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Using

RELMA
OrIn Search of the Missing LOINC
Laboratory LOINC Meeting June 2012

James T. Case MS, DVM, PhD, FHL7


Health Program Specialist, SNOMED CT National Library of Medicine

2012 Regenstrief Institute and James Case

Acknowledgements
LOINC Development Team
Clem McDonald, Dan Vreemen, Kathy Mercer, Jaci Phillips, Kelly Mallot, David Baorto

RELMA Development Team LOINC Commi7ee Supporters:

John Hook, Anandhi Sowmyan, James Dennis

NLM, Regenstrief (including the Indiana Center of Excellence in Public Health InformaKcs), Regenstrief FoundaKon
2012 Regenstrief Institute and James Case

What will we cover today?


Overview of LOINC Reviewing new RELMA features! Installing RELMA SePng personal preferences Loading a Local ObservaKon File (LMOF) Searching for a LOINC Term Preparing LMOF for Mapping Review of Map Screen FuncKons SePng Search Limits Mapping Local Terms to LOINC Viewing LOINC Term Details Proposing/SubmiPng New LOINC Terms ExporKng/PrinKng Mapped Terms Mapping your own LMOF data
2012 Regenstrief Institute and James Case

2012 Regenstrief Institute and James Case

Why are we doing this?


Goals of Health Information Standards

Interoperability the ability to exchange informaKon between organizaKons Comparability the ability to ascertain the equivalence of data from dierent sources Data Quality the measurement of accessibility, completeness, accuracy and precision (and more)

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Levels of Interoperability
Basic allows data to be exchanged between computer systems

Word processing documents, text messages

FuncConal describes the standard syntax (format) of the data


Document templates, forms, data structures Message standards

SemanCc requires use of standardized content (vocabularies) within the data structure
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Comparability
Meaning of the data is consistent when shared among dierent parKes

Erysipelas Human skin disease; Streptococcus Grp A Erysipelas Animal SepKcemia/dermaKKs; Erysipelothrix rhusiopathiae Should work in the background

Common terminology required

Words are not enough


Codes uniquely idenKfy terms Vocabulary specialized, precise terms that remove ambiguity Ontology describes nature of enKKes and their relaKons ClassicaKon groups related terms
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Potential Uses of Health Data are Constrained by Data Quality Factors


Data quality issues

Dierent for client/paKent communicaKons vs. clinical decision support vs. epidemiological analysis O\en constrained by external forces

e.g. criteria for diagnosis o\en diers from the criteria for reporKng

UnidirecKonal eect of data consolidaKon


Detailed General General Detailed


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The Problem
In a_empKng to arrive at the truth, I have applied everywhere for informaKon, but in scarcely an instance have I been able to obtain hospital records t for any purpose of comparison. If they could be obtained, they would enable us to decide many other quesKons They would show [subscribers] how their money was being spent [and] what amount of good was really being done with it
Florence Nightingale - Notes on a Hospital, 1873

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Test comparisons
What you see in the order list

Lab A
Test Name: Lyme Disease Serology Measures: B. burgdorferi Ab IgG Method: ELISA Scale: quanCtaCve e.g.: Titer 1:40

Lab B
Test Name: Lyme Disease AnCbody Measures: B. burgdorferi Ab IgM Method: Immune blot Scale: qualitaCve e.g.: PosiCve

LOINC Code = 5062-5

LOINC Code = 6321-4

2012 Regenstrief Institute and James Case

Why LOINC?
Within one laboratory, local jargon terms may be used which are usually well understood between colleagues, but would not be suciently widely known for communicaKon with the outside world.

U. Forsum et al., Pure Appl. Chem 72:555-745, 2000 Proper3es and Units in the Clinical Laboratory Sciences Part VII. Proper3es and Units in Clinical Microbiology
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101 LOINC
Emphasis on Laboratory LOINC

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Anatomy of a LOINC Term


5193-8:Hepatitis B virus surface Ab:ACnc:Pt:Ser:Qn:EIA LOINC Code Component Property Measured Timing System Scale Method 5193-8 HepaCCs B virus surface Ab ACnc Pt Ser Qn EIA

There are six major LOINC axes


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What is NOT part of a LOINC Name?


