Introduction to Clinical LOINC

An Introduction to Clinical LOINC Stanley M. Huff, M.D. Intermountain Healthcare [email_address]

Outline for All Tutorials ,[object Object],[object Object],[object Object],[object Object],08/21/11

Outline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11

Important facts ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11

Coverage ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11

The Messaging Paradigm 08/21/11 System A System B Trigger Event Network Order Result

HL7 Result Message (ORU) 08/21/11 Segment Data Field MSH|^~amp;|||||19981105131523||ORU^R01| PID|||100928782^9^M11||Smith^John^J| OBR||||Z0063-0^BP^LN| OBX||CE|8361-4^POSITION^LN||SIT^Sitting| OBX||NM|8479-8^SBP^LN||138|mmHg| Component

OBX: a name-value pair approach 08/21/11 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 Status A code that identifies the units of numerical data in OBX-5 A code that identifies the datatype of OBX-5 OBX-5: Data

OBX: with a coded value 08/21/11 OBX||CE|883-9^ Blood Group ^LN||58460004^ Group O ^SCT| The code is from SNOMED The code is from LOINC OBX-5: Data A code for Group O A code that identifies the datatype as a coded element A code that identifies the data in OBX-5 (ABO Blood Group)

So we are all using HL7, what is the problem? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],You and I may know that these are similar results, but our computers will not.

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],The Goal 08/21/11 Agree on a universal coding system for clinical observations.

How terminologies fit into the model ,[object Object],[object Object],[object Object],[object Object],08/21/11

Focus of LOINC ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11

Brief History of LOINC ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11

Approach ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11

LOINC makes names for things in use ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11

Two LOINC committees ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11

Current and Former Clinical LOINC Members ,[object Object],08/21/11

Clinical LOINC Subject Areas ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11

[object Object],General Form of Clinical LOINC Names 08/21/11 <component> : <property> : <timing> : <system> : <scale> : <method> The first 5 parts are mandatory, but method is optional. Subparts of the six axes are created as needed in specific subject areas. 8331-1 Body Temperature :TEMP :PT :MOUTH :QN

Summary of the six primary axes (clinical) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11

Component 08/21/11 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Subtypes – period as a separator ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11

Challenge/Pre condition - ^ as a separator ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11

Adjustments - ^ ^ as a separator ,[object Object],[object Object],08/21/11

Kind of Property ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11 The characteristic or attribute of the component that is measured, evaluated, or observed.

Timing ,[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11 The interval of time over which the observation or measurement was made.

System ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11 The system (context) or body part about which the observation was made.

Patient, Control, or Donor (as part of system) ,[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11 Non-patient values for this axis should be used with care, or combinatorial explosion could result

Scale ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11

Method ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11 Procedure used to make the measurement or observation. Only used when it makes an important distinction in sensitivity or specificity.

Putting it all together ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11

Use of XXX and {} (curly braces) ,[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11

Pre and post coordination with LOINC codes # 70 Dry Weight: Site #1 kg Weight: Site #2 kg 70 70 70 Dry Wet Ideal

Two ways to say the same thing ,[object Object],[object Object],[object Object],[object Object],[object Object],#

Model fragment in XML ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],#

Relational database implications # How would you calculate the desired weight loss during the hospital stay? Patient Identifier Date and Time Observation Type Observation Value Units 123456789 7/4/2005 Dry Weight 70 kg 123456789 7/19/2005 Current Weight 73 kg Patient Identifier Date and Time Observation Type Weight type Observation Value Units 123456789 7/4/2005 Weight Dry 70 kg 123456789 7/19/2005 Weight Current 73 kg

More complex examples ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11

HL7 & the Claims Attachment Recommendation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11

Unsolicited Attachment 08/21/11

Request for Additional Information 08/21/11

Organizations & Documents 08/21/11 X12 277 Transaction 12748-1 9832-1 X12 275 Transaction HL7 CDA R1 15748-3 7832-8 20118-5 4332-7 12748-1 9832-1 ASC X12 & Subcommittee X12N X12 Trans. Sets 277, 275 TG2 Impl. Guides 277, 275 Health Level Seven HL7 CDA R 1 HL7 Claims Attachments Impl. Guide LOINC Consortium LOINC Codes LOINC Attachment Booklets

Attachment Types Selected for HIPAA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11

CDA: Semi- or fully-structured HIPAA Claims Attachments 08/21/11 Autoadjudicate Provider Payer Transcription * Scanned Paper or Document Imaging * Level 3 CPR Image + XML Semistructured Structured and coded Specific XML forms *

Use cases for Context Specific Hierarchies ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11

Consultation Note Example ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11

Issues related to “collections” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11

Proposed strategy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],08/21/11

Literature References ,[object Object],[object Object],[object Object],[object Object],08/21/11

Introduction to Clinical LOINC

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