# Presentation: 490591

## LOINC(Logical Observation Identifier Names and Codes)

- Presentation to:** ****NCVHS**
**May 17, 1999**

- Stan Huff - coshuff@ihc.com

**Stanley M. Huff, M.D.**
- Intermountain Health Care (co-development partner with 3M HIS)
- Senior Medical Informaticist (Data Dictionary and Interfaces)
- University of Utah
- Associate Professor (Clinical) - Medical Informatics
- LOINC
- Co-chair, Clinical LOINC
- HL7
- Chair-elect, HL7 Board
- Co-chair, Vocabulary Committee
- SNOMED Editorial Board
- Advisor

- © 1999, Health Level Seven, Inc.

- 3/18/1999

## LOINC Facts

**Initiated by Clem McDonald in 1995**
**Contains 20,000+ names and codes**
**Free for Use (Copyright Regenstrief Institute)**
**FTP:**
**ftp://www.mcis.duke.edu/standards/termcode/**
**WWW:**
**http://www.mcis.duke.edu/standards/termcode/loinc.htm**
**Readme - LOINRDME.TXT**
**LOINC Manual, Database files, Text files**
**RELMA - LOINC matching application**
**Copy of LOINC slides: coshuff@ihc.com**

- © 1999, Health Level Seven, Inc.

- 3/18/1999

## What are we trying to do?

- Communication of clinical data between independent computer systems
- _Intra_-enterprise data sharing
- reduce redundant data entry
- better clinical care
- _Inter_-enterprise data sharing
- public health reporting
- clinical studies
- outcomes
- clinical trials
- patient administration
- enrollment, claims, payments

- © 1999, Health Level Seven, Inc.

- 3/18/1999

## Why interface standards?

- Decrease the cost of interfaces
- implementation time
- implementation cost (resources)
- Enable component architecture
- greater choice and flexibility
_*Approach*_ “plug-and-play”
-  we may not get all the way there for a while

- © 1999, Health Level Seven, Inc.

- 3/18/1999

## HL7 Messaging Paradigm

**System**
**A**

**System**
**B**

- © 1999, Health Level Seven, Inc.

- 3/18/1999

## ORU: The usual HL7 result message

**                                  ****Element Loop**

**                                  ****Answer Part Loop**

- © 1999, Health Level Seven, Inc.

- 3/18/1999

## OBX: the flexible segment

**                                  ****A code that identifies the data in OBX-5****(Temp Reading)**

**OBX||NM|11289-6^^LN||38|C^^ISO+|||||F**

**Other data fields include: date of observation, identity of provider giving observation, normal ranges, abnormal flags**

- © 1999, Health Level Seven, Inc.

- 3/18/1999

## Site 1:
OBX|1|CE|ABO^ABO GROUP||O^Type O|
Site 2:
OBX|1|CE|BLDTYP^ABO GROUP||TYPEO^Type O|
Site 3:
OBX|1|CE|ABOTYPE^ABO GROUP||OPOS^Type O|

- Site 1:
**OBX|1|CE|****ABO****^****ABO GROUP****||****O****^****Type O****|**
- Site 2:
**OBX|1|CE|****BLDTYP****^****ABO GROUP****||****TYPEO****^****Type O****|**
- Site 3:
**OBX|1|CE|****ABOTYPE****^****ABO GROUP****||****OPOS****^****Type O****|**

- The problem

- You and I may know that these are similar results, but our computers will not.

- © 1999, Health Level Seven, Inc.

- 3/18/1999

## The goal of the LOINC committee

- Use LOINC as a universal coding system for clinical observations.

- Site 1:
**OBX|1|CE|****883-9****^****ABO GROUP****||****F-D1250****^****Group O****|**
- Site 2:
**OBX|1|CE|****883-9****^****ABO GROUP****||****F-D1250****^****Group O****|**
- Site 3:
**OBX|1|CE|****883-9****^****ABO GROUP****||****F-D1250****^****Group O****|**

- © 1999, Health Level Seven, Inc.

- 3/18/1999

## OBX: with a coded value

**OBX||CE|883-9^****Blood Group****^LN||F-D1250^****Group O****^SMI|**

- © 1999, Health Level Seven, Inc.

- 3/18/1999

## OBX Using Standard Codes

**SNOMED International **
**(Systematized Nomenclature of Medicine)**

**F-D1111**** ****Blood group A**
**F-D1201**** ****Blood group B**
**F-D1250**** ****Blood group O**
**F-D1281**** ****Blood group AB**

**LOINC 1.0L**

**883-9**** ****ABO GROUP:TYPE:PT:BLD^PATIENT:NOM**

- © 1999, Health Level Seven, Inc.

- 3/18/1999

## Blood Types

_**Interface A (atomic)**_
**OBX|1|CE|****883-9****^****ABO****^LN|1****|F-D1250****^****O****^SNI|**
**OBX|1|CE|****14906-2****^****RH****^LN|1|****G-A200****^****Positive****^SNI|**

- Vocabulary and structure must be coordinated to achieve an integrated whole.

_**Interface B (molecular)**_
**OBX|1|CE|****882-1****^****ABO+RH****^LN|1|****???****^****O Positive****^SNI|**

- © 1999, Health Level Seven, Inc.

- 3/18/1999

## Federal Initiatives Involving LOINC

- Proposal for use in Claims Attachments (HIPAA)
- DEEDS Database (Dan Pollock, CDC)
- Electronic Laboratory Reporting (CDC)
- Proposal for Cancer Registries (NAACCR, CDC)
- Included as part of UMLS Metathesaurus

- © 1999, Health Level Seven, Inc.