The instrument used in tesKng Specic details about the specimen Priority (e.g. STAT) Where tesKng was done Who did the test Test interpretaKon Anything that is not an intrinsic part of the name of the result Other things that are carried in;

The OBR or OBX segment An HL7 Version 3 ObservaKon Object


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Component/Analyte
The substance or enKty that is measured, evaluated, or observed
- Sodium

- Glucose - Brucella sp. organism - Inuenza A Virus anKgen - Cytomegalovirus Virus anKbody - Lipids.Total
5193-8:Hepatitis B virus surface Ab:ACnc:Pt:Ser:Qn:EIA
2012 Regenstrief Institute and James Case

Component/Analyte Structure
Analyte Name^Challenge^Adjustments
Formal name of Analyte (e.g. Calcium)

Must specify any subanalyte

May have a subclass separated by .


e.g. Calcium.Free

e.g. Coronavirus Ag

Challenge - e.g, 1H post 100 gm Glucose PO


Adjustments/correcKons
E.g. Adjusted to pH 7.4

Two subparts separated by post <Kme delay> post <challenge type>

2012 Regenstrief Institute and James Case

Property
the most dicult LOINC axis

The characterisKc or a_ribute of the analyte that is measured, evaluated, or observed


Major Categories Mass: ObservaKons reported with mass (milligrams, grams, etc.) in the numerator of their units of measure Substance: ObservaKons reported with moles or milliequivalents in the numerator of their units of measure CatalyCc acCvity: ObservaKons that report enzymaKc acKvity Arbitrary: Results that report arbitrary units in the numerator of their units of measure Number: Counts
5193-8:Hepatitis B virus surface Ab:ACnc:Pt:Ser:Qn:EIA 2012 Regenstrief Institute and James Case

Property
the most dicult LOINC axis

Combine Major Categories with Subtypes for Full Property MCnc mass concentraKon (mass/unit vol) MCnt mass content (mass/unit mass) NCnc number concentraKon (number/unit vol) TmStp Kme CCnc catalyKc concentraKon (acKvity) Prid presence or idenKty Imp impression/interpretaKon Find subjecKve or objecKve observaKon Type Kind-of
5193-8:Hepatitis B virus surface Ab:ACnc:Pt:Ser:Qn:EIA 2012 Regenstrief Institute and James Case

Common Issues with LOINC Properties


FracKon (proporKon) vs. RaKo a/a+b vs. a/b FracKon = Part/whole

Number fracKon (NFr): % Eosinophils Substance fracKon (SFr): % HGB which is A2

RaKo = Measures mulKple analytes from the same system (specimen)


Mass concentraKon raKo - MCrto

e.g., BUN/Creat in urine specimen Urea/CreaKnine expressed as mmol/L (SI units)

Substance raKo-SCrto

RelaKve RaKo = Measures from dierent systems


RelRto Lithium.saliva/Lithium.serum RlTm Kme from actual and normal control MoM MulKple of the Median
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Timing*
The interval of Kme over which the observaKon or measurement was made

Pt - at a point in Kme 12H - a twelve hour collecKon 24H - a twenty four hour collecKon

*non-Pt Kmings are usually associated with Rate Property


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System
The system (context) or specimen type upon which the observaKon was made. Ser - Serum Bld - Whole blood (RBC) Ur- Urine BldA - Arterial blood Liver - Liver Flu Body Fluid, unspecied Gast Gastric uid/ contents Food Food or feedstu Tiss Tissue XXX To be specied in another part of the message

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System Structure
System^Super System

Super System
PaKent is the default Used to indicate

blood product unit bone marrow donor fetus


photo via Xurble

818-5:A Ag:ACnc:Pt:RBC^BPU:Ord: 54417-1:ABO+Rh group:Type:Pt:Bld^fetus:Nom:

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Scale
Qn - QuanKtaKve

ConKnuous numeric (real, integer, raKo) OpKonal operator (>, , , <)

When assay detecKon limits are exceeded

Ord - Ordinal

a ranked set of possible values (1+, 2+, 3+) an unranked collecKon of possible values a taxonomy (e.g list of bacteria) free text narraKve (e.g., visit note)
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Nom - Nominal

Nar - NarraKve

Scale (Special)
OrdQn Ordinal or QuanKtaKve

Primarily used for anKmicrobial observaKons e.g. MIC reported as resistant, intermediate, suscepKble or as the mm diameter of the inhibiKon zone Use is discouraged in other contexts e.g. chromatography output Use is discouraged

MulK structured text globs


Doc Clinical documents Set Clinical a_achments (headers)


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Method
Methods only needed if interpretaKon aected

Dierent normal ranges Test SensiKvity/Specicity AggluKnaKon (limited subtypes) Immunoassay Probe with target amplicaKon

Generally listed only at the generic level


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Hierarchies
LOINC Class Each LOINC axis MulK-axial
Component | System Separate download

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Mapping Terms to LOINC


Things to Remember
The thing ordered is not always the thing measured:

Blood Culture live organism(s) idenKed VDRL Treponema pallidum Ab Urinalysis lots of dierent things

The quesKon (what am I measuring? e.g. Glucose) is not the answer (e.g. 90 mg/dl)

You are mapping the quesKon, not the answer!

