2014 12 03 - laboratory loinc and relma workshop
TRANSCRIPT
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Using RELMA
Or In Search of the Missing LOINC
James T. Case MS, DVM, PhD, FHL7, FACMIHealth Program Specialist, SNOMED CT
National Library of Medicine
Laboratory LOINC Meeting
December 2014
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Acknowledgements
LOINC Development Team Clem McDonald, Dan Vreeman, Jami Deckard,
David Baorto, Rachel Fuhr, Katy Holck, Swapna
Abhyankar RELMA Development Team John Hook, Anandhi Sowmyan, James Dennis
LOINC Committee Supporters: NLM, Regenstrief Institute,
Regenstrief Foundation
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What will we cover today? Overview of LOINC
Reviewing new RELMA features! Installing RELMA Setting personal preferences Loading a Local Observation File (LMOF)
Searching for a LOINC Term Preparing LMOF for Mapping Review of Map Screen Functions Setting Search Limits
Mapping Local Terms to LOINC Viewing LOINC Term Details Proposing/Submitting New LOINC Terms Exporting/Printing Mapped Terms
Mapping your own LMOF data
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Why are we doing this?Goals of Health Information Standards
Interoperability the ability to exchangeinformation between organizations
Comparability the ability to ascertain theequivalence of data from different sources
Data Quality the measurement ofaccessibility, completeness, accuracy andprecision (and more)
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Levels of Interoperability
Basic allows data to be exchanged betweencomputer systems Word processing documents, text messages
Functional describes the standard syntax(format) of the data Document templates, forms, data structures
Message standards
Semantic requires use of standardizedcontent (vocabularies) within the datastructure
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Comparability Meaning of the data is consistent when sharedamong different parties
Erysipelas Human skin disease; Streptococcus Grp A Erysipelas Animal Septicemia/dermatitis; Erysipelothrix
rhusiopathiae Common terminology required Should work in the background
Words are not enough Codes uniquely identify terms Vocabulary specialized, precise terms that remove
ambiguity Ontology describes nature of entities and their relations Classification groups related terms by category
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Potential Uses of Health Data areConstrained by Data Quality Factors Data quality issues
Different for client/patient communications vs.clinical decision support vs. epidemiological
analysis Often constrained by external forces
e.g. criteria for diagnosis often differs from the criteriafor reporting
Unidirectional effect of data consolidation Detailed General
General Detailed
This is a problem evenwhen standard
terminologies are used
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The ProblemIn attempting to arrive at the truth, I have applied
everywhere for information, but in scarcely aninstance have I been able to obtain hospital
records fit for any purpose of comparison. If theycould be obtained, they would enable us todecide many other questions They would show[subscribers] how their money was being spent
[and] what amount of good was really being donewith it
Florence Nightingale - Notes on a Hospital, 1873
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Test comparisons
Lab A Test Name: Lyme Disease Serology
Measures: B. burgdorferi Ab IgG
Method: ELISA
Scale: quantitative
e.g.: Titer 1:40
Lab BTest Name: Lyme Disease Antibody
Measures: B. burgdorferi Ab IgM
Method: Immune blot
Scale: qualitative
e.g.: Positive
LOINC Code = 5062 5 LOINC Code = 6321 4
What you see in the order list
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Why LOINC?Within one laboratory, local jargon termsmay be used which are usually well
understood between colleagues, butwould not be sufficiently widely known forcommunication with the outside world.
