOLIC
POBPD POST BLOOD PRESSURE DIASTOLIC
The solution
Standards make
health data more
portable and
understandable to
different computer
systems.
The universal standard for
identifying health measurements,
observations, and documents.

Est. 1994
A non-profit research organization in Indianapolis, USA

Established LOINC in 1994

Overall steward and owner of LOINC

Develops and licenses LOINC

A small team that does BIG things
 With the help of many
LOINC Committee
Lab and Clinical

LOINC Community
Submitters
Translators
Advocates
Enthusiasts
And generous financial support
Many sources over the 20+ years of LOINC
AHCPR, ASPE, CDC, CHCF, CMS*, Hartford Foundation, IN
CTSA, Regenstrief Foundation*, Regenstrief Institute,
bioMrieux*, NCATS*, NCRR, NIBIB*, NIDDK*, NLM*,
LOINC User Community*
*active now

Today, the U.S. National Library of Medicine

(NLM) accounts for about 2/3 of our funding.
LOINC is free,
but invaluable
We do measurements
LOINC is focused on one piece of
the interoperability puzzle

photo via puuikibeach| cc-by

Laboratory LOINC
Clinical LOINC
 A rich trove of 80,000+ standardized variables
Genetics Lifestyle

21654-9 CFTR gene targeted mutation analysis

24475-6 F2 gene c.20210G>A [Presence] 41950-7 Number of steps in 24 hour Measured

75547-0 Noninvasive prenatal fetal aneuploidy 75296-4 Carbohydrate intake 24 hour Estimated
and microdeletion panel based on Plasma cell- 82289-0 Rating of perceived exertion [Score]
free+WBC DNA by Dosage of chromosome-specific
circulating cell free (ccf) DNA 72166-2 Tobacco smoking status NHIS

82245-2 Chromosome region 22q11.2 deletion in 64098-7 Distance walked in 6 minutes

Amniotic fluid or CVS by FISH

Lab and clinical Environmental

82464-9 Mosquito count [#] in Environmental specimen

4548-4 Hgb A1c MFr Bld 67784-9 Individuals below poverty line Neighborhood
8462-4 Diastolic blood pressure 63736-3 Materials to which you were exposed in your
work or daily life
24725-4 Head CT
63805-6 How long did you handle paints or solvents
57021-8 CBC W Auto Differential panel - Blood yourself?

8633-0 QRS duration 67640-3 My teachers believe that I can do well in my

school work
Codes for individual observations
Leukocytes [#/volume] in Blood by Automated count
Erythrocytes [#/volume] in Blood by Automated count
Hematocrit [Volume Fraction] of Blood by Automated count

and collections of observations

CBC W Auto Differential panel - Blood
Vital signs, weight and height panel
PHQ-9 quick depression assessment panel
Grown in Indiana
Serving a global community
Translations
into 18 variants
of 12 languages
52,000+ registered users from 170 countries

6,000 new users per year

Many kinds of LOINC Users
Referral / reference labs and radiology centers
Health-related federal agencies
Care organizations
Professional societies
Health information exchange networks
Insurance companies
Health IT vendors
Instrument manufacturers
Health app developers
Official national standard in 30+ countries
A small taste of LOINC
adoption around the world
Austrian National Patient
Health Record (ELGA)
LOINC for laboratory tests as well as for
document and section encoding.
A value set of LOINC codes and preliminary
ELGA-wide codes was developed for
laboratory analyses and is constantly
maintained and updated in coordination with
the laboratory community.

Seerainer C, Sabutsch SW. eHealth Terminology Management in Austria. Stud Health Technol Inform. 2016;228:426-30. PubMed PMID: 27577418.
Nictiz

Many national projects in the

Netherlands are using LOINC
Nationwide surveillance network for bacterial
typing and antibiotic resistance surveillance
National laboratory code list (selected by NVKC
and NVMM societies)
National special test registry (WieDoetWat-
database)

Nictiz is a LOINC Premium Member

http://www.cchi.gov.sa/en/Projects/SHIP/Pages/Dictionary.aspx
International Patient
Summary (IPS)
A non-exhaustive patient summary, specialty-
agnostic, condition-independent, but readily
usable by clinicians for the cross-border
unscheduled care of a patient.

Coordinated with the IPS project mandated to

CEN TC 251 by the European Commission.

Uses LOINC for:

Document type, sections, lab results, other clinical
observations, and radiology reports

http://international-patient-summary.net
Ministrio da Sade Brasil

Official adoption of LOINC for laboratory test

reporting

Used in large-scale regional data exchange

project in So Paulo for many years

Instituto HL7 Brasil has organized the

Portuguese LOINC translation

http://bvsms.saude.gov.br/bvs/saudelegis/gm/2011/prt2073_31_08_2011.html
Saudi Arabia s Council of
Cooperative Health Insurance
Project aims to provide all 12 million
beneficiaries with first class medical
insurance services and improve
information exchange between various
stakeholders (beneficiaries, companies,
and health providers).