You must know the specics of the component being tested for (what is this test actually measuring?)

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What is in LOINC? Content


Term structures Submi_ed units, Example UCUM units

aiming toward preferred units sorKng

Synonyms Answer lists (increasing number) Text descripKons links to info sources about individual tests

Panel structures Foreign language translaKons

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Regenstrief LOINC Mapping Assistant

RELMA

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Purpose of Tutorial
Eliminate need to read the Users Manual Become familiar with RELMA features Provide some insight into mapping Kps/pi}alls Help begin the mapping process for your insKtuKon Hang with some really cool folks

2012 Regenstrief Institute and James Case

RELMA Functions
LOINC les and indexes Manual and automated mapping funcKons Same free use as LOINC (see license) RELMA tools transform local words in local le

User creates le of local term/name and codes

Assigns LOINC term to local test/ba_ery code Common tests subset to speed mapping Context sensiKve hierarchies for local use. Flexible Google-like search funcKons
2012 Regenstrief Institute and James Case

New in This Version (Rel. 5.7)


Search and mapping screen redesigned to be cleaner and more intuiKve. Answer lists may be searched and displayed via Answer List Search tab on the Mapping screen. The details screen displays:

LOINC Part ID and text values in the answer list Answer list ID LOINCs that use the answer list

Right-click on an Answer List Search result to access "Find LOINCs that use this answer list" acKon.

2012 Regenstrief Institute and James Case

New in This Version (Rel. 5.7)


The grids on the "Edit Term in Local Term File" form now have context sensiKve (i.e. right-click) menus with persistent Custom Export sePngs. ImporKng HL7 or delimited les requires a new name for the local term le.

Prevent accidental import into wrong local term le.

2012 Regenstrief Institute and James Case

New in This Version (Rel. 5.7)


Support for ltering results on SI version of the Top 2000+ "common" lab results.

h_p://loinc.org/usage

"Clear Limits" on the Mapping Screen now clears all limits including units.

Formerly labeled "Clear Most Limits

New warning: RELMA ignores units it does not recognize or if searching without a units restricKon.
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New in This Version (Rel. 5.7)


RELMA automaKcally trims local term le names of leading or trailing spaces upon loading. New PDF output opKon for "Report Local Terms and Their LOINC Mappings...". PrinKng without using Custom Export prints only selected rows.

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LOINC Web Site

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Whats available to download?


RELMA - mapping and browsing tool

HL7 message converter- Makes a database suitable for mapping HL7 lint (nds bad messages)

LOINC database and spreadsheets LOINC User guide; RELMA User Guide Tools to assist language translaKons by part Tools for building databases to map from HL7 messages New guidance documents for mappers
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RELMA Highlights
Browse-able hierarchies of LOINC parts Display search results in tree view Enhanced details view of terms/parts

References DescripKons Sample units

Empirically-derived common test list Empirically-derived common order list Special features for panels/forms Enhanced export/copy-paste opKons
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Installing RELMA

2012 Regenstrief Institute and James Case

Make sure you have enough free disk space!

Installation Steps

2Gb is recommended

From CD - Start Run <drive>:\RELMA\Setup Specify installaKon directory

Life will be easier if you accept the default RELMA.MDB LOINC Terms Database LMOF3.MDB Local Master ObservaKon File

Two database les installed


Two sample les included Run from Start (All) Programs Regenstrief RELMA

2012 Regenstrief Institute and James Case

File Locations
Database and Ancillary Files

Windows XP = C:\Documents and SePngs\All Users \Documents\RELMA\ Windows Vista = C:\Users\Public\Documents\RELMA\ Windows 7 = C:\Users\Public\Documents\RELMA\ Windows XP = C:\Documents and SePngs\All Users \Documents\RELMA\Samples\ Windows Vista = C:\Users\Public\Documents\RELMA \Samples\ Windows 7 = C:\Users\Public\Documents\RELMA \Samples\
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Sample les

Running RELMA
Version 5.7

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Copyright Screen

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Main Menu/Welcome Screen

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Set Preferred Language


Click File, Set Preferred Language

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Select Linguistic Variant(s)


Selecting a translation may require indexes to be built

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LOINC Terms with Spanish Linguistic Variant

All Spanish!