U. Forsum et al., Pure Appl. Chem 72:555-745, 2000 Properties and Units in the ClinicalLaboratory Sciences Part VII. Properties and Units in Clinical Microbiology
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LOINC 101Emphasis on Laboratory
LOINC
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5193-8:Hepatitis B virus surface Ab:ACnc:Pt:Ser:Qn:EIA
5193-8 LOINC Code
Hepatitis B virus surface Ab
ACnc
Pt
Ser
Qn
EIA
Component
Property Measured
Timing
System
Scale
Method
There are six major LOINC axes
Anatomy of a LOINC Term
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NOT part of a LOINC Name Reason for the test (why it was ordered or the disease it
diagnoses)
Testing instrument Specific details about the specimen
Priority (e.g. STAT) Where testing was done Who did the test
Test interpretation Pricing or cost Anything not part of naming the test
Things from other fields in an HL7 artifact
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The substance or entity that is measured,evaluated, or observed
Component/Analyte
- Sodium
- Glucose- Brucella sp. organism- Influenza A Virus antigen- Cytomegalovirus Virus antibody- Lipids.Total
5193-8: Hepatitis B virus surface Ab :ACnc:Pt:Ser:Qn:EIA
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Mass: Observations reported with mass (milligrams, grams, etc.) in the
numerator of their units of measure Substance: Observations reported with moles or milliequivalents in the
numerator of their units of measure
Catalytic activity: Observations that report enzymatic activity
Arbitrary: Results that report arbitrary units in the numerator of their unitsof measure (slowly being retired) Threshold: Results that represent the relation between a value and some
established limit or cut -off
Number: Counts
Property
5193-8:Hepatitis B virus surface Ab: ACnc :Pt:Ser:Qn:EIA
The characteristic or attribute of the analyte that ismeasured, evaluated, or observed
the most difficult LOINC axis
Major Categories
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MCnc mass concentration (mass/unit vol; e.g. mg/dL) MCnt mass content (mass/unit mass; e.g. mg/Kg)
NCnc number concentration (number/unit vol; e.g. num/mL) TmStp time CCnc catalytic concentration (activity; e.g. kat/L) Prid presence or identity Imp impression/interpretation Find subjective or objective observation Type Kind-of
Property
5193-8:Hepatitis B virus surface Ab: ACnc :Pt:Ser:Qn:EIA
the most difficult LOINC axis
Combine Major Categories with Subtypes for Full Property
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Common Property Issues
Fraction = Part/WholeNFr: % Eosinophils / leukocytes
SFr: % HGB which is A2
Ratio = multiple analytes from same system
MCrto: BUN/Creatinine in serum
Relative Ratio = measures from different system
RelRto: Albumin.pericard fld/Albumin.SerPl
F r ac t i o n v e r s u s R a t io
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Important property changes
ACNC was always a placeholder For P/N results, changed to Threshold
Additional migrations occurring gradually
LOINC IDs being retained
Flavors of Threshold Property ThrSCnc Threshold Substance Concentration
ThrMCnc Threshold Mass Concentration
ThrACnc Threshold Arbitrary Concentration
PR vs PRID Presence or absence of an analyte now represented as
PR (presence)
For nominal results, property is still PRID
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Pt - at a point in time 12H - a twelve hour collection 24H - a twenty four hour collection
Timing*
*non-Pt timings are usually associated with Rate Property
The interval of time over which the observation ormeasurement was made
5193-8:Hepatitis B virus surface Ab:ACnc: Pt: Ser:Qn:EIA
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SystemThe system (context) or specimen type upon
which the observation was made.
Ser
Ser/PlasBldUrFluTissXXX
serum
serum or plasmawhole bloodurinebody fluidtissuespecified elsewhere
photo via AlishaV
5193-8:Hepatitis B virus surface Ab:ACnc:Pt: Ser: Qn:EIA
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System Structure
Super System Patient is the default
Used to indicate blood product unit
bone marrow donor fetus
818-5:A Ag:ACnc:Pt: RBC^BPU :Ord:54417-1:ABO+Rh group:Type:Pt: Bld^fetus :Nom:
System^Super System
photo via Xurble
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ScaleQn
OrdNom
Nar
Quantitativecontinuous numericcan have operators ()
OrdinalRanked set (1+, 2+, 3+)Nominal
unranked collectionTaxonomy (e.g. bacteria)
Narrative
photo via puuikibeach
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Scale (Special) OrdQn Ordinal or Quantitative Primarily used for antimicrobial observations e.g.
MIC reported as resistant, intermediate, susceptibleor as the mm diameter of the inhibition zone
Use is discouraged in other contexts Multi structured text globs
e.g. chromatography output Use is discouraged
Doc Clinical documents Set Clinical attachments (headers)
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Method Only needed if interpretation affected
Different normal ranges Test sensitivity/specificity
Generally listed at the genericlevel Agglutination
Enzyme Immunoassay Probe with target amplification
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Hierarchies LOINCClass
one per term
arbitrarily assigned One for each LOINC axis
Multi-axial Component | System
Separate download
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Mapping Terms to LOINCThings to Remember
The thing ordered is not always the thing measured: Blood Culture live organism(s) identified VDRL Treponema pallidum Ab Urinalysis lots of different things
You must know the specifics of the component beingtested for (what actually being measured?)
