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Daniel J. Vreeman, PT, DPT, MScAssistant Research Professor
, Indiana University School of Medicine
Associate Director for Terminology Services
, Regenstrief Institute, Inc
2013
Daniel J. Vreeman, PT, DPT, MScAssistant Research Professor
, Indiana University School of Medicine
Research Scientist
, Regenstrief Institute, Inc
2013loinc@loinc.org2013.12.05
Laboratory LOINC Workshop - Indianapolis, IN
Introduction and Overview
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Origins of LOINCThe lingua franca of clinical observation exchange
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photo via noshaMcDonald et al. Canopy Computing: using the Web in Clinical Practice.JAMA
. 1998;280(15):1325-1329.
http://www.flickr.com/photos/nosha/8/13/2019 2013 12 05 - LOINC Introduction - Brief
7/203photo via noshaMcDonald et al. Canopy Computing: using the Web in Clinical Practice.JAMA. 1998;280(15):1325-1329.
The rain forest canopy is aseamless web through which
arboreal creatures efficientlymove to reach the edible
fruits without any attentionto the individual trees.
http://www.flickr.com/photos/nosha/8/13/2019 2013 12 05 - LOINC Introduction - Brief
8/203photo via beckstei
http://www.flickr.com/photos/beckstei/6269438822/sizes/o/in/photostream/8/13/2019 2013 12 05 - LOINC Introduction - Brief
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Arboreal Informatics Pioneers
40 years of EMR work
Indiana Network for Patient Care
Regenstrief
the Data Switzerland
Nations most comprehensive and longest tenured HIE
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More than Meets the Eye
photo via chadlewis
http://www.flickr.com/photos/chadlewis8/13/2019 2013 12 05 - LOINC Introduction - Brief
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Fundamental challenge:Local systems have different ways of
identifying the same concept.
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Only way to corral the
infinite indiosyncracies iswith standards
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A vocabulary standard
would serve as theRosetta Stone.
photo via Hans Hillewaert / CC-BY-SA-3.0
http://creativecommons.org/licenses/by-sa/3.0/8/13/2019 2013 12 05 - LOINC Introduction - Brief
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Logical
ObservationIdentifiers
Names and
CodesA universal code system that facilitates exchange,
pooling, and processing of results
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Established in 1994 byRegenstrief Institute.
Vocabulary standard forobservation identifiers.
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Similar name, different meaning
photo via Caption Time
i il di i
http://captiontime.tumblr.com/8/13/2019 2013 12 05 - LOINC Introduction - Brief
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Similar name, different meaning
meerkat meerkat mere cat meerkat
photo via Caption Time
http://captiontime.tumblr.com/8/13/2019 2013 12 05 - LOINC Introduction - Brief
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MEASUREMENTSUS
R
photo via puuikibeach
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If an observation is a question and
the observation value is
an answerLOINC provides codes for questionsWhere needed, other vocabulariesprovide codes for answers
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What is my patientshemoglobin level?718-7:Hemoglobin:MCnc:Pt:Bld:Qn
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How fast does my patientusually walk?