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Setting User Preferences

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Set User Preferences


Select User Preferences From the File Menu ...or from Welcome Screen

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Set User Preference Dialog

New File Locations: (See prior slide for location) Startup Screen Preference

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User Map Screen Preferences


Click Map Screen Tab Auto create search terms Include/Exclude Battery Terms Add comments on Mappings

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Importing Local Terms into RELMA

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4 Ways to Load LMOF Files


Direct entry into LMOF from within RELMA (painful)

Handy for individual entries/edits

Create an Access table that mimics the LMOF structure (less painful but tedious)

Appendix A: RELMA Manual

Create a delimited ASCII le from your local test catalog (good choice) Load directly from HL7 v2.x messages

Pulls data from OBR and OBX segments Stores NTE segment data
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Constructing a Local Dataset


Create extract of your test catalog with:

Ba_ery/Panel Code Ba_ery/Panel DescripKon or Name *Local Code *Test DescripKon or Name

Units Example Values Laboratory SecKon

Include Method if Important

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Creating Delimited ASCII File


RELMA cant parse free text

Need to create separate elds Tab, Semicolon, Comma, Space Can dene your own

Can use any of these delimiters


Fields can be in any order Minimum required elds


Local Code Local DescripKon Units (highly recommended)


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Entering New Local Terms into RELMA

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Manual Enter/Edit
View/Add/Edit Local Terms

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Edit Term Dialog

Edit\Add\Delete Terms Export Terms

Text alignment option

Print Preview List

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Export Local Term File

Delimiters supported: Tab, comma, bar (|)

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Add Local Term


MICRO!

BUBPLAG! BUBONIC PLAGUE RRT PCR!

Click to Add to Current Working File

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Search Local Term File


Calcium

Enter Keyword from any Return to Full List Field

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Print Preview Local Term File


New! Only prints selected rows

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Steps to Import Local Terms


1. Click Import Local Terms Bu_on from Main Menu
a) File>Import Local Terms from Delimited File

2. Locate your local terms text le

3. Name your Working Set (New! Now mandatory)


a) LMOF database can contain mulKple work sets

a) E.g. WinXP Sample les loaded into C:\Documents and SePngs\All Users\Shared Documents\RELMA

4. Dene default secKon (OpKonal) 5. IdenKfy le delimiter 6. Assign elds to LMOF a_ributes
a) b)

7. Check Case-sensiKve if needed 8. Click Import.


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Ignore elds you dont need Combine elds if needed

Example Tab-Delimited File

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Importing Local Files


Select Import Local Terms from Delimited File

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Navigate to File Location


Select File iles stored ipen Sample j and Click O n RELMA Directory

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Open File in RELMA


Name your working set. RELMA allows multiple sets in LMOF database

Select your delimiter

Import Button

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Fields Segregated

Assign working set name

Assign LMOF Attribute

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Working set import


LOINC Workshop OBR"

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Ready to Import
Minimum assignments

Now you can click the Import button!

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Post-Processing of Local File


A\er import, RELMA Searches for terms (words) that it does not recognize Stored in a le for future reconciliaKon

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Local Term File Options

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Change Local Term File


Select the Working Set Current mapping status

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Alternative Pragmatic Way


Use large set of HL7 messages AutomaKcally make dataset of:

OBR ID OBR descripKon OBX ID OBX descripKon Sample of results with


Real values Units Abnormal ags Normal ranges


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Generate Local term jile from HL7 messages


Select Import Terms from HL7 File

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Select File to Import

Select HL7 File

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Specify HL7 File Name and Sample Size

Skip import of sample values Name the Local Term File (working set) Select which codes to store Select the number of sample values

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HL7 Messages Data Statistics

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New Terms added to LMOF

Click on Edit Term to see Sample Data New Battery Code

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Sample Results for Observation


New Test Code

Sample Values from Messages

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Lenny LOINC says: Load the Sample Files Into RELMA now! Import the two sample les provided

Import_Sample_OBR.txt

Import_Sample_OBX.txt

Contains ba_ery code and descripKon Contains test code and descripKon

Create 2 working sets Load your personal data set


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Cleaning your data

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Preparing your Data for Mapping Improve mapping success by:


Expanding abbreviaKons Standardizing colloquial terms Ignoring administraKve terms Standardizing Kme references

Can be done prior to imporKng Be_er to use tools built into RELMA
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RELMA Cleaning Tools


Use this tool to edit unknown terms

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Review Unknown Local Terms


May Re-Scan File for Unknown Terms

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Replace Local Terms

Assign LMOF Attribute Replacement Options

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RELMA Cleaning Tools


Use this tool to make global substitutions

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Term Substitution

Save this global substitution for only this working set


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Lenny LOINC says: Begin to clean your data now!

Using the OBR or OBX sample les, take 15-20 minutes to clean up these unrecognized terms

You may use your own data if you wish.