The question (what am I measuring? e.g. Glucose) isnot the answer (e.g. 90 mg/dl)
You are mapping the question, not the answer!
Need to get the observation/result boundary correct. Sample values help substantially
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What is in LOINC?Content
Term structures Submitted units, Example UCUM units
aiming toward preferred units sorting
Synonyms Answer lists (increasing number) Text descriptions links to info sources
about individual tests Panel structures Foreign language translations
And much more
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RELMARegenstrief LOINC Mapping Assistant
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Download of latest version
The latest version of the installation filemay be downloaded from:
https://iu.box.com/relma67
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Purpose of Tutorial
Eliminate need to read the Users Manual Become familiar with RELMA features Provide some insight into mapping tips/pitfalls Help begin the mapping process for your
institution Hang with some really cool folks
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LOINC files and indexes Manual and automated mapping functions RELMA tools transform local words in local file
User creates file of local term/name and codes
Assigns LOINC term to local test/battery code Common tests subset to speed mapping Context sensitive hierarchies for local use. Flexible Google -like search functions
RELMA Functions
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New in This Version (Rel. 6.7) LOINC Part CLASS values are available for searching on
the PART search screen using the new "ClassList" field. Cardinality representation changed.
Ex. optional with no upper bound is now displayed as "0..*"instead of "0..n."
LOINC CreatedOn and PART CreatedOn fields Now indexed and available for searching. See the advanced
search help topics of the user manual.
Have been added to the "BASIC ATTRIBUTES" section of thedetail pages.
"Export full panel structure to Excel" function includesthe LOINC answer list id ("LL" code) and answer list
name on the ANSWERS tab of the spreadsheet.
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New in This Version (Rel. 6.7) Added LMOF backup feature. Enhanced Local Term tagging feature.
Assign a tag to multiple local terms.
Assign a tag during the import process.
Exporting of local terms now includes the tag value(s). Answer list information now available via the main
search screen. A true/false field that indicates whether or not a term has an
associated answer list. (e.g. AnswerList: true) AnswerListId field - search by LOINC answer list number. (e.g.
AnswerListID: LL1919-1)
AnswerListName field - search by keywords in the answer listname. (e.g. AnswerListName: artificial)
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LOINC Web Site
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Whats available to download? RELMA - mapping and browsing tool
HL7 message converter- Makes a database suitable formapping
LOINC database and spreadsheets
Accessory files (panels, forms, top 2000, etc.) LOINC User guide; RELMA User Guide Tools to assist language translations by part Tools for building databases to map from HL7
messages Guidance documents for mappers
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RELMA Highlights Browse-able hierarchies of LOINC parts
Display search results in tree view Enhanced details view of terms/parts
References
Descriptions
Sample units
Empirically-derived common test list Empirically-derived common order list Special features for panels/forms Enhanced export/copy-paste options
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ll
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Installation Steps Requires Windows (or VM on a Mac)
Make sure you have enough free disk space! 2Gb is recommended
From CD - Start Run :\RELMA\Setup
Specify installation directory Life will be easier if you accept the default
Two database files installed RELMA.MDB LOINC Terms Database
LMOF3.MDB Local Master Observation File
Two sample files included Run from Start (All) Programs Regenstrief RELMA
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File Locations
Database and Ancillary Files Windows XP = C:\Documents and Settings\All
Users\Documents\RELMA\
Windows Vista = C:\Users\Public\Documents\RELMA\
Windows 7, 8 = C:\Users\Public\Public Documents\RELMA\ Sample files
Windows XP = C:\Documents and Settings\AllUsers\Documents\RELMA\Samples\
Windows Vista = C:\Users\Public\Documents\RELMA\Samples\ Windows 7, 8 = C:\Users\Public\Public
Documents\RELMA\Samples\
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Running RELMAVersion 6.7
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Join the LOINC Community
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LOINC crowdsourcing
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Main Menu/Welcome Screen
S P f d L
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Set Preferred Language
Click File, Set PreferredLanguage
S l Li i i V i ( )
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Select Linguistic Variant(s)
Selecting a translation mayrequire indexes to be built
LOINC Terms with Spanish Linguistic Variant
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LOINC Terms with Spanish Linguistic Variant
All Spanish!