41959-8:Walking speed:Vel:1W^mean:^Patient:Qn:Calculated
photo via Ed Yourdon
http://www.flickr.com/photos/yourdon/8/13/2019 2013 12 05 - LOINC Introduction - Brief
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Indiana Network for Patient Care
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Indiana Network for Patient Care
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I di N k f P i C
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MSH|^~\&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay|||||||||||||||PID|||$patientId$||$patientName$||||||||||||||||||||PV1|||||||$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|
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MSH|^~\&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay|||||||||||||||PID|||$patientId$||$patientName$||||||||||||||||||||PV1|||||||$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|
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MSH|^~\&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay|||||||||||||||PID|||$patientId$||$patientName$||||||||||||||||||||PV1|||||||$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|
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MSH|^~\&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay|||||||||||||||PID|||$patientId$||$patientName$||||||||||||||||||||PV1|||||||$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|
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MSH|^~\&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay|||||||||||||||PID|||$patientId$||$patientName$||||||||||||||||||||PV1|||||||$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|
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MSH|^~\&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay|||||||||||||||PID|||$patientId$||$patientName$||||||||||||||||||||PV1|||||||$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|
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MSH|^~\&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay|||||||||||||||PID|||$patientId$||$patientName$||||||||||||||||||||PV1|||||||$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|
LocalCode^LocalName^CodeSystem^LOINCcode^LOINCname^CodeSystem
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MSH|^~\&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay|||||||||||||||PID|||$patientId$||$patientName$||||||||||||||||||||PV1|||||||$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|
LocalCode^LocalName^CodeSystem^LOINCcode^LOINCname^CodeSystem
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MSH|^~\&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay|||||||||||||||PID|||$patientId$||$patientName$||||||||||||||||||||PV1|||||||$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|
LocalCode^LocalName^CodeSystem^LOINCcode^LOINCname^CodeSystem
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MSH|^~\&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay|||||||||||||||PID|||$patientId$||$patientName$||||||||||||||||||||PV1|||||||$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|
LocalCode^LocalName^CodeSystem^LOINCcode^LOINCname^CodeSystem
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MSH|^~\&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay|||||||||||||||PID|||$patientId$||$patientName$||||||||||||||||||||PV1|||||||$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|
LocalCode^LocalName^CodeSystem^LOINCcode^LOINCname^CodeSystem
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OBX||CE|57131-5^Newborn conditions with pos markers^LN||7573000^PKU^SCT
Result with a Coded Value
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OBX||CE|57131-5^Newborn conditions with pos markers^LN||7573000^PKU^SCT
Result with a Coded Value
Data type of result
(OBX-5) is a coded
element
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OBX||CE|57131-5^Newborn conditions with pos markers^LN||7573000^PKU^SCT
Result with a Coded Value
Data type of result
(OBX-5) is a coded
element
This code is
from LOINC
Code identifying this
observation
(what are these results?
Conditions identified by
newborn screening )
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OBX||CE|57131-5^Newborn conditions with pos markers^LN||7573000^PKU^SCT
Result with a Coded Value
Data type of result
(OBX-5) is a coded
element
This code is
from LOINC
Code identifying this
observation
(what are these results?
Conditions identified by
newborn screening )
This code is from
SNOMED
Code identifying the result
(Phenylketonuria )
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photo via eye of einstein
A brief aside aboutterminology
http://www.flickr.com/photos/35188692@N00/466404658/sizes/o/in/photostream/http://www.flickr.com/photos/35188692@N00/466404658/sizes/o/in/photostream/8/13/2019 2013 12 05 - LOINC Introduction - Brief
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LOINC Terminology
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LOINC Terminology
LOINC (noun)
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LOINC Terminology
LOINC (noun)To LOINC, LOINCing, LOINCed (verb)
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LOINC Terminology
LOINC (noun)To LOINC, LOINCing, LOINCed (verb)
[Chief, Head, etc] LOINCer, LOINCologist (noun)
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LOINC Terminology
LOINC (noun)To LOINC, LOINCing, LOINCed (verb)
[Chief, Head, etc] LOINCer, LOINCologist (noun)
LOINCification (noun)
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LOINC Terminology
LOINC (noun)To LOINC, LOINCing, LOINCed (verb)
[Chief, Head, etc] LOINCer, LOINCologist (noun)
LOINCification (noun)
SNOMED Terminology
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LOINC Terminology
LOINC (noun)To LOINC, LOINCing, LOINCed (verb)
[Chief, Head, etc] LOINCer, LOINCologist (noun)
LOINCification (noun)
SNOMED Terminology
SNOMED (noun)
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LOINC Terminology
LOINC (noun)To LOINC, LOINCing, LOINCed (verb)
[Chief, Head, etc] LOINCer, LOINCologist (noun)
LOINCification (noun)
SNOMED Terminology
SNOMED (noun)
SNOMEDicated???
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LOINC Terminology
LOINC (noun)To LOINC, LOINCing, LOINCed (verb)
[Chief, Head, etc] LOINCer, LOINCologist (noun)
LOINCification (noun)
SNOMED Terminology
SNOMED (noun)
SNOMEDicated???
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photo via Ludovic Hirlimann
Different standards for differentparts of the elephant.