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Searching for LOINC Terms

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Even more simplijied Search Only Tool

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Search Window
Help File

Enter Search Terms

Limit to Specijic Units Restrict to Common Limits

Use different logic

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Search Window
hematocrit bld qn

Common Tests selected

Common Tests rank

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RELMA Search Helpjile

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Context Menu

Right click to bring up context menu

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Mapping Local Terms

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Mapping Local Terms


Select your Working Set to Map
File>Select Local Term File to Process Select Map Local Terms to LOINC from

Welcome Screen Select the subset of terms to work with:


All Mapped Unmapped Set your Search Limits

Set Search Limits

Bu_on

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Standard Mapping Window Features


Customizable grid View details of LOINC term Sort by column

Click column Custom Sort

Print or export results grid Spell check squiggly line to signify words not known to RELMA

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Mapping Screen
View or edit local term

Enter local term number

Quick select button list

Custom Grid Conjiguration

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Conjigure Grid
Select elements to display Reorder grid elements

Visually resize elements Reset Default Conjiguration

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Quick choice buttons

Viewing LOINC term detail

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View Local Term Details


Can scroll down a single formatted page Select level of detail to display

Can scroll through returned subset of terms

Change text size

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View Local Term Details


Select text size

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Select detail display level

Select level of detail to display

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Standard Mapping Screen

Begin a search (or hit enter)

EEK! Whatll I do?!

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Standard Mapping Screen

Click to show words used in search


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Initial Mapping Results

Use term checkbox

Number of LOINC terms containing keyword

Battery terms included in search

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Revised Mapping Results

Number of matching records found

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Re-revised Mapping Results

Match units selected

Number of matching records found

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Standard Mapping Screen

CANINE DISTEMPER VIRUS IF

Enter keywords here Clear all input jields

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Ad hoc term search

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Standard Mapping Screen

Navigate through the local terms

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Tabbed Access to Functions

Navigate to Functions from Mapping Page

Switch between Grid and Tree Views

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Tree View

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Tree View
Results displayed hierarchically

Dened by the mulK-axial hierarchy in search restricKons (covered later)

Map to a term in tree by clicking Map bu_on or double clicking term

Only to rows that have LOINC Codes

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Tree View
Can map to terms with LOINC Codes Tree Navigation Buttons Cannot map to terms representing LOINC parts

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Assigning a LOINC Map

Click Map Button Highlight correct term


(or doubleclick)

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Adding Mapping Comments

If comments option is selected, prompt appears

Check with Frank in Chemistry

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Assigning a LOINC Map

LOINC Term Assigned

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View Panel Children

Select View Panel Children from context menu


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Panel Children

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Conjigure Export Options

Output Options Save Conjiguration and/or Export Include column headers

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Excel Export Format

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More on Searching Mapping Screen

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Basic Search Syntax


Special Character(s) AND OR NOT ? Example Inuenza virus A Morphine AND Opiates Inuenza OR Parainuenza Inuenza NOT equine Gluc?se (glucose,glucase) Gluc*se (glucose, glucuronidase, etc.) DeniCon Linked terms must appear together Both terms must appear in the search result term Either or both terms must appear in the search result term Excludes terms with the word following the NOT. Cannot be used alone. SubsKtutes a single character in the string. Cannot be used as the rst character; cannot be used in phrases SubsKtute mulKple characters in the string. Cannot be used as the rst character; cannot be used in phrases

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Search Qualijiers

Detailed help available Includes Glucuronidase, Glucosidase, Glucosylceramidase, etc.

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Combining Search Terms

Exclude Glucosidase

Reduced number of terms

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Advanced Search Syntax based on Google-like search syntax


Parameter + - ( ) Fieldname: Fieldname:() ~ ~ {}, [] \ DescripCon Term must be included in search Term must be excluded from the search Group terms for subquery (i.e. A OR B; A AND B) Limit term search to the associated eld (e.g. Component: glucose) Group mulKple terms in a single eld Fuzzy search (e.g. Hemoilus~) Proximity search for mulKple terms (e.g. funcKon panel~1) Upper and lower bounds; {} exclusive, [] inclusive Special character escape

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Applying advanced search

83 terms 33 terms 32 terms 14 terms


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Limiting Searches

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Setting Search Limits


Narrows search to specic subset of LOINC terms Reduces number of candidate terms Limits can be applied to all components Component a_ribute can be further restricted by number of words Tree structure allows for hierarchical constraints

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General Search Constraints


Controls features including:

Limit to LOINC terms compaKble with submi_ed units Forced match with any specimen contained in name Method-less terms only Limit to components/analytes with N or fewer words in their name Pop up search Kming staKsKcs a\er each search (Note parallel control switches at bo_om of screen)