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S t U P f
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Select User PreferencesFrom the File Menu
Set User Preferences
...or from Welcome Screen
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Set User Preference Dialog
Startup Screen Preference
File Locations:(See prior slide for location)
New Local Term Backup Tab
U M S P f
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User Map Screen PreferencesClick Map Screen Tab
Include/Exclude Battery Terms
Add comments on Mappings
Auto create search terms
U D t il P g P f
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User Detail Pages Preferences
Download detail pages from LOINC.org
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Request Submission Preference
Preferred method of request submission
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New! Local Backup Preferences
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Importing LocalTerms into RELMA
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5 Ways to Load LMOF Files
Direct entry into LMOF from within RELMA (painful) Handy for individual entries/edits
Create an Access table that mimics the LMOF structure(less painful but tedious)
Appendix A: RELMA Manual
Create a delimited ASCII file from your local testcatalog (good choice)
Import Excel file Load directly from HL7 v2.x messages
Pulls data from OBR and OBX segments
Stores NTE segment data
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Constructing a Local DatasetCreate extract of your test catalog with:
Battery/Panel Code Battery/Panel Description or Name *Local Code *Test Description or Name
Include Method if Important Units
Example Values Laboratory Section
C i D li i d ASCII Fil
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Creating Delimited ASCII File RELMA cant parse free text
Need to create separate fields
Can use any of these delimiters Tab, Semicolon, Comma, Space
Can define your own Fields can be in any order Minimum required fields
Local Code Local Description Units (highly recommended)
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Entering New Local Terms
into RELMA
Manual Enter/Edit
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Manual Enter/Edit
View/Add/Edit Local Terms
Edit Term Dialo
g
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Edit Term Dialo g
Edit\Add\Delete TermsExport Terms
Print Preview ListText alignment option
User assigned tags
E L l T Fil
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Export Local Term File
Delimiters supported:Tab, comma, bar (|)
Export to Microsoft Excelor Text File
New feature! Exportassigned tags
Add Local Term
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Add Local Term
Click to Add to CurrentWorking File
MICRO
BUBPLAG
BUBONIC PLAGUE RRT PCR
Add tags
Search Local Term File
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Search Local Term File
Enter Keyword from anyField
Calcium
Return to Full List
Tags panel only appears iftags have been assigned
Open or close tag list
Using tags to filter local terms
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Using tags to filter local terms
Print preview local termfile
Configure output prior toviewing and printing
Print Preview Local Term File
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Print Preview Local Term File
Only prints selected rows
Steps to Import Local Terms
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Steps to Import Local Terms1. Click Import Local Terms Button from Main Menu
a) File>Import Local Terms from Delimited File 2. Locate your local terms text file3. Name your Working Set (Mandatory)
a) LMOF database can contain multiple work sets4. Define default section (Optional)5. Identify file delimiter6. Assign fields to LMOF attributes