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We now return to your
regularly scheduledprogram
photo via x-ray delta one
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Laboratory LOINC
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Clinical LOINC
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Laboratory LOINC Committee Chair:
Clem McDonald, MD
Clinical LOINC Committee Chair:
Stan Huff, MD
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LOINC CollectionsPanels, forms, surveys, and other patientassessments
photo via LuzA
Standardized Assessments and Collections
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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.
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The LOINC ApproachOpen. Nimble. Pragmatic.
Open Development
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Open Development
Worldwide distribution at no cost
New terms from end-users
Welcome all comersCommittees are volunteers
Open Development
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Open Development
Worldwide distribution at no cost
New terms from end-users
Welcome all comersCommittees are volunteers
Open Development
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Open Development
Worldwide distribution at no cost
New terms from end-users
Welcome all comersCommittees are volunteers
Its free, but invaluable
R i f I i
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Regenstrief Institute
Steward
Developer of content
Developer of tools
Developer of community
DistributorVoice
F di S
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Funding Support
Main current sources are:U.S. National Library of Medicine
Regenstrief Foundation
Prior support from
Several other U.S. federal agencies,John A. Hartford Foundation
LOINC Codes Over Time by Release
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12345678
4/24
/199
5|1
.0
5/24/
1995
|1.0
a
6/23/
1995
|1.0b
6/28/
1995
|1.0
c
7/14/
1995
|1.0
d
9/15/
1995
|1.0
e
12/2
1/19
95|1
.0f
4/28/
1996
|1.0
g
8/29/
1996
|1.0h(
2)
12/3/
1996
|1.0h(
3)
1/8/
1999
7|1
.0i
10/9/1
997
|1.0j-a
5/1/
1998
|1.0k
2/12
/199
9|1
.0l
7/23/
1999
|1.0
m
8/6/1
999
|1.0
ma
2/4/
2000
|1.0
n
6/13/
2000
|1.0
0
1/1/
2001
|2.0
0
1/31/
2001
|2.0
1
7/1/
2001
|2.0
3
1/1/
2002
|2.0
4
2/1/
2002
|2.0
5
2/19/
2002
|2.0
6
8/1/
2002
|2.07
9/1/
2002
|2.0
8
5/1/
2003
|2.0
9
10/1/
2003
|2.1
0
1/1/
2004
|2.1
1
2/1/
2004
|2.1
2
12/1/
2004
|2.1
3
12/1/
2004
|2.1
4
6/1/
2005
|2.1
5
12/1/
2005
|2.1
6
6/1/
2006
|2.17
12/21
/200
6|2.
19
6/21
/200
7|2.
21
12/03
/200
7|2.
22
7/10
/200
8|2.
24
1/10
/200
9|2.
26
07/06
/200
9|2.
27
12/30
/200
9|2.
29
2/26
/201
0|2.
30
6/15
/201
0|2.
32
12/29
/201
0|2.
34
06/30
/201
1|2.
36
12/30
/201
1|2.
38
6/30
/201
2|2.
40
12/30
/201
2|2.
42
06/29
/201
3|2.
44
LOINC Codes
Only Lab LOINC Codes
y
laboratory terms only
LOINC Codes Over Time by Release
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12345678
4/24
/199
5|1
.0
5/24/
1995
|1.0
a
6/23/
1995
|1.0b
6/28/
1995
|1.0
c
7/14/
1995
|1.0
d
9/15/
1995
|1.0
e
12/2
1/19
95|1
.0f
4/28/
1996
|1.0
g
8/29/
1996
|1.0h(
2)
12/3/
1996
|1.0h(
3)
1/8/
1999
7|1
.0i
10/9/1
997
|1.0j-a
5/1/
1998
|1.0k
2/12
/199
9|1
.0l
7/23/
1999
|1.0
m
8/6/1
999
|1.0
ma
2/4/
2000
|1.0
n
6/13/
2000
|1.0
0
1/1/
2001
|2.0
0
1/31/
2001
|2.0
1
7/1/
2001
|2.0
3
1/1/
2002
|2.0
4
2/1/
2002
|2.0
5
2/19/
2002
|2.0
6
8/1/
2002
|2.07
9/1/
2002
|2.0
8
5/1/
2003
|2.0
9
10/1/
2003
|2.1
0
1/1/
2004
|2.1
1
2/1/
2004
|2.1
2
12/1/
2004
|2.1
3
12/1/
2004
|2.1
4
6/1/
2005
|2.1
5
12/1/
2005
|2.1
6
6/1/
2006
|2.17
12/21
/200
6|2.