Use carefully or search may not be successful


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Setting Search Limits

Click Hierarchy & Search Limits Tab


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Setting search limits


Can also set most of them by toggling bu_ons at the bo_om of the screen

Toggle Buttons

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Search Constraints
Attribute trees

Limit to LOINC terms consistent with local units

Predejined, general search constraints Type toggle boxes

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Terms Consistent with Units

Only terms consistent with mmol/L appear

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Setting Search Limits

Specimen constraints

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Terms Consistent with Specimen

CSF

Enter default Specimen

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Terms Consistent with Specimen

Only CSF Terms are returned


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Setting Search Limits

Exclude laterality

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Exclude laterality

Laterality terms

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Setting Search Limits

Restrict to common orders

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Restriction to common orders

Common orders rank

Large number of candidates

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Setting Search Limits

Methodless Terms Restriction

Override Methodless Terms Restriction

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Limit to Methodless Terms

Both method and method-less terms


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Limit to Methodless Terms

Only Methodless Terms Appear


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More on Methodless Terms


Some LOINC categories do not have methodless terms Checking methodless only will remove these from view on results grid Checking addiKonal box allows these to be seen

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Methodless Only Unchecked

All terms returned

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Methodless Only Checked


Only Methodless terms returned

Differ in one or more components

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Conditional Methodless
More terms returned

No method-less term; all shown

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Setting Search Limits

Limit Number of Words in the Component Attribute

2012 Regenstrief Institute and James Case

Limit Number of Component Words

Without Limit Applied: 855 terms returned

2012 Regenstrief Institute and James Case

Limit Number of Component Words


Restriction appears on Toggle Bar (cannot toggle off) Component limited to 1 word With Limit Applied: 68 terms returned

2012 Regenstrief Institute and James Case

Setting Search Limits

Include Trial, Deprecated or Discouraged LOINC Codes with Returned Terms


2012 Regenstrief Institute and James Case

Include Deprecated LOINC Terms


-You cannot map to deprecated LOINC terms - The map button is grayed out if one of these terms is selected

Discouraged LOINC Terms appear as an inverted triangle Deprecated LOINC Terms appear as Strikethrough Text with a Do Not Symbol 2012 Regenstrief Institute and James Case

Favor Property Restriction

Favor one type of property over others All other components being equal MCnc only will be displayed

2012 Regenstrief Institute and James Case

Order/Observation Restriction

Order or Observation preference

2012 Regenstrief Institute and James Case

LOINC Hierarchies Class Tree

Three top-level branches Tree Navigation Buttons

2012 Regenstrief Institute and James Case

Before Class Restriction


Many terms have class of CHAL

Large number of candidate terms


2012 Regenstrief Institute and James Case

Search Trees

Restrict eligible tests to non-challenge chemistry tests only

2012 Regenstrief Institute and James Case

Following Class Restriction

Only Non-Challenge Chemistry tests returned

2012 Regenstrief Institute and James Case

System Hierarchy

2012 Regenstrief Institute and James Case

Component Hierarchy
Click on details for more information about the selection

Show the LOINC Codes associated with these components

2012 Regenstrief Institute and James Case

Details Screen LOINC Part

2012 Regenstrief Institute and James Case

Show Associated LOINCs

2012 Regenstrief Institute and James Case

LOINC Term Details Screen

Detailed Information on LOINC Parts

2012 Regenstrief Institute and James Case

Tree Export Tools


Export according to Conjiguration

Conjigure Export Format

2012 Regenstrief Institute and James Case

Tree Export Conjiguration

2012 Regenstrief Institute and James Case

RELMA - Tree Features


All trees operate the same way Shows terms spelled out Can expand and collapse parts or all of tree. Tree is string searchable Search can be based on one or more branches of a tree with or without other criteria Use Clear Most Limits bu_on on Mapping Screen to remove all tree selecKons

2012 Regenstrief Institute and James Case

LOINC Part Search


Same look as term search Uses Google-like query language

Extremely fast Include and exclude criteria ParKal string matching (using wildcards) Campylobacter fetus, not Ab

Demo

2012 Regenstrief Institute and James Case

LOINC Answer List Search

Nominal LOINC terms are now required to be submi_ed with answer lists. Finding answer lists and the use of them can be done with Answer List Search tab

2012 Regenstrief Institute and James Case

Answer List Search

Answer Lists associated with LOINC term

2012 Regenstrief Institute and James Case

Navigating through the Mapping Process

2012 Regenstrief Institute and James Case

LOINC Mapping Tactics


Limit eort to one lab secKon at a Kme and focus experKse Chemistry and hematology will be easiest For manufactured assays, use package insert as source informaKon Sample results give clue to property and scale Consider prioriKzing by frequency of use