a) Ignore fields you dont need b) Combine fields if needed
7. Check Case -sensitive if needed 8. Click Import .
Example Tab-Delimited File
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Example Tab-Delimited File
Importing Local Files
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Importing Local Files
Select Import Local Termsfrom Delimited File orExcel Spreadsheet
Navigate to File Location
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Navigate to File LocationSelect File and Click OpenSample files stored in
RELMA Directory
Open File in RELMA
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Open File in RELMA
Name your working set.RELMA allows multiple sets in
LMOF database
Select your delimiter
Import Button
Fields Segregated
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Fields Segregated
Assign LMOF Attribute
Assign working set name
Working set import
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Working set importLOINC Workshop OBR
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New feature import tags
You can include tags in your import filethat allow you to categorize your local
terms New fields in import function allow
assignment of Tag with
Local term file with added tags
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Local term file with added tags
Tag terms
Assign tag values
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Assign tag values
New fieldassignment
Tagged local terms
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Tagged local terms
Imported tags
Post-Processing of Local File
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Post-Processing of Local File
After import, RELMA Searches for terms(words) that it does not recognize
Stored in a file for future reconciliation
Importing Excel file
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p g
Excel files now appear
along with text files
Excel format for import
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Excel format for import
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Local Term File Options
Change Local Term File
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Select the Working Set
Current mapping status
Can delete local term set; notthe active one
Alternative Pragmatic Way
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Alternative Pragmatic Way Use large set of HL7 messages
Automatically make dataset of: OBR ID OBR description
OBX ID OBX description Sample of results with
Real values Units Abnormal flags Normal ranges
Generate Local term file from HL7 messages
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Select Import Terms fromHL7 File
Select File to Import
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Select HL7 File
Specify HL7 File Name and Sample Size
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Name the Local TermFile (working set)
Select which codes to store
Skip import ofsample values
Select the number ofsample values
HL7 Messages Data Statistics
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New Terms added to LMOF
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New Battery Code
Click on Edit Term to seeSample Data
Sample Results for Observation
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pNew Test Code
Sample Values from
Messages
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RELMA Cleaning Tools
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gUse this tool to edit
unknown terms
Only available if nolanguage variant selected
Review Unknown Local Terms
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May Re-Scan File forUnknown Terms
Replace Local Terms
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p
Assign LMOF AttributeReplacement Options
RELMA Cleaning Tools
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gUse this tool to make
global substitutions
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Term Substitution
Save this global substitutionfor only this working set
Lenny LOINC says:
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y yBegin to clean your
data now!
Using the OBR sample file oryour own data, take 15-20minutes to clean up theseunrecognized terms
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Searching for LOINC Terms
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Search Window
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Enter Search Terms
Limit toSpecific Units
Use differentlogic
Help File
Restrict Limits
Search Window
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Common Tests selected Common Tests rank
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Changed search function Max words
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Large number ofresults
KeywordComponentWordCount
restricts word countRestricting to Commonlabs refines further
New search function - Answerlist
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Large number ofresults
Restricting to terms thathave answer lists
Answerlist details
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M i L l T
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Mapping Local Terms
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Standard Mapping Window Features
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Customizable grid View details of LOINC term New! Add searchable tags to local term Sort by column
Click column Custom Sort
Print or export results grid Spell check squiggly line to signify words
not known to RELMA
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Configure Grid
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Reorder grid elements
Select elements to display
Reset Default ConfigurationVisually resize elements
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View Local Term Details
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Select level of detail todisplay
Can scroll through
returned subset ofterms
Change text size
Can scroll down a singleformatted page
Details Text Size
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Select text size
Select detail display level
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Select level of detail todisplay
Standard Mapping Screen
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Begin a search
(or hit enter) EEK! Whatll
I do?!
Standard Mapping Screen
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Click toshow words
used insearch
Initial Mapping Results
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Use termcheckbox
Number of LOINCterms containing
keyword Battery termsincluded in
search
Revised Mapping Results
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Number ofmatching
records found
Re-revised
Mapping Results
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Number ofmatching
records foundMatch units
selected
Standard Mapping Screen
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Clear allinput fields
Enter keywords here
CANINE DISTEMPER VIRUS IF
Standard Mapping Screen
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Navigate throughthe local terms
Tabbed Access to Functions
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Navigate to Functionsfrom Mapping Page
Switch between Grid andTree Views
Tree View
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Tree View
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Results displayed hierarchically Defined by the multi-axial hierarchy in search
restrictions (covered later)
Map to a term in tree by clicking Map button
or double clicking term Only to rows that have LOINC Codes
Tree View
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Cannot map toterms
representingLOINC parts
Can map to termswith LOINC Codes
Tree NavigationButtons
Assigning a LOINC Map
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Highlight correctterm
Click Map Button(or doubleclick)
Adding Mapping Comments
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If commentsoption is selected,prompt appears
Check with Frank in Chemistry
Assigning a LOINC Map
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LOINC Term Assigned
View Panel Children
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Select View Panel Childrenfrom context menu
Panel Children
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Excel Export Format
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New feature linked answer lists
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Adds answer list IDs to the answer tab of apanel export Allows linkage using the AnswerlistID with
the LOINC codes and the answer to seewhich answer go with a specific LOINC
Search for a panel
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Search for panel orLOINC code
Find the panelsassociated
Get panel details and export
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Export the full panelstructure
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More on SearchingSearch Screen
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Search Screen
Basic Search SyntaxSpecialCharacter(s)
Example Definition
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Character(s)
Influenza virus A Linked terms must appear together
AND Morphine ANDOpiates
Both terms must appear in the search resultterm
OR Influenza ORParainfluenza
Either or both terms must appear in thesearch result term
NOT Influenza NOT equine Excludes terms with the word following theNOT. Cannot be used alone.
