2012 10 25 - meeting terminology requirements for order entry and result reporting

8/13/2019 2012 10 25 - Meeting Terminology Requirements for Order Entry and Result Reporting

1/56

Meeting terminology requirements for

order entry and result reporting

!"#$%& ()%%*"#+!"#"$%&'(") +$%,&-&" . /0+12

,"#-.)$/ 0&12+ !"3$4 5")67%&& 8 9%#2 0:"/6*"#+$&"'$3,4$35 6"35&7 8"'9($454#:;&3$


2/56

Overview

! Requirements! Background and status of the agreement! An introduction to LOINC! Practical details of the agreement!

Implementing the agreement and looking forward


3/56

Requirements for order entry & result reporting

! Consistent ways to represent types tests andmeasurements in!! Requests (or orders) for investigation! Reports of results of investigations! Clinical records of subjects of investigation

! Aggregated clinical information for research! Aggregated data for service management and audit


4/56

Possible ways of meeting the requirements for orderentry & result reporting

! SNOMED CT the leading global clinical terminology! Contains concepts representing laboratory tests & observables! However, its coverage in the laboratory domain is incomplete

! LOINC the most widely used code system for requestingand reporting laboratory tests! Contains codes for specific tests in ways that meets practical

requirements for communication of orders and reports! However, it lacks some of the detailed semantics that the SNOMED

CT concept model offers

! A combination of LOINC and SNOMED CT! Already used in several countries! However, currently this results in duplication of effort, perceived

competition and mixed semantics where the domains overlap


5/56

Practical overlaps betweenlaboratory and clinical terminology

Clinical Terminology

Laboratory Terminology


6/56

Logical overlaps betweenlaboratory and clinical terminologies

Findings Procedures

Organism

Body structure

Morphology

Substance

Method

!

Attribute Values

Laboratory

Tests / Observables

When reported

with a value

represent findings

Are observed or

measured byprocedures

Can be definedby common

attributes


7/56

Background: An Opportunity for Cooperation

! SNOMED CT is the leading global clinical terminology! IHTSDO, the owner of SNOMED CT, is a not for profit organisation

with objectives directed at enhancing health care delivery to servethe public good.

! LOINC is the worlds most widely used code system for

requesting and reporting laboratory tests! Regenstrief Institute (RI), the owner of LOINC, is a not for profit

organisation with objectives directed at enhancing health caredelivery to serve the public good.

! An cooperation agreement between IHTSDO and RI!

Should be possible due to shared objectives! Could address SNOMED CT/LOINC boundary issues! Would thus provide an effective way to address requirements for

order entry and result reporting


8/56

Update: The Opportunity is being Taken

! Good progress has been made! Shared objectives! Agreement on practical issues at operational level in both

organizations! Common understanding on key business issues at executive level in

both organizations! The governance bodies in both organization have accepted theproposed agreement in principle (subject to contract)

! Next step! Drafting and signature of a final legal agreement

!

Future steps! Undertaking work on implementing the agreement including!! Making links between SNOMED CT and LOINC content! Providing implementation advice on using SNOMED CT and

LOINC together


9/56

Objectives of the proposed agreement

! To support consistent coding of order entry and resultreporting! by addressing coding and modeling of terminology content in the

domains covered by LOINC orders and observations

! To avoid unnecessary duplication of effort

! To develop cooperation between IHTSDO & Regenstrief" Not a one-off activity" Not an acquisition or merger" Not an exclusive arrangement

#A long-term working relationship


10/56

An introduction to LOINC

Daniel Vreeman


11/56


12/56photo 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.


13/56


14/56

40 years of EMR workIndiana Network for Patient Care

Arboreal Informatics Pioneers

Regenstrief the Data Switzerland

Nations most comprehensive and longest tenured HIE


15/56


16/56


17/56

Same or Different?