2012 Regenstrief Institute and James Case

Vreeman DJ, Finnell JT, Overhage JM. A Rationale for Parsimonious Laboratory Term Mapping by Frequency. AMIA Annu Symp Proc. 2007;:771-775.
2012 Regenstrief Institute and James Case

More LOINC Mapping Tactics


Try using method-less terms rst

Specic methods can be transmi_ed in:

OBX17 (v2.x), ObservaKon.methodCode (v3.0)

Examine local units or real results to verify correct property and scale

ProperKes are rarely disKnguishable in test names Use the Unmapped funcKon to return where you le\ o

You dont have to do it all at one siPng

With every release - Update previous mappings to idenKfy deprecated terms


2012 Regenstrief Institute and James Case

Common Mapping Issues


Locally Dened Test Name Ambiguity

Reuse of local test code (Miscellaneous serology, PCR)

Analyte-free Local Test Names

Incongruent Value sets (Scale ambiguity) Result vs. InterpretaKon Available LOINC Terms too Specic/General Panel vs. Discrete Test

Common in Microbiology
2012 Regenstrief Institute and James Case

Using your Mapped Terms


Print results of LOINC Mapping Export to File

2012 Regenstrief Institute and James Case

Conjigure Export Format

Context Sensitive Export Conjiguration

2012 Regenstrief Institute and James Case

LMOF Export Conjiguration

Select Export Format

Select Fields to Export Save Conjiguration and Export

2012 Regenstrief Institute and James Case

Print Mapped Terms from View/Add/Edit Menu

May highlight terms to be printed

Click Print button to Preview output

2012 Regenstrief Institute and James Case

Formatted Report Output

Click Print button to output formatted report

2012 Regenstrief Institute and James Case

Excel Export

2012 Regenstrief Institute and James Case

Lab Auto Mapper


Run in batch mode to nd N- closest terms Can then use this output to do nal mapping Again units are VERY important Can pick all limits available to regular mapping

2012 Regenstrief Institute and James Case

Picking the Lab Auto Mapper

2012 Regenstrief Institute and James Case

Lab Auto Mapper Start Screen

Can restrict search to common tests

Maximum number of terms to return

2012 Regenstrief Institute and James Case

Lab Auto Mapper Start Screen

Local test code

Terms used for mapping


2012 Regenstrief Institute and James Case

Lab Auto Mapper - Mapping Screen

2012 Regenstrief Institute and James Case

Exporting Mapped Terms

Export Terms to Delimited File

2012 Regenstrief Institute and James Case

Export Terms Dialog


Select Term Set

Select Delimiter

Check Fields you wish to export


2012 Regenstrief Institute and James Case

Other RELMA

Features
2012 Regenstrief Institute and James Case

Panels, Forms and Survey Review


Review Panels, Forms and Surveys

Review Panels, Forms and Surveys

2012 Regenstrief Institute and James Case

Government Forms

Component LOINC terms

Form Name

2012 Regenstrief Institute and James Case

Laboratory Panels

Expand category to see panels

Double-click panel test to see components

2012 Regenstrief Institute and James Case

Expanded Panel Detail

2012 Regenstrief Institute and James Case

Expanded Clinical Panel

2012 Regenstrief Institute and James Case

Clinical Panels

35089-2, 35090-0

Find where a term has been used

2012 Regenstrief Institute and James Case

LOINC Term Panel Usage

2012 Regenstrief Institute and James Case

Other Survey Instruments

2012 Regenstrief Institute and James Case

HIPAA Attachments

View Various HIPAA Attachments

2012 Regenstrief Institute and James Case

HIPPA Attachment Tree

2012 Regenstrief Institute and James Case

Expanded Attachment Data

2012 Regenstrief Institute and James Case

Cant jind the term you want?

2012 Regenstrief Institute and James Case

Search Hints and Tips


Keywords with zero frequency are ignored

May need to rephrase use synonym Too many keywords in search uncheck some Limits applied that dont make sense

Some causes for no returned terms


E.g. Method-less tests plus Method tree set to EIA Local units not in RELMA

Did not nd and revise words not in RELMA

Units are GREAT discriminators You may have tests that need to be added to LOINC
2012 Regenstrief Institute and James Case

Proposing New LOINC Terms

2012 Regenstrief Institute and James Case

Proposing New Terms


Make sure the term is really needed

Think of other names for the same concept Avoid detailed methods or localizaKons Is the disKncKon really important? Package inserts, sample reports (email to Regenstrief) The more the be_er!
File>Propose a new LOINC