? Gluc?se(glucose,glucase)
Substitutes a single character in the string.Cannot be used as the first character; cannotbe used in phrases
* Gluc*se(glucose,glucuronidase, etc.)
Substitute multiple characters in the string.Cannot be used as the first character; cannotbe used in phrases
Search Qualifiers
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Includes Glucuronidase,Glucosidase,Glucosylceramidase, etc.
Detailed help available
Combini
ng Search Terms
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Reduced number of terms
Exclude Glucosidase
Advanced Search Syntaxbased on Google-like search syntax
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g y
Parameter Description
+ Term must be included in search
- Term must be excluded from the search
( ) Group terms for subquery (i.e. A OR B; A AND B)
Fieldname: Limit term search to the associated field (e.g. Component: glucose)
Fieldname:() Group multiple terms in a single field
~ Fuzzy search (e.g. Hemofhilus~)
~ Proximity search for multiple terms (e.g. function panel~1) {}, [] Upper and lower bounds; {} exclusive, [] inclusive
\ Special character escape
Applying advanced search
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91 terms
Applying advanced search
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33 terms
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Applying advanced search
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8 terms
Limiting Searches
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g
Setting Search Limits
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Narrows search to specific subset of LOINC terms Reduces number of candidate terms Limits can be applied to all components
Component attribute can be further restricted bynumber of words
Tree structure allows for hierarchical constraints
General Search Constraints
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Controls features including: Limit to LOINC terms compatible with submitted units Forced match with any specimen contained in name Method-less terms only
Restrict by class type Remove lateralized terms
Use carefully or search may not be successful(Note parallel control switches at bottom of screen)
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Setting search limits
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Can also set most of them by toggling
buttons at the bottom of the screen
Toggle Buttons
Search Constraints
Attribute trees
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Expanded predefined,general search constraints
Limit to LOINC termsconsistent with local units
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Setting Search Limits
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Specimenconstraints
Terms Consistent with Specimen
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CSF
Enter defaultSpecimen
Terms Consistent with Specimen
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Only CSF Terms arereturned
Setting Search Limits
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Exclude laterality
Exclude laterality
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Laterality terms
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Restriction to common orders
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Large number ofcandidatesCommon orders
rank
Setting Search Limits
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Methodless TermsRestriction
Override Methodless TermsRestriction
Limit to Methodless Terms
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Both method andmethod-less terms
Limit to Methodless Terms
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Only MethodlessTerms Appear
More on Methodless Terms
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Some LOINC categories do not havemethodless terms
Checking methodless only will remove thesefrom view on results grid
Checking additional box allows these to beseen
Methodless Only Unchecked
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All terms returned
Methodless Only Checked
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Only Methodlessterms returned
Differ in one or
more components
Conditional Methodless
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More terms
returned
No method-lessterm; all shown
Setting Search Limits
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Include Trial, Deprecated orDiscouraged LOINC Codes with
Returned Terms
Include Deprecated LOINC Terms
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Deprecated LOINC Terms appear asStrikethrough Text with a Do Not
Symbol
You cannot map todeprecated LOINC terms
The map button is grayedout if one of these termsis selected
Discouraged LOINC Terms appear as an
inverted triangle
Favor Property Restriction
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Favor one type ofproperty over others
All other componentsbeing equal MCnconly will be displayed
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LOINC Hierarchies Class Tree
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Three top-levelbranches
Tree NavigationButtons
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Search Trees
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Restrict eligible teststo non-challenge
chemistry tests only
Following Class Restriction
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Only Non-ChallengeChemistry tests
returned
System Hierarchy
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Component Hierarchy
Click on details for morei f ti b t th
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Show the LOINC Codes
associated with thesecomponents
information about the
selection
Details Screen LOINC Part
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Show Associated LOINCs
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LOINC Term Details Screen
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Tree Export Tools
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Configure Export Format
Export according toConfiguration
Tree Export Configuration
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RELMA - Tree Features All trees operate the same way
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p y
Shows terms spelled out Can expand and collapse parts or all of tree. Tree is string searchable
Search can be based on one or morebranches of a tree with or without othercriteria
Use Clear Most Limits button on MappingScreen to remove all tree selections
LOINC Part Search
Same look as term search
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Same look as term search
Uses same Google -like query language Extremely fast
Include and exclude criteria
Partial string matching (using wildcards)
LOINC CLASS values may now be searchusing "ClassList:" field
Demo Campylobacter fetus, not Ab
LOINC Answer List Search
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Nominal LOINC terms are now requiredto be submitted with answer lists.