Lab ATest Name: Lyme Disease Serology

Measures: B. burgdorferiAb IgG

Method: ELISA

Scale: quantitative

e.g.: Titer 1:40

Lab BTest Name:Lyme Disease Antibody

Measures:B. burgdorferiAb IgM

Method: Immune blot

Scale: qualitative

e.g.: Positive

What you see in the test catalog


18/56

Similar name, different meaning

meerkat meerkat mere cat meerkat

photo via Caption Time
http://captiontime.tumblr.com/http://captiontime.tumblr.com/


19/56

MEASUREMENTS

US

R

photo via puuikibeach
http://www.flickr.com/photos/puuikibeachhttp://www.flickr.com/photos/puuikibeachhttp://www.flickr.com/photos/puuikibeach


20/56

5671-3 LOINC Code

Lead

MCnc

Pt

Bld

Qn

Component

Property Measured

Timing

System

Scale

Method

There are six major LOINC axes

Anatomy of a LOINC Term

We call these

LOINC Parts


21/56

If an observation is a question and the

observation value is an answer LOINC provides codes for

questions

Where needed, othervocabularies (e.g. SNOMED CT)provide codes for answers


22/56

What is my patients

hemoglobin level?718-7:Hemoglobin:MCnc:Pt:Bld:Qn


23/56

How fast does my patient

usually walk?41959-8:Walking speed:Vel:1W^mean:^Patient:Qn:Calculated

photo via Ed Yourdon
http://www.flickr.com/photos/yourdon/http://www.flickr.com/photos/yourdon/http://www.flickr.com/photos/yourdon/


24/56

Indiana Network for Patient Care

HL7 v2.x Message


25/56

Result with a Coded Value

This code is from

LOINC

Data type of

result (OBX-5) is a

coded element

Code identifying thisobservation

(what are these results?

listeria culture )

This code is from

SNOMED CT

Code identifying the

result

(L. monocytogenes )

b O C


26/56

Laboratory LOINC

Cli i l LOINC


27/56

Clinical LOINC


28/56

Laboratory LOINC Committee Chair:

Clem McDonald, MD

Clinical LOINC Committee Chair:

Stan Huff, MD


29/56

photo via LuzA
http://www.flickr.com/photos/luchilu/http://www.flickr.com/photos/luchilu/


30/56

Standardized Assessments and Collections

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.


31/56

Open Development

Worldwide distribution at no cost

New terms from end-users

Welcome all comersCommittees are volunteers

Its free, but invaluable


32/56

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


33/56

010,00020,00030,00040,00050,00060,00070,00080,000

4/24/1

995

|1.0

5/24/19

95|1

.0a

6/23/

1995

|1.0b

6/28/19

95|1

.0c

7/14/

1995

|1.0

d

9/15/19

95|1

.0e

12/21/

1995

|1.0f

4/28/

1996

|1.0

g

8/29

/1996

|1.0h(

2)

12/3

/1996

|1.0h(

3)

1/8/1

9997

|1.0i

10/9/1

997

|1.0j-a

5/1/19

98|1

.0k

2/12/1

999

|1.0l

7/23/1

999

|1.0

m

8/6/19

99|1

.0m

a

2/4/20

00|1

.0n

6/13/20

00|1

.00

1/1/20

01|2

.00

1/31/20

01|2

.01

7/1/20

01|2

.03

1/1/20

02|2

.04

2/1/20

02|2

.05

2/19/20

02|2

.06

8/1/20

02|2

.07

9/1/20

02|2

.08

5/1/20

03|2

.09

10/1/20

03|2

.10

1/1/20

04|2

.11

2/1/20

04|2

.12

12/1/20

04|2

.13

12/1/20

04|2

.14

6/1/20

05|2

.15

12/1/20

05|2

.16

6/1/20

06|2

.17

12/21

/200

6|2.

19

6/21/2

007|

2.21

12/03

/200

7|2.

22

7/10/2

008|

2.24

1/10/2

009|

2.26

07/06

/200

9|2.

27

12/30

/200

9|2.

29

2/26/2

010|

2.30

6/15/2

010|

2.32

12/29

/201

0|2.

34

06/30

/201

1|2.

36

12/30

/201

1|2.