Adopted LOINC for lab orders/results

http://www.cchi.gov.sa/en/Projects/SHIP/Pages/Dictionary.aspx
Turkish Ministry of
Health

General Directorate of Health

Services recently mandated LOINC
for laboratory results in public,
university, and private health facilities

Maintain a Turkish translation of LOINC and

mapping to national billing codes (plus online
search/mapping tool).

http://www.cchi.gov.sa/en/Projects/SHIP/Pages/Dictionary.aspx
And so many more

Australia, Canada, Estonia, France, Italy, Malaysia,

New Zealand, Qatar, South Africa, etc
A few highlights from the USA
87 mentions of LOINC
 Lots o LOINC
Representing Patient Allergic Reactions
Representing Patient Family Health History
Representing Patient Functional Status and/
or Disability
Representing Imaging Diagnostics,
Interventions and Procedures
Representing Laboratory Tests
Nursing
Representing Nursing Assessments
Representing Nursing Interventions
Representing Outcomes for Nursing
Representing Patient Clinical
Problems (i.e., Conditions)
Sex at Birth, Sexual Orientation and
Gender Identity
Representing Patient Gender Identity
Representing Patient Sex (At Birth)
Representing Patient-Identified Sexual
Orientation
Social Determinants
Representing Financial Resource
Strain
Representing Level of Education
Representing Stress
Representing Depression
Representing Physical Activity
Representing Alcohol Use
Representing Social Connection and
Isolation
Representing Exposure to Violence
(Intimate Partner Violence)
Representing Patient Tobacco Use (Smoking
Status)
Representing Patient Vital Signs
U.S. Food and Drug
Administration

LOINC codes will be required for

laboratory test data in studies
starting after March 2018

Actively facilitating discussion

with IVD vendors about
identifying the LOINC codes
associated with their products

Funding creation of an
implementation guide for LOINC
Microbiology content
Centers for Medicare &
Medicaid Services

Long term goal of unification across

settings. Representing all data
elements from assessment
instruments in LOINC.

Focused on MDS, OASIS, IRF-PAI,

LCDS instruments now.

2,000+ individual data elements!

Contract HHSM-500-2016-00040C
Centers for Disease Control
and Prevention

Longtime users of LOINC:

Electronic Laboratory Reporting

Case Reporting
Reportable Condition Mapping Table
Immunization Messaging
National Emergency Medical Services Info System
National Trauma Data Standards
National Healthcare Safety Network - Healthcare
Associated Infection (HAI)

https://phinvads.cdc.gov/
Advocate for the adoption of
SNOMED CT and LOINC as
national standards for clinical
data, and link them with
nursing terminologies
through mappings.
Know LOINC?
Get Hired!
Do you have an iPhone?

photo via Prime Number | by-nc-sa

 LOINC codes! Oh snap!

Apple Health Export in C-CDA Format

Moving standardization
upstream
Let all the downstream data recipients benefit
photo via Fishking_1 | cc-by
Banding together
for global good
photo via scarlatti2004_images | cc-by-sa
Many Active Collaborations
IICC
HL7
IEEE
SNOMED International
RSNA
CDISC
ANI
 Everyone loves LOINC

photo via mccaughan

 The LOINC
Distribution
LOINC Table, Accessory Files, and Tools and
Resources for Implementers
Major releases
twice per year
(June and December)

photo via striatic | cc-by

 LOINC Codes Over Time by Release
90,000
LOINC Codes

80,000 Only Lab LOINC Codes

70,000

60,000

50,000

40,000

30,000

20,000
laboratory terms only
10,000

0
84,000 codes
havent you finished yet?
Lots cooking

photo via liber | cc-by

LOINC grows
because YOU ask
 Last Year:
New term requests from 50+ organizations in 14 countries
 LOINC Table
The main LOINC database content
 One Record Per Term
Cholesterol in LDL [Mass/volume] in Serum
Long Common Name
or Plasma by Direct assay
Short Name LDLc SerPl Direct Assay-mCnc

Class Type Lab

Class Chem

Example Units (local) mg/dL

Example Units mg/dL

Order/Obs Both
LOINC Accessory Files
Special representations of LOINC content
 Accessory Files
LOINC Part File
LOINC Answer File
LOINC Panels and Forms File
LOINC Document Ontology File
LOINC Multiaxial Hierarchy File
LOINC/IEEE Medical Device Code Mapping File
LOINC/RSNA Radiology Playbook File
LOINC/SNOMED CT Expression Association and Map Sets
Legal Stuff
http://loinc.org/terms-of-use
 LOINC License
No cost use
Worldwide
In perpetuity
Commercial or noncommercial
purposes
Encourages translation
One major prohibition
CANNOT use any
Licensed Material to
develop or promulgate
a different standard for
orders or observations.
That would defeat
the purpose of
having a standard!
 Read more about
Regenstriefs approach
to licensing LOINC
danielvreeman.com/licensing-loinc
A big toolbox for
Implementers
All available at loinc.org

photo via Robert S Donovan | cc-by-nc

Many free
resources:
RELMA
search.loinc.org
Community resources
Reference material
LForms
FHIR Vocabulary server
and more!
loinc.org/members
An exceptional value

Takes as input
Local test codes, names, units, and mappings

Returns
Spreadsheet with issues detected by the evaluation process
Sample of Evaluation Rules
Unknown local units
Deprecated LOINC
Discouraged LOINC
Property/units mismatch
Scale/units mismatch
Concentration missing denominator
What LOINC Essentials covers
LOINC basics

A framework and techniques for picking out the subtle

but important distinctions between LOINC terms

Step by step guidance for mapping with RELMA

Best practices in LOINC mapping and how to set

yourself up for success in the long run
Disclosure
Im the author of the book LOINC Essentials
published by Blue Sky Premise, LLC where I
serve as President.

Net profit going to a special charitable project:

danielvreeman.com/build-a-school
loinc.org/slideshows