clinical loinc and relma workshop v1
DESCRIPTION
Clinical LOINC and RELMA workshipTRANSCRIPT
©2014 Regenstrief Institute
Using RELMA Or…In Search of the Missing LOINC
Susan A. Matney, PhD, RN-C, FAANMedical Informatics Consultant3M Health Information Systems
Clinical LOINC Meeting – August 2015
©2014 Regenstrief Institute
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• Clinical LOINC Committee • Supporters: NLM, Regenstrief Institute,
Regenstrief Foundation• Lab LOINC RELMA Tutorial: James Case
©2014 Regenstrief Institute
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 Special Situations• Mapping your own LMOF data
©2014 Regenstrief Institute
Why are we doing this?Goals of Health Information Standards
• Interoperability – the ability to exchange information between organizations
• Comparability – the ability to ascertain the equivalence of data from different sources
• Data Quality – the measurement of accessibility, completeness, accuracy and precision (and more)
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Levels of Interoperability• Basic – allows data to be exchanged between
computer 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 standardized content (vocabularies) within the data structure
©2014 Regenstrief Institute
Comparability• Meaning of the data is consistent when shared
among 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
©2014 Regenstrief Institute
Potential Uses of Health Data are Constrained 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 criteria
for reporting
• Unidirectional effect of data consolidation• Detailed → General• General → Detailed
This is a problem even when standard
terminologies are used
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The Problem“In attempting to arrive at the truth, I have applied
everywhere for information, but in scarcely an instance have I been able to obtain hospital records fit for any purpose of comparison. If they could be obtained, they would enable us to decide many other questions… They would show [subscribers] how their money was being spent [and] what amount of good was really being done with it…”
Florence Nightingale - Notes on a Hospital, 1873
©2014 Regenstrief Institute
Test comparisons
Lab ATest Name: Lyme Disease SerologyMeasures: B. burgdorferi Ab IgGMethod: ELISAScale: quantitativee.g.: Titer 1:40
Lab BTest Name: Lyme Disease AntibodyMeasures: B. burgdorferi Ab IgMMethod: Immune blotScale: qualitativee.g.: Positive
LOINC Code = 5062-5 LOINC Code = 6321-4
What you see in the order list
©2014 Regenstrief Institute
Why LOINC?“Within one laboratory, local jargon terms
may be used which are usually well understood between colleagues, but
would not be sufficiently widely known for communication with the outside world.”
U. Forsum et al., Pure Appl. Chem 72:555-745, 2000 Properties and Units in the Clinical Laboratory Sciences Part VII. Properties and Units in Clinical Microbiology
©2014 Regenstrief Institute
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
©2014 Regenstrief Institute
Component StructureAnalyte Name^Challenge^Adjustments
Formal analyte name
Specify “subanalytes”May have subclasses
ChallengeTwo parts separated by “post”
Adjustments
CalciumCoronavirus AgCalcium.ionized
1H post 100 g Glucose PO
<time delay>post<challenge type>
Adjusted to pH 7.4
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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 units
of 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 is measured, 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 / leukocytesSFr: % HGB which is A2
Ratio = multiple analytes from same systemMCrto: BUN/Creatinine in serum
Relative Ratio = measures from different systemRelRto: Albumin.pericard fld/Albumin.SerPl
Fraction versus Ratio
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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
©2014 Regenstrief Institute
• 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 or measurement was made
5193-8:Hepatitis B virus surface Ab:ACnc:Pt:Ser:Qn:EIA
©2014 Regenstrief Institute
SystemThe system (context) or specimen type upon which the observation was made.