- 3/18/1999

## What should the government do?

- Use HL7 standards for clinical data that is sent to government agencies (others will follow)
- standardization of communication
- Select and support “free for use” medical terminologies with public money via contracts with existing terminology providers
- could be a public-private partnership
- use good maintenance tools and technology
- Manage contracts and make the terminologies available through a publicly funded support/service center
- NLM
- UMLS Metathesaurus

- © 1999, Health Level Seven, Inc.

- 3/18/1999

## Which terminologies

- Make the most cost effective choices
- Don’t study it to death
- My picks
**Observation Identifiers (LOINC)**
**Clinical Findings (SNOMED/Read, Medcin?, others?)**
**Drugs**
**Clinical Drugs in UMLS Metathesaurus**
**NDC codes (assuming improvements in maintenance)**
**Classifications (as needed)**
**Diagnosis: ICD-9CM, ICD-10CM**
**Billing: CPT?**

- © 1999, Health Level Seven, Inc.

- 3/18/1999

## LOINC codes are created systematically using a six axis model

**<component> : <property> :**
**<timing> : <system> :**
**<scale> : ****<method>**

- General Form of LOINC Names

- © 1999, Health Level Seven, Inc.

- 3/18/1999

## Laboratory LOINC Subject Areas

**Chemistry**
**Urinalysis**
**Toxicology**
**Hematology**
**Microbiology**
**Antibiotic Susceptibilties**
**Immunology/Serology**
**Genetic testing**

- © 1999, Health Level Seven, Inc.

- 3/18/1999

## Clinical LOINC Subject Areas

**Vital Signs**
**Hemodynamics**
**Fluid Intake/Output**
**Body Measurements**
**Operative Notes**
**Emergency Department**
**Respiratory Therapy**

**EKG (ECG)**
**Cardiac Ultrasound**
**Obstetrical Ultrasound**
**Discharge Summary**
**History & Physical**
**Pathology Findings**
**Colonoscopy/Endoscopy**

- © 1999, Health Level Seven, Inc.

- 3/18/1999

## Organizations

- 3M, ARUP Laboratories, California Veterinary Diagnostic Labs, Cerner Corporation, Columbia Presbyterian Medical Ctr, Dallas ISC, Dept of Veterans Affairs, Denver VA Medical Ctr, Duke Medical Ctr, Hewlett Packard, Hospital for Sick Children, Toronto, Indiana University Hospital, Intermountain Health Care, Laboratory Corporation of America, LifeChem Laboratory Services, Maryland Dept of Health & Mental Hygiene, Mayo Medical Laboratories, National Center for Injury Prevention and Control, Quest Diagnostics Incorporated, Quintiles, Regenstrief Institute for Health Care, Reparto Informatica Medica, Roudebush VA Medical Ctr, SmithKline Beecham Clinical Laboratories, SpaceLabs Medical, Inc, Univ of California Veterinary Medicine, University Hospital, Indianapolis, IN, University Hospital, Linkoping Sweden, University of Missouri Hospital and Clinics, University of Utah, University of Washington, World Health Organization

- © 1999, Health Level Seven, Inc.

- 3/18/1999

## Laboratory LOINC Committee

**Ray Aller, John Baenziger, Pamela D. Banning, Jim Bristol, Tom Burgess, Jim Case, Linda Charles, Jim Cimino , Diane Dwyer, Arden Forrey, Andy Gajda, Norbert Goldfield, Brian Griffin, Ed Hazell, Gil Hill, Stan Huff, Kathy Hutchins, Kathy Kammerer, Dennis Leavelle, Diane Leland, Pat Maloney, Doug Martin, Clem McDonald, Bill Meilahn, Karen Sieber, Frank Stalling, John Stelling, Bill Thurston, Dan Yokota**

- © 1999, Health Level Seven, Inc.

- 3/18/1999

## Clinical LOINC Committee

**James Barthel , Dean Bidgood, Bruce Bray, Bill Francis, Alan Golichowski, Brian Griffin, Karl Hammermeister, Stan Huff, Kathy Hutchins, Doug Martin, Clem McDonald, Dan Pollock, Angelo Rossi Mori, Karen Sieber, Blaine Takesue, Anders Thurin, Wayne Tracy**

- © 1999, Health Level Seven, Inc.

- 3/18/1999

## Future

- Inclusion in SNOMED (in progress)
- Addition of Orderables (in progress)
- Expand Clinical Content
- Create Short names
- Physical Exam Findings

- Current and Future Activities

- © 1999, Health Level Seven, Inc.

- 3/18/1999

## Literature References

**Huff SM, Rocha RA, McDonald CJ, De Moor GJE, etal.  Development of the LOINC (Logical Observation Identifier Names and Codes) Vocabulary.  **_**Journal of American Medical Informatics Association**_**, 1998, 5:276-292.**
**Dolin RH, Huff SM, Rocha RA, Spackman KA, Campbell, KE.  Evaluation of a “Lexically Assign, Logically Refine”Strategy for Semi-Automated Integration of Overlapping Terminologies.  **_**Journal of American Medical Informatics Association**_**, 1998, 5****:****203-213.**
**Rocha RA, Huff SM.  Coupling Vocabularies and Data Structures:  Lessons from LOINC.  **_**Journal of American Medical Informatics Association, AMIA Annual Fall Symposium Supplement**_**, 1996, 90-4.**
**Forrey AW,  McDonald CJ, DeMoor G, Huff SM , Leavelle D, Leland Fiers DT, Charles L, Griffin B, Stalling F, Tullis A, Hutchins K, Baenziger J.  *****Logical Observation Identifier Names and Codes (LOINC) Database: A public use set of codes and names for electronic reporting of clinical laboratory test results*****.  **_**Clinical Chemistry**_**, 1995.**

- © 1999, Health Level Seven, Inc.

- 3/18/1999