19
6/21
/200
7|2.
21
12/03
/200
7|2.
22
7/10
/200
8|2.
24
1/10
/200
9|2.
26
07/06
/200
9|2.
27
12/30
/200
9|2.
29
2/26
/201
0|2.
30
6/15
/201
0|2.
32
12/29
/201
0|2.
34
06/30
/201
1|2.
36
12/30
/201
1|2.
38
6/30
/201
2|2.
40
12/30
/201
2|2.
42
06/29
/201
3|2.
44
LOINC Codes
Only Lab LOINC Codes
y
Slope = 600
laboratory terms only
LOINC Codes Over Time by Release
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12345678
4/24
/199
5|1
.0
5/2
4/19
95|1
.0a
6/23/
1995
|1.0b
6/28/
1995
|1.0
c
7/14/
1995
|1.0
d
9/1
5/19
95|1
.0e
12/2
1/19
95|1
.0f
4/2
8/19
96|1
.0g
8/29/
1996
|1.0h(
2)
12/3/
1996
|1.0h(
3)
1/8/
1999
7|1
.0i
10/9/1
997
|1.0j-a
5/1
/199
8|1
.0k
2/12
/199
9|1
.0l
7/23/
1999
|1.0
m
8/6/1
999
|1.0
ma
2/4/
2000
|1.0
n
6/13/
2000
|1.0
0
1/1/
2001
|2.0
0
1/31/
2001
|2.0
1
7/1/
2001
|2.0
3
1/1/
2002
|2.0
4
2/1/
2002
|2.0
5
2/19/
2002
|2.0
6
8/1/
2002
|2.07
9/1/
2002
|2.0
8
5/1/
2003
|2.0
9
10/1/
2003
|2.1
0
1/1/
2004
|2.1
1
2/1/
2004
|2.1
2
12/1/
2004
|2.1
3
12/1/
2004
|2.1
4
6/1/
2005
|2.1
5
12/1/
2005
|2.1
6
6/1/
2006
|2.17
12/21
/200
6|2.
19
6/21
/200
7|2.
21
12/03
/200
7|2.
22
7/10
/200
8|2.
24
1/10
/200
9|2.
26
07/06
/200
9|2.
27
12/30
/200
9|2.
29
2/26
/201
0|2.
30
6/15
/201
0|2.
32
12/29
/201
0|2.
34
06/30
/201
1|2.
36
12/30
/201
1|2.
38
6/30
/201
2|2.
40
12/30
/201
2|2.
42
06/29
/201
3|2.
44
LOINC Codes
Only Lab LOINC Codes
y
Slope = 600
Slope = 2200
laboratory terms only
LOINC Codes Over Time by Release
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12345678
4/24
/199
5|1
.0
5/2
4/19
95|1
.0a
6/23/
1995
|1.0b
6/2
8/19
95|1
.0c
7/14/
1995
|1.0
d
9/1
5/19
95|1
.0e
12/2
1/19
95|1
.0f
4/2
8/19
96|1
.0g
8/29/
1996
|1.0h(
2)
12/3/
1996
|1.0h(
3)
1/8/
1999
7|1
.0i
10/9
/199
7|1
.0j-a
5/1
/199
8|1
.0k
2/12
/199
9|1
.0l
7/23/
1999
|1.0
m
8/6/1
999
|1.0
ma
2/4/
2000
|1.0
n
6/13/
2000
|1.0
0
1/1/
2001
|2.0
0
1/31/
2001
|2.0
1
7/1/
2001
|2.0
3
1/1/
2002
|2.0
4
2/1/
2002
|2.0
5
2/19/
2002
|2.0
6
8/1/
2002
|2.07
9/1/
2002
|2.0
8
5/1/
2003
|2.0
9
10/1/
2003
|2.1
0
1/1/
2004
|2.1
1
2/1/
2004
|2.1
2
12/1/
2004
|2.1
3
12/1/
2004
|2.1
4
6/1/
2005
|2.1
5
12/1/
2005
|2.1
6
6/1/
2006
|2.17
12/21
/200
6|2.
