LOINC Tutorial Panels, Forms, and Patient Assessments
Daniel J. Vreeman, PT, DPT, MSc Assistant Research Professor, Indiana University School of Medicine
Research Scientist, Regenstrief Institute, Inc
Clinical LOINC Meeting
02.16.2012 © 2012 [email protected]
Overview
photo via Vernio77
1. Background 2. Standard panels in LOINC 3. Patient assessment model 4. Current projects 5. Lessons learned
Assessments are widely used…
…and not unlike other clinical observations
Purpose
LOINC could be a
master question file and
uniform representation
Standardized Assessments in LOINC
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.
Iterative Refinement
Started almost 10 years ago Gradually expanded the base panel model Informing ideas:
Survey instruments have psychometric properties
Question meaning tightly coupled with answers
Many collaborators esp Tom White, Susan Bakken
CHI Functioning and Disability workgroup ASPE, AHIMA, CMS, RTI, HL7, HITSP
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Consolidated Health Informatics
Standards ^
LOINC Model for Collections Panels, forms, surveys, and other patient assessments
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Hierarchy of a Panel in LOINC
Assessment Items
Question Text Question Source
External Copyright Terms of Use
Description/Definition
Units of Measure (UCUM)
HL7 Data Types (v2, v3)
Structured Answer Lists Answer List Attributes
OID External Link
Answer Item Attributes ID (contains “LA” prefix)
String Sequence
Local code Score
Attributes of Items in a Panel Instance
Display name override Coding instructions Cardinality
Local code on that form Skip logic Data type in form
Answer sequence override Consistency/validation checks Relevance equation
Panels/Forms Available as Separate Download
Assessments Currently in LOINC US Government Forms
CARE, MDSv2, MDSv3, OASIS B1, OASIS C, RFC US Surgeon General’s Family Health Portrait
Brief Interview for Mental Status (BIMS)
Confusion Assessment Method (CAM)
Geriatric Depression Scale (GDS)
HIV Signs and Symptoms Checklist
Home Health Care Classification howRU
Living with HIV (LIV-HIV)
Morse Fall Scale
OMAHA
PHQ (9 and 2) Quality Audit Marker (QAM)
Translational Research Variables
11,000+ variables
Oh snap!
Recently Added Neuro-QOL OPTIMAL CARE long term care hospital (LTCH) survey Core behavioral health terms for SAMHSA
Find them in RELMA
Hit this!
Government Forms
Laboratory Panels
Double-click panel name to see components
Expanded Panel Detail
Newborn Screening (loinc.org/newborn-screening)
Clinical Panels
Find where a term has been used
3141-9
LOINC Term Panel Usage
DEEDS
NAACCR
NEMSIS
Other Survey Instruments
More Cooking… CDC
APA NIH
Many more…
photo via liber
Lessons
and
Recommendations
LOINC
TIMP
GDS PHQ
Advantages of the Master Catalog
Advantages of the Master Catalog
Lesson 1 Variation Abounds
Variation Abounds
Despite item similarity, much variation…
…many differences might have been avoided
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Original PHQ-9
CARE
MDSv3
MDSv3
MDSv2
OASIS
CARE
• Frequency with which resident complains or shows evidence of pain (in last 7 days)?
• No pain, Pain less than daily, Pain daily MDSv2
• How much of the time have you experienced pain or hurting over the last 5 days?
• Almost constantly, Frequently, Occasionally, Rarely, Unable to answer
MDSv3
• Have you had pain or hurting at any time during the last 2 days? • Yes, no, unable to respond CARE
• Frequency of Pain Interfering with patient's activity or movement • Patient has no pain or pain does not interfere with activity or
movement, Less often than daily, Daily but not constantly, All of the time
OASIS-B1
• Frequency of Pain Interfering with patient's activity or movement • Patient has no pain, Patient has pain that does not interfere with
activity or movement, Less often than daily, Daily but not constantly, All of the time
OASIS-C
Weigh the cost of losing comparability before inventing something new
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Lesson 2 Starting from a uniform data model may bring clarity
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We usually started from paper forms…
…but some had custom programs and databases
!
Discrepancies and Incongruences How do you store “Other specified ____________” Which text is the question and which is help Storing “unknown” or “unable to determine” as answers versus flavors of null Every “check all that apply” stored as a separate yes/no binary value item
Many Yes/No Diseases
Starting with the LOINC model may help elucidate hidden challenges
Lesson 3 IP issues present large challenges
Funders should require developers to avoid restrictive licenses
Conclusion LOINC has a uniform model with a (rapidly) growing “master question file” that enables interoperable exchange of assessment data
Acknowledgements Clinical LOINC Committee Kathy Mercer, Jo Anna Hernandez, Jaci Phillips Regenstrief Software Engineers
Michelle Dougherty, Barbara Gage, Jennie Harvell, Tom White
Funding Support NLM: HHSN2762008000006C
AHIMA Foundation: FORE-ASPE-2007-5
RTI International: 0-312-0209853
photo via milos milosevic