SerSer/PlasBldUrFluTissXXX
serumserum or plasmawhole blood urinebody fluidtissuespecified elsewhere
photo via AlishaV
5193-8:Hepatitis B virus surface Ab:ACnc:Pt:Ser:Qn:EIA
©2014 Regenstrief Institute
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
Ord
Nom
Nar
Quantitativecontinuous numericcan have operators (<,>)
OrdinalRanked set (1+, 2+, 3+)
Nominalunranked collectionTaxonomy (e.g. bacteria)
Narrative
photo via puuikibeach
5193-8:Hepatitis B virus surface Ab:ACnc:Pt:Ser:Qn:EIA
©2014 Regenstrief Institute
Scale (Special)• OrdQn – Ordinal or Quantitative
• Primarily used for antimicrobial observations e.g. MIC reported as resistant, intermediate, susceptible or 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 generic level• Agglutination• Enzyme Immunoassay• Probe with target amplification
5193-8:Hepatitis B virus surface Ab:ACnc:Pt:Ser:Qn:EIA
©2014 Regenstrief Institute
Hierarchies• LOINC “Class”
• 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 being tested for (what actually being measured?)
• The question (what am I measuring? e.g. Glucose) is not 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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Download of latest version
• The latest version of the installation file may be downloaded from:
• https://iu.box.com/relma67
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Purpose of Tutorial• “Eliminate” need to read the User’s 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
©2014 Regenstrief Institute
New in Recent Versions (6.7-10) • A new search restriction of “PanelType” has been
added• A new search restriction of “LForms”• Cardinality representation changed.
• Ex. optional with no upper bound is now displayed as "0..*" instead of "0..n."
• "Export full panel structure to Excel" function includes the LOINC answer list id ("LL" code) and answer list name on the ANSWERS tab of the spreadsheet.
• Answer list information now available via the main search screen.
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What’s available to download?• RELMA - mapping and browsing tool
• HL7 message converter- Makes a database suitable for mapping
• 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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Installation Steps• Requires Windows (or VM on a Mac)• Make sure you have enough free disk space!
• 2Gb is recommended
• From CD - Start – Run – <drive>:\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\All Users\
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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Select Linguistic Variant(s)
Selecting a translation may require indexes to be built
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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
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User Map Screen PreferencesClick Map Screen Tab
Include/Exclude Battery Terms
Add comments on Mappings
Auto create search terms
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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 test catalog (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
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Creating Delimited ASCII File• RELMA can’t 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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Edit Term Dialog
Edit\Add\Delete TermsExport Terms
Print Preview ListText alignment option
User assigned tags
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Export Local Term File
Delimiters supported:Tab, comma, bar (|)
Export to Microsoft Excel or Text File
New feature! Export assigned tags
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Add Local Term
Click to Add to Current Working File
MICRO
BUBPLAG
BUBONIC PLAGUE – RRT PCR
Add tags
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Search Local Term File
Enter Keyword from any Field
Calcium
Return to Full List
Tags panel only appears if tags have been assigned
Open or close tag list
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Using tags to filter local terms
Print preview local term file
Configure output prior to viewing and printing
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Steps to Import Local Terms
1. Click Import Local Terms Button from Main Menu
a) File>Import Local Terms from Delimited File2. 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 delimiter 6. Assign fields to LMOF attributes
a) Ignore fields you don’t needb) Combine fields if needed
7. Check “Case-sensitive” if needed8. Click Import.
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Importing Local Files
Select Import Local Terms from Delimited File or
Excel Spreadsheet
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Navigate to File Location
Select File and Click OpenSample files stored in RELMA Directory
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Open File in RELMA
Name your working set. RELMA allows multiple sets in
LMOF database
Select your delimiter
Import Button
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Ready to Import
Minimum assignments
Now you can click the Import button!
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New feature – import tags
• You can include “tags” in your import file that allow you to categorize your local terms
• New fields in import function allow assignment of “Tag with”
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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
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Change Local Term File
Select the Working Set
Current mapping status
Can delete local term set; not the active one
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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
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Generate Local term file from HL7 messages
Select Import Terms from HL7 File
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Specify HL7 File Name and Sample Size
Name the Local Term File (working set)
Select which codes to store
Skip import of sample values
Select the number of sample values
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New Terms added to LMOF
New Battery Code
Click on “Edit Term” to see Sample Data
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Lenny L’OINC says:“Load the Sample Files
Into RELMA now!”