19
6/21
/200
7|2.
21
12/03
/200
7|2.
22
7/10
/200
8|2.
24
1/10
/200
9|2.
26
07/06
/200
9|2.
27
12/30
/200
9|2.
29
2/26
/201
0|2.
30
6/15
/201
0|2.
32
12/29
/201
0|2.
34
06/30
/201
1|2.
36
12/30
/201
1|2.
38
6/30
/201
2|2.
40
12/30
/201
2|2.
42
06/29
/201
3|2.
44
LOINC Codes
Only Lab LOINC Codes
y
Slope = 600
Slope = 2200
laboratory terms onlynot a lab cliff, just no data available
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Lots CookingAlways more lab testsGenetic reporting
Lots of survey instruments, forms, and assessments
More radiology reportsStructured document titles
photo via liber
http://www.flickr.com/photos/liber8/13/2019 2013 12 05 - LOINC Introduction - Brief
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27,500+ users in 158 countries
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27,500 users in 158 countries
loinc.org members
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0
5,000
10,000
15,000
20,000
25,000
6/1/08
12/1/08
6/1/09
12/1/09
6/1/10
12/1/10
6/1/11
12/1/11
6/1/12
12/1/12
6/1/13
g
loinc.org members
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0
5,000
10,000
15,000
20,000
25,000
6/1/08
12/1/08
6/1/09
12/1/09
6/1/10
12/1/10
6/1/11
12/1/11
6/1/12
12/1/12
6/1/13
g
22 new members per day667 new members per month
loinc.org members
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0
5,000
10,000
15,000
20,000
25,000
6/1/08
12/1/08
6/1/09
12/1/09
6/1/10
12/1/10
6/1/11
12/1/11
6/1/12
12/1/12
6/1/13
g
22 new members per day667 new members per month
Doubled in 19 months!
loinc.org members
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0
5,000
10,000
15,000
20,000
25,000
6/1/08
12/1/08
6/1/09
12/1/09
6/1/10
12/1/10
6/1/11
12/1/11
6/1/12
12/1/12
6/1/13
22 new members per day667 new members per month
Ave growth/mo:
2009 = 2762010 = 307
2011 = 3792012 = 500
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Tools forImplementers
photo via Robert S Donovan
loinc.org/downloads
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loinc.org/downloads
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downloads: ~1500/month
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loinc.org/get-started
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search.loinc.org
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g
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Alternate Language Search
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Alternate Language Search
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Everything in Italian!
loinc.org/mailing-lists
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N ! N l tloinc.org/mailing-lists
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No spam! News + release notices
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@LOINC
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N t dditi
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Li t y i ti F !
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List your organization. Free!
forum.loinc.org
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loinc.org/usage
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loinc.org/usage
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loinc.org/collaboration
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loinc.org/terms-of-use
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photo via 917press
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Just kidding.
Copyright is agoodthing for
standards.Its the licensing part that isinteresting.
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No cost
Worldwide
In perpetuity
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Use
Copy
Distribute
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Any purpose:
commercial
non-commercialphoto via Refracted Moments
http://www.flickr.com/photos/refractedmoments/8/13/2019 2013 12 05 - LOINC Introduction - Brief
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CANNOTuse anyLicensed Material to
develop or promulgate adifferent standard for
orders or observations.
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That would defeat
the purpose of
having a standard!
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International Adoptionparticipation, translation, implementation
LOINC Submitters
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Si 2009 150 i ti LOINC Translators
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22 organizations.
Currently translations into 17 variants of 11 languages
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Vreeman DJ, Chiaravalloti MT, Hook J, McDonald CJ. Enabling international adoption of LOINC through translation. J Biomed Inform.2012 Aug;45(4):667-73. PMID: 22285984.
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Vreeman DJ, Chiaravalloti MT, Hook J, McDonald CJ. Enabling international adoption of LOINC through translation. J Biomed Inform.2012 Aug;45(4):667-73. PMID: 22285984.
1st I t ti l
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Vreeman DJ, Chiaravalloti MT, Hook J, McDonald CJ. Enabling international adoption of LOINC through translation. J Biomed Inform.2012 Aug;45(4):667-73. PMID: 22285984.