Finding answer lists and the use of themcan be done with Answer List Search tab
Answer List Search
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Answer Lists associated withLOINC term
Navigating through theMapping Process
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Mapping Process
Li it ff t t l b ti t ti d
LOINC Mapping Tactics
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Limit effort to one lab section at a time andfocus expertise
Chemistry and hematology will be easiest For manufactured assays, use package insert as
source information Sample results give clue to property and scale Consider prioritizing by frequency of use
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Vreeman DJ, Finnell JT, Overhage JM. A Rationale for Parsimonious Laboratory TermMapping by Frequency. AMIA Annu Symp Proc . 2007;:771-775.
More LOINC Mapping Tactics Try using method-less terms first
f h d b d
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Specific methods can be transmitted in: OBX 17 (v2.x), Observation.methodCode (v3.0)
Examine local units or real results to verifycorrect property and scale Properties are rarely distinguishable in test names
You dont have to do it all at one sitting Use the Unmapped function to return where you
left off With every release - Update previous mappings
to identify deprecated terms
Common Mapping Issues
Locally Defined Test Name Ambiguity
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Locally Defined Test Name Ambiguity Reuse of local test code
Analyte- free Local Test Names (Miscellaneous serology, PCR)
Incongruent Value sets (Scale ambiguity) Result vs. Interpretation Available LOINC Terms too Specific/General
Panel vs. Discrete Test Common in Microbiology
Using your Mapped Terms
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Print results of LOINC Mapping Export to File
Configure Export Format
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Context Sensitive ExportConfiguration
LMOF Export Configuration
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Select Fields to Export
Select Export Format
Save Configuration andExport
Print Mapped Terms from View/Add/Edit Menu
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May highlight terms to beprinted
Click Print button to Previewoutput
Formatted Report Output
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Click Print button to outputformatted report
Excel Export
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Picking the Lab Auto Mapper
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Lab Auto Mapper Start Screen
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Maximum number of termsto return
Can restrict search tocommon tests
Lab Auto Mapper Start Screen
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Terms used formapping
Local test code
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Exporting Mapped Terms
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Export Terms toDelimited File
Export Terms Dialog
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Check Fields youwish to export
Select Delimiter
Select Term Set
Direct export toExcel
Select file location
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Other RELMA Features
Panels, Forms and Survey Review
Review Panels, Forms andSurveys
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Review Panels, Forms andSurveys
Laboratory Panels
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Expand category tosee panels
Double-clickpanel test to seecomponents
Expanded Panel Detail
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Government Panels
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Form Category
Panel Codes
Government Panel Children
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Expanded Clinical Panel
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Clinical Panels
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Find where a term hasbeen used
35089-2, 35090-0
LOINC Term Panel Usage
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Other Survey Instruments
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HIPAA Attachments
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View Various HIPAA Attachments
HIPPA Attachment Tree
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Expanded Attachment Data
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Cant find the
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term youwant?