38

6/30/2

012|

2.40

LOINC CodesLab Codes

LOINC Codes Over Time by Release

Slope = 600

Slope = 2200

laboratory terms only

loinc org


34/56

loinc.org

18 900 i 148 t i


35/56

18,900+ users in 148 countries

loinc org members


36/56

0

5,000

10,000

15,000

20,000

5/2/0

8

7/2/0

8

9/2/0

8

11/2/0

8

1/2/0

9

3/2/0

9

5/2/0

9

7/2/0

9

9/2/0

9

11/2/0

9

1/2/1

0

3/2/1

0

5/2/1

0

7/2/1

0

9/2/1

0

11/2/1

0

1/2/1

1

3/2/1

1

5/2/1

1

7/2/1

1

9/2/1

1

11/2/1

1

1/2/1

2

3/2/1

2

5/2/1

2

7/2/1

2

loinc.org members

15 new members per day

480 new members per month

Doubled in 19 months!

d l d 1400/ th


37/56

downloads: ~1400/month

search loinc org


38/56

search.loinc.org


39/56


40/56

photo via 917press
http://www.flickr.com/photos/917press/http://www.flickr.com/photos/917press/http://www.flickr.com/photos/917press/


41/56

Just kidding.

Copyright is agoodthing for

standards.

Its the licensing part that isinteresting.


42/56

No cost

Worldwide

In perpetuity


43/56

Use

Copy

Distribute


44/56

Any purpose:

commercial

non-commercial

photo via Refracted Moments
http://www.flickr.com/photos/refractedmoments/http://www.flickr.com/photos/refractedmoments/http://www.flickr.com/photos/refractedmoments/


45/56

CANNOTuse anyLicensed Material to

develop or promulgate adifferent standard for

orders or observations.


46/56

That would defeat

the purpose of

having a standard!


47/56


48/56

Adopted as National Standard

BrazilCanada

France

GermanyThe Netherlands

Mexico

Rwanda

Thailand

USA


49/56

Large Implementations

SIGA Sade projectCanada Health Infoway

ePSOS

Assistance publique - Hpitaux de Paris

Red Agrolab

BiTACHong Kong Hospital Authority

Many re


50/56

photo via ryarwood
http://www.flickr.com/photos/yarwood/http://www.flickr.com/photos/yarwood/


51/56

EnablingSNOMED CT and LOINC

to work together


52/56

The practical approach

! Maps between LOINC Parts and SNOMED CT!Addition of content where necessary to complete these maps

! LOINC terms linked to SNOMED CT Expressions toprovide SNOMED CT semantic view of LOINC Terms! Limited additions of content subject to specific restrictions intended

to limit duplication of effort and content


53/56

Planned outcomes

!

Additions to SNOMED CT International Release! Map Refset to/from LOINC Parts! Association Refset from LOINC Terms to SNOMED CT Expressions

! Additions to LOINC release files! Equivalent SNOMED CT concept identifiers added to relevant LOINC Parts

! SNOMED CT Expressions linked to LOINC Terms

! Associations between LOINC Terms & sets of SNOMED CT answer values! Licensing and distribution of LOINC and SNOMED CT will continue

according to the policies & practices of each organization

! Consistent advice on implementing SNOMED CT and LOINC together

supported by both IHTSDO and RI!

Taking account of recommendations of HL7 TermInfo R2 project! Based on a model of observables which will allow semantic comparison of

combinations of LOINC questions and

SNOMED CT coded answers


54/56

How Much Work is Involved?

!Putting this agreement into effect will require both IHTSDOand the LOINC Committee to do some work! Creating maps & associations between LOINC & SNOMED CT! Adding content! Developing implementation guidance

!Without this agreement work would have been needed tocover the known content gaps in SNOMED CT coverage ofthe laboratory domain

! With the agreement there are many benefits! Working together reduces the barriers to adoption of both SNOMED

CT and LOINC! Cooperation will also encourage IHTSDO Membership growth in

countries that have already adopted LOINC


55/56

Summary

!Objective and approach have been agreed at operationallevels in both organization

! The governance bodies of IHTSDO and RegenstriefInstitute have accepted the principles of the agreement

! The next step is to finalize a legal agreement

! Beyond this there is work to be done!

! Note:! This presentation is a brief summary of key points from the agreement! More details of the proposal will be made publicly available as soon as possible


56/56

Thank you for your attention

Questions?

IHTSDO! Contact IHTSDO: [email protected]! Web site: www.ihtsdo.org

Regenstrief! Contact LOINC: [email protected]! Web site: loinc.org
http://www.ihtsdo.org/http://loinc.org/mailto:[email protected]:[email protected]://www.ihtsdo.org/http://www.ihtsdo.org/mailto:[email protected]:[email protected]

2012 10 25 - meeting terminology requirements for order entry and result reporting

Documents