1stInternationalLOINC PhD student
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Adopted as National Standard
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p
Australia
Austria
Belgium
Brazil
Canada
Cyprus
Estonia
Finland
France
Germany
Iceland
India
Mexico
Mongolia
The Netherlands
New Zealand
Philippines
Portugal
Rwanda
Slovakia
Slovenia
Spain
Thailand
Turkey
United States
Large Implementations
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g p
SIGA Sade project7+ Provincial systems in Canada
8+ Regional Health Information Exchanges in Spain
ePSOS
Assistance publique - Hpitaux de Paris
Hong Kong Hospital Authority
Philippine Health Insurance Corporation
InFSE Project in 5 regions in Italy (LOINC Italia)
Many more...
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h l f h h
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For the last few years, the AP-HP has
been using the LOINC internationalnomenclature
Thanks to this catalogue, the AP-HP isable to use the nomenclature in itstreatment processes, whenever
biology analyses and test results arerequested.
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Vandenbussche PY, Cormont S, Andr C, et al. Implementation and management of a biomedical observation dictionary in a large healthcare information system.
J Am Med Inform Assoc. 2013 May 1. PMID: 23635601.
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Vandenbussche PY, Cormont S, Andr C, et al. Implementation and management of a biomedical observation dictionary in a large healthcare information system.
J Am Med Inform Assoc. 2013 May 1. PMID: 23635601.
The results of our workvalidate the choice made to
develop a local dictionaryaligned with LOINC.
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Vandenbussche PY, Cormont S, Andr C, et al. Implementation and management of a biomedical observation dictionary in a large healthcare information system.
J Am Med Inform Assoc. 2013 May 1. PMID: 23635601.
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Members of the Korean National StandardsCommittee have enthusiastically embraced LOINC
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Some serious LOINCing in Hong Kong
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S t i LOINCi
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Talking about LOINC at the Thai Ministry of
I f ti d C i ti T h l y
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D C l di LOINCi i Cy
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US AdoptionA few key highlights
Some Key US Adoptions
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All the big labsAll health-related federal agencies
Lots of care organizations
HIEs
Insurance companies
EHR vendorsInstrument manufacturers (nascent)
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In USA, major driver ofeHealth standards adoption is
EHR Incentive Programa.k.a. Meaningful Use
Blumenthal D, Tavenner M. The "meaningful use" regulation for electronic health records. N Engl J Med. 2010 Aug 5;363(6) :501-4. Epub 2010 Jul 13. PubMed PMID: 20647183.
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Stage 12011-2012
Data capture
and sharing
Stage 22014
Advance clinical
processes
Stage 32016
Improved care
outcomes
progressive requirements for data standards
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Stage 2starting 2014
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LOINC adopted for:1. View, download, transmit data to third party2.Cancer case reporting to state registry
3.Send/receive electronic lab results inambulatory settings
4.Provide a care summary at care transition
5.Provide clinical summaries for patients6.Submit reportable lab results to public health
Lab reporting to EHRs
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Use in Quality Measures
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LOINC Adopted For
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Patient Characteristics
[Non-lab] Diagnostics studies
Patient experience
Family history
Functional statusHealth record component
Interventions (that produce an assessment or measured results)
Laboratory tests
Physical exam
Patient preference
Risk evaluation
System resources (healthcare resources)
An Example Quality Measure
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National Committee for Quality Assurance
Diabetes: Hemoglobin A1c
Poor Control
Percentage of patients 18-75 years of age with diabetes who had
hemoglobin A1c > 9.0% during the measurement period.
Find HbA1c in the EHR with LOINC
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Everyone loves LOINC
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photo via mccaughan
http://www.flickr.com/photos/mccaughan/3484111996/8/13/2019 2013 12 05 - LOINC Introduction - Brief
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Key Lessonsfor Today
photo via IMLS DCC
http://www.flickr.com/photos/imlsdcc/5637868432/sizes/o/in/photostream/8/13/2019 2013 12 05 - LOINC Introduction - Brief
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N t t I bl
If Murky, Dont Assume
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Units of measure are critical.
Sample results can help identify thecorrect LOINC Scale.
Local experts, package inserts can bevery informative.
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photo via Fishking_1
Upstream standardization.
Ask instrument or test kitmanufacturers.
ivdconnectivity.org
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A journey.