Supply sucient annotaKon to jusKfy the new term


Construct new terms within RELMA

Linked to the trees to allow browsing

Can review and submit them to LOINC from within RELMA


2012 Regenstrief Institute and James Case

Propose new LOINC terms

Select Propose a new LOINC

2012 Regenstrief Institute and James Case

Advanced/Simple toggle Required jields in red

Navigate through proposed terms

Create new term, save current term or Exit form

2012 Regenstrief Institute and James Case

Preview Proposed Terms

Review your new terms

2012 Regenstrief Institute and James Case

Review Proposed Terms


James T. Case DVM, PhD NIH/NLM 301-555-1314 301-555-1315 James.case@mail.nih.gov

X X X

Choose whether to send or postpone All proposed terms fully editable

2012 Regenstrief Institute and James Case

Submitting New Terms


Must supply name, organizaKon, phone and email of submi_er Must select at least one proposed term to send Congure export does not aect submission output Email resulKng le to Regenstrief

2012 Regenstrief Institute and James Case

Use Existing Terms as Template


Click the Propose Term button

Select your closest match

2012 Regenstrief Institute and James Case

Use Existing Terms as Template

All required components jilled in

2012 Regenstrief Institute and James Case

Using LOINC and SNOMED Together

2012 Regenstrief Institute and James Case

Where do LOINC and SNOMED Fit? Remember:


LOINC represents the quesKon:

Is there any Botulism toxin in my specimen? (33708-9) Organisms idenKed in specimen? (634-6) NegaKve (SCTID 260385009) E. coli O157:H7 (SCTID 103429008)

SNOMED represents the answer:


2012 Regenstrief Institute and James Case

Where do LOINC and SNOMED Fit?


In an HL7 message, LOINC may be used:

In OBR-4 (Universal Service IdenKer) In OBX-3 (ObservaKon IdenKer

SNOMED may be used:


In OBX-5 (where nominal values are needed) Almost anyplace else in an HL7 message where coded values are needed

2012 Regenstrief Institute and James Case

OBX: With a Coded Value


A code that identijies the data type in OBX-5 as a coded element The code is from LOINC The code is from SNOMED

OBX||CE|6609-2^Listeria ID^LN||36094007^L. monocytogenes^SCT

OBX-3:A code that


identijies the data in OBX-5 (Listeria culture)

OBX-5: Data A c for L. ode monocytogenes

2012 Regenstrief Institute and James Case

HL7 2.5 Example (ER-7 format)


MSH|^~\&| LABGL1|| DMCRES|| 199812300100|| ORU^ R01| LABGL1199510221838581| P| 2.3||| NE| NE PID||| 6910828^ Y^ C8|| Newman^ Alfred^ E|| 19720812| M|| W| 25 Centscheap Ave^^ First Order OBR Whatmeworry^ UT^ 85201^^ P||( 555) 777- 6666|( 444) 677- 7777|| M|| 773789090alue (Culture and ID) First Result V (SNOMED) OBR|| 110801^ LABGL| 387209373^ DMCRES|634-6^Bacteria XXX Aerobe Cult ^LN||| 199812292128||||||||Stool| IN2973^ Schadow^ Gunther^^^^ MD^ Second Order OBR UPIN|||||||||||||||| CA20837^ Spinosa^ John^^^^ MD^ UPIN (Susceptibility) OBX|| CE| 634-6^Bacteria XXX Aerobe Cult^ LN||50136005^Salmonella typhimurium ^SCT|||||| F||| 199812292128|| CA20837 OBR|| 110801^ LABGL| 387209373^ DMCRES| 29567-9^Bacterial Susceptibility First Result Description Second Result(s) First LN||| Panel^esult 199812300934||||||||Bacterial isolate| IN2973^ Schadow^ OBX (LOINC) (Culture and ID) OBXs Gunther^^^^ MD^ UPIN||||||||| Salmonella typhimurium ||||||| CA20837^ Spinosa^ John^^^^ MD^ UPIN OBX|| CE|23631-5^Trimethoprim/Sulfasoxazole^ LN||264841006^Intermediate ^SCT|||||| F||| 199812300934|| CA20837 OBX|| CE|18967-7^Penicillin^LN||30714006^Resistant^SCT|||||| F||| 199812300934|| CA20837 OBX|| CE|18928-2^Gentamicin^ LN||131196009^Susceptible^SCT|||||| F||| 199812300934|| CA20837

2012 Regenstrief Institute and James Case

Q and A Session

2012 Regenstrief Institute and James Case

Exercise Map your own data

2012 Regenstrief Institute and James Case