Search Hints and Tips Keywords with zero frequency are ignored
May need to rephrase use synonym
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May need to rephrase use synonym
Some causes for no returned terms Too many keywords in search uncheck some Limits applied that dont make sense
E.g. Method-less tests plus Method tree set to EIA Did not find and revise words not in RELMA
Local units not in RELMA
Units are GREAT discriminators You may have tests that need to be added toLOINC
Proposing New LOINC Terms
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Proposing New Terms Make sure the term is really needed
Think of other names for the same concept
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p Avoid detailed methods or localizations Is the distinction really important?
Supply sufficient annotation to justify the new term Package inserts, sample reports (email to Regenstrief) The more the better!
Construct new terms within RELMA File>Propose a new LOINC Linked to the trees to allow browsing
Can review and submit them to LOINC from withinRELMA
Propose new LOINC terms
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Select Propose anew LOINC
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Preview Proposed Terms
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Review your newterms
Review Proposed Terms
James T. Case DVM, PhD
NIH/NLM
301-555-1314
301-555-1315
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All proposed termsfully editable
Choose whether to
send or postpone
Direct submissionvia web
Submit Proposed Terms Add additionalinformation, if
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Select your closestmatch
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All requiredcomponents filled in
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Where do LOINC and SNOMED Fit?
Remember:
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LOINC represents the question: Is there any Botulism toxin in my specimen?
(33708-9)
Organisms identified in specimen? (634-6)
SNOMED represents the answer: Negative (SCTID 260385009)
E. coli O157:H7 (SCTID 103429008)
Where do LOINC and SNOMED Fit?
In an HL7 message, LOINC may be used:
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In OBR-4 (Universal Service Identifier) In OBX-3 (Observation Identifier
SNOMED may be used: In OBX-5 (where nominal values are needed)
Almost anyplace else in an HL7 message wherecoded values are needed
A code thatidentifies the
OBX: With a Coded Value
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The code isfrom SNOMED
The code isfrom LOINC
OBX-5: Data A code for L.
monocytogenes
data type inOBX-5 as a
coded element
OBX-3:A code thatidentifies the data in
OBX-5(Listeria culture)
OBX||CE|6609-2^Listeria ID^LN||36094007^L. monocytogenes^SCT
HL7 2.5 Example (ER-7 format)MSH|^~\&| LABGL1|| DMCRES|| 199812300100|| ORU^ R01|LABGL1199510221838581| P| 2.3||| NE| NE
PID||| 6910828^ Y^ C8|| Newman^ Alfred^ E|| 19720812| M|| W| 25 Centscheap Ave^^Whatmeworry^ UT^ 85201^^ P||( 555) 777- 6666|( 444) 677- 7777|| M|| 773789090
First Order OBR(Culture and ID)
First Result Value
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OBR|| 110801^ LABGL| 387209373^ DMCRES|634-6^Bacteria XXX Aerobe Cult^LN||| 199812292128||||||||Stool| IN2973^ Schadow^ Gunther^^^^ MD^
UPIN|||||||||||||||| CA20837^ Spinosa^ John^^^^ MD^ UPIN
OBX|| CE| 634-6^Bacteria XXX Aerobe Cult^ LN||50136005^Salmonella typhimurium^SCT|||||| F||| 199812292128|| CA20837
OBR|| 110801^ LABGL| 387209373^ DMCRES| 29567-9^Bacterial SusceptibilityPanel^ LN||| 199812300934||||||||Bacterial isolate| IN2973^ Schadow^Gunther^^^^ MD^ UPIN||||||||| Salmonella typhimurium ||||||| CA20837^ Spinosa^John^^^^ MD^ UPIN
OBX|| CE|23631-5^Trimethoprim/Sulfasoxazole^ LN||264841006^Intermediate^SCT|||||| F||| 199812300934|| CA20837
OBX|| CE|18967-7^Penicillin^LN||30714006^Resistant^SCT|||||| F||| 199812300934||CA20837
OBX|| CE|18928-2^Gentamicin^ LN||131196009^Susceptible^SCT|||||| F|||199812300934|| CA20837
First Result(Culture and ID)
First Result(Culture and ID)Second Result(s)
OBXs
(SNOMED)
First Result DescriptionOBX (LOINC)
Second Order OBR(Susceptibility)
Q and A Session
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ExerciseMap your own data
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