LOINC
A Vital Tool for Electronic Exchange of Clinical Data
© 2018 © 2019
Welcome to the
LOINC Community
📷 jamescridland | cc-by
Slides available at:
danielvreeman.com/hcsrn
Disclosure
I’m President of Blue Sky Premise, LLC which published the book LOINC
Essentials.
This material contains content from LOINC® (http://loinc.org). The LOINC Table, LOINC Table Core, LOINC Panels and
Forms File, LOINC Answer File, LOINC Part File, LOINC Group File, LOINC Document Ontology File, LOINC Hierarchies,
LOINC Linguistic Variants File, LOINC/RSNA Radiology Playbook, and LOINC/IEEE Medical Device Code Mapping Table are
copyright © 1995-2018, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC)
Committee and is available at no cost under the license at http://loinc.org/license.
!
Financial Support for LOINC
Regenstrief Institute Grant 1R24ES028479-01
Regenstrief Foundation Research Triangle Institute International via CMS
U.S. National Library of Medicine Contract 0-312-0209853
Contracts NO1-LM-4-3510, N01-LM-6-3546, N01-LM-9-3517, and John A. Hartford Foundation
HHSN276200800006C, HHSN276201400138P,
Agency for Health Care Policy and Research
HHSN276201400239P
Grants HS 08750 and HS 07719-03
U.S. Food and Drug Administration
Centers for Disease Control and Prevention
Contracts HHSF223201710178P, HHS223201810268P
Grant and Contracts R13/CCR517099 and H75/CCH520501
American Physical Therapy Association
Centers for Medicare and Medicaid Services
BD
Contract HHSM-500-2016-00040C
bioMérieux
National Center for Advancing Translational Sciences
Indiana Clinical and Translational Sciences Institute
Grant 3UL1TR001108-04S1
California Healthcare Foundation
National Institute of Diabetes and Digestive and Kidney Diseases
Radiological Society of North America through the National Institute of
Biomedical Imaging and Bioengineering Contract HHSN275201600752P
Contract HHSN268201500247A Office of the National Coordinator for Health IT
AHIMA Foundation Grant 90AX0021/01-00
Contract FORE-ASPE-2007-5 Members of the LOINC Community who have made donations or
became Premium Members
Research Triangle Institute International via NIEHS
🌐 loinc.org/funding-support
High Level Outline
📷 Vernio77 | cc-by-sa
The Superhero Origin Story
The industrialist pioneer of automatic dishwashers sought to
apply technological and engineering advances to medicine.
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?
📷 glasgowamateur | cc-by-sa
📷 unamid-photo | cc-by-nd
78,000+ registered users from 175 countries
🌐 loinc.org/atlas
Today, there are hundreds of
millions of patients with billions
of discrete results stored in
systems around the world that
are coded with LOINC.
Taking a little deeper
LOINC dive
LOINC’s content scope
Where to use LOINC codes
Key features of LOINC’s development approach
High Level LOINC Landscape
Codes for individual observations
6690-2 Leukocytes [#/volume] in Blood by Automated
2339-0 count
Glucose [Mass/volume] in Blood
29463-7 Body weight
55423-8 Number of steps in unspecified time Pedometer
Property MCnc
Timing Pt
System Ser/Plas
Scale Qn
Newborn screening
Full set of terms, included in HL7 IG Lab Results Interface (LRI)
Genetic reporting
2000+ tests, including collections for structured reporting of simple variants, structural and copy number variants, complex variants,
and pharmacogenomic studies. [PMID: 25656513] See HL7 LRI and the developing FHIR CG IG.
Orders
Not only single tests, but 1,000+ order panels and a consensus-vetted list of 1,500 order codes covering 95% of common volume. See
loinc.org/usage/orders
Public health
Close work with CDC on emerging diseases and reportable conditions
Clinical Notes and Documents
2,700+ terms with a specialized structure
loinc.org/document-ontology
Radiology Procedures
Wonderful collaboration with RSNA [PMID: 29850823]
5,800 terms with rich metadata
loinc.org/radiology
📷 unamid-photo | cc-by-nd
Broad collection of other clinical variables
Vital signs
CDC’s vital statistics forms (birth, death, etc)
CMS’s patient assessment instruments
Nursing Assessments
Physical Therapy National Outcomes Database
NEMSIS and NTDS
ESRD variables
Chronic kidney disease management
Ophthalmology variables
Medical device measurements via IEEE 11073
ECG, PFT, spirometry, etc
…10,000+ assessment and patient reported outcome terms
10,000+ assessment terms
and growing…
Social, psychological and behavioral observations - 2015 Edition Geriatric Depression Scale (GDS)
Health IT Certification Criteria set
Humiliation, Afraid, Rape, and Kick questionnaire
Adverse Childhood Events
HIV Signs and Symptoms Checklist
ADAPTABLE patient report item set
howRU
Borderline Symptom List - 23 Item
International Physical Activity Questionnaire
Brief Interview for Mental Status (BIMS)
Living with HIV (LIV-HIV)
Comprehensive Behavior Health Screen
Morse Fall Scale
Confusion Assessment Method (CAM)
My Mood Monitor
Core behavioral health terms (SAMHSA)
Neuro-QOL
Edinburgh Postnatal Depression Scale
PROMIS (e.g. Social Isolation item bank)
Everyday Cognition
PhenX (eg. Social Environments domain)
Exercise Vital Sign
PHQ
FACIT
VR 12 and 36
LOINC Development
We’ll focus on the key features
📷 jurvetson | cc-by
Guiding Principles
Openness
Accessibility
Growth
Pragmatics
Agility
Diligence
Respect
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LOINC Terms Over Time
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laboratory terms only
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Vocabulary standards grow
because USERS ask
(broad user community drives new content)
CDC
Argonaut Project Lab reporting, case reporting,
immunization messaging, National
EMS Info System, National Trauma
FDA Data Standards, vital statistics, etc
Barda AJ, Ruiz VM, Gigliotti T, Tsui FR. An argument for reporting data standardization procedures in multi-site predictive modeling: case study on the impact of LOINC standardization on model performance. JAMIA Open.
2019 Apr;2(1):197–204. PMCID: PMC6435008
Add clarity to other VDW
domains by linking to LOINC
See: ONC’s 2019 ISA Reference Edition
Patient Allergic Reactions Alcohol Use
Patient Family Health History Depression
Patient Functional Status and/or Disability Exposure to Violence (Intimate Partner Violence)
Imaging Diagnostics, Interventions and Procedures Financial Resource Strain
Laboratory Tests Level of Education
Clinical/Nursing Assessments Physical Activity
Outcomes for Nursing Social Connection and Isolation
Patient Pregnancy Status Stress
Patient Gender Identity Patient Tobacco Use (Smoking Status)
Patient Sex (At Birth) Patient Vital Signs
Patient-Identified Sexual Orientation
True even if your data
structure is “flat”
Vital Signs, Social History, etc
📷 Fishking_1 | cc-by
https://ivdconnectivity.org/livd/
https://usdiagnostics.roche.com/en/documentation.html#/q/loinc/s/SCORE_DESC
Bonus Tip
LOINC can augment your QA
LOINC Property -> Units mismatch
LOINC System (Specimen) -> SPECIMEN_SOURCE
Take home lesson:
When clinical data is coded with LOINC, diverse IT
applications can understand and interact with it for
the benefit of many in the health ecosystem.
Happy LOINCing!
Q & A