Not a destination.
Ongoing Journey
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Plan for updating as yourtesting
changes(less common), or your localcode identifiers change (more common).
Prioritization
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Local or national policies may helpprioritize mapping subsets.
For example:
common results
+ panel elements
+ public health reportable tests
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Need to be mindful ofSecondary Data Usespublic health reporting | electronic quality measures
photo via pagedooley
http://www.flickr.com/photos/pagedooley/8435953365/sizes/o/in/photostream/8/13/2019 2013 12 05 - LOINC Introduction - Brief
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Wu J, Finnell JT, Vreeman DJ. Evaluating Congruence Between Laboratory LOINC Value Sets for Quality Measures, Public Health Reporting, and Mapping Common Tests.
AMIA Annu Symp Proc. 2013; 1525-1532.
n=2852
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n=2852
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LOINC Top 2000 Results + LOINC Top 300 Orders +
NCD T 129 VSAC Q lit LOINC
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Our newest ideas...
photo via cblue98
http://www.flickr.com/photos/cblue98/7254347346/8/13/2019 2013 12 05 - LOINC Introduction - Brief
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Wisdom of the HerdCan it help novice LOINCers?
photo via suffolktouristguide.com
http://www.suffolktouristguide.com/8/13/2019 2013 12 05 - LOINC Introduction - Brief
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photo via jdhancock
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A corpus-based approach for
automated LOINC mappingMustafa Fidahussein, MD, MS
Daniel J. Vreeman, PT, DPT, MSc
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Fidahussein M, Vreeman DJ. A corpus-based approach for automated LOINC mapping. J Am Med Inform Assoc. 2013 May 15. [Epub ahead of print] PubMed PMID: 23676247.
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Maxent vs. Lucene
Mapping Performance on 3 INPC LabsCorpus = 101 code sets with about 80,00 local terms
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Institution 1n=1,099
Institution 2n=1,705
Institution 3n=838
Maxent Top 1 78.6% (864) 73.5% (1,253) 84.6% (709)
Lucene Top 1 72.6% (798) 66.5% (1,133) 76.6% (642)
Maxent Top 5 90.5% (995) 88.8% (1,514) 94.7% (794)
Lucene Top 5 89.8% (987) 86.0% (1,466) 94.3% (790)
Mapping Performance on 3 INPC Labs
Corpus = 101 code sets with about 80,00 local terms
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Institution 1n=1,099
Institution 2n=1,705
Institution 3n=838
Maxent Top 1 78.6% (864) 73.5% (1,253) 84.6% (709)
Lucene Top 1 72.6% (798) 66.5% (1,133) 76.6% (642)
Maxent Top 5 90.5% (995) 88.8% (1,514) 94.7% (794)
Lucene Top 5 89.8% (987) 86.0% (1,466) 94.3% (790)
~79% = Not bad!
57%
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57%of local lab codes would alwayshave
the correct LOINC ranked first byusing a Maxent cutoff of 0.46
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Connecting RELMA to acommunity repository
of LOINC MappingsDaniel J. Vreeman, PT, DPT, MSc
Masoud Hosseini, MS
John HookAnandhi Sowmyan
James Dennis
Brian E. Dixon, MPA, PhD, FHIMSS
photo via jamescridland
http://www.flickr.com/photos/jamescridland8/13/2019 2013 12 05 - LOINC Introduction - Brief
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RELMAREgenstrief LOINC Mapping Assistant
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photo via Stig Nygaar
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27 submissions, 18 organizations, 5 countries92,000 mappings
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Now you can just log in with your loinc.org ID
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# of codes and institutions mapped to this LOINC
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# of codes and institutions mapped to this LOINC
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# of codes and institutions mapped to this LOINC
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Click here to see the local codes!
# of codes and institutions mapped to this LOINC
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Click here to see the local codes!
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When youve got a decent number of mappings,share them back with the community
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When youve got a decent number of mappings,share them back with the community
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When youve got a decent number of mappings,share them back with the community
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In closing...
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photo viajaneandd
Glad youre here to at leastget your feet wet...
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photo via gmayster01 on & off ...
get your feet wet...
Jump In!
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photo via Justin Ornellas
The Race is On!
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Happy LOINCing!photo via ryarwood
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