• Import the two sample files provided• Import_Sample_OBR.txt
• Contains battery code and description
• Sample_HL7.HL7• Contains test code and
description and sample values• Create 2 working sets• Load your personal data set
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Preparing your Data for Mapping
• Improve mapping success by:• Expanding abbreviations• Standardizing colloquial terms• Ignoring “administrative” terms• Standardizing time references
• Can be done prior to importing• Better to use tools built into RELMA
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RELMA Cleaning ToolsUse this tool to edit
unknown terms
Only available if no language variant selected
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Term Substitution
Save this global substitution for only this working set
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Lenny L’OINC says:“Begin to clean your
data now!”
• Using the OBR sample file or your own data, take 15-20 minutes to clean up these unrecognized terms
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Search Window
Enter Search Terms
Limit to Specific Units
Use different logic
Help File
Restrict Limits
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Changed search function – Max words
Keyword ComponentWordCount
restricts word count
Restricting to “Component Axis” refines further
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Search function - Answerlist
Large number of results Restricting to terms that
have answer lists
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Mapping Local Terms
• Select your Working Set to Map• File>Select Local Term File to Process
• Select “Map Local Terms to LOINC” from Welcome Screen
• Select the subset of terms to work with:• All• Mapped• Unmapped
• Set your Search Limits• Set Search Limits Button
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Standard Mapping Window Features
• 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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Mapping Screen
View or edit local term
Quick select button list
Custom Grid Configuration
Enter local term number
User assigned tags
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Configure Grid
Reorder grid elements
Select elements to display
Reset Default ConfigurationVisually resize elements
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View Local Term Details
Select level of detail to display
Can scroll through returned subset of
terms
Change text size
Can scroll down a single formatted page
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Standard Mapping Screen
Begin a search(or hit “enter”) EEK! What’ll
I do?!
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Initial Mapping Results
Use term checkbox
Number of LOINC terms containing
keywordBattery terms
included in search
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Re-revised Mapping Results
Number of matching
records foundMatch units
selected
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Standard Mapping Screen
Clear all input fields
Enter keywords here
CANINE DISTEMPER VIRUS IF
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Tabbed Access to Functions
Navigate to Functions from Mapping Page
Switch between Grid and Tree Views
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Tree View• 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
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Tree View
Cannot map to terms
representing LOINC parts
Can map to terms with LOINC Codes
Tree Navigation Buttons
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Assigning a LOINC Map
Highlight correct term
Click “Map” Button (or doubleclick)
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Adding Mapping Comments
If comments option is selected, prompt appears
Check with Frank in Chemistry
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Configure Export Options
Output Options
Include column headersSave Configuration
and/or Export
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New feature – linked answer lists
• Adds answer list IDs to the answer tab of a panel export
• Allows linkage using the AnswerlistID with the LOINC codes and the answer to see which answer go with a specific LOINC
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Search for panels
Search for panel or LOINC code
Find the panels associated
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Exported Wound “Forms” Tab
Panel Children
ParentLOINC code
Panel NameConditionality
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Basic Search SyntaxSpecial Character(s)
Example Definition
“ “ Influenza “virus A” Linked terms must appear together
AND Morphine AND Opiates
Both terms must appear in the search result term
OR Influenza OR Parainfluenza
Either or both terms must appear in the search result term
NOT Influenza NOT equine Excludes terms with the word following the NOT. Cannot be used alone.
? Gluc?se(glucose,glucase)
Substitutes a single character in the string. Cannot be used as the first character; cannot be used in “phrases”
* Gluc*se(glucose, glucuronidase, etc.)
Substitute multiple characters in the string. Cannot be used as the first character; cannot be used in “phrases”
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Search Qualifiers
Includes Glucuronidase, Glucosidase,
Glucosylceramidase, etc.
Detailed help available
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Advanced Search Syntax based on Google-like search syntax
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
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Setting Search Limits
• 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 by
number of words• Tree structure allows for hierarchical constraints
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General Search Constraints• 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 limitsCan also set most of them by toggling buttons
at the bottom of the screen
Toggle Buttons
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Search Constraints
Expanded predefined, general search constraints
Attribute trees
Limit to LOINC terms consistent with local units
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Restriction to common orders
Large number of candidates Common orders
rank
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Setting Search Limits
Methodless Terms Restriction
Override Methodless Terms Restriction
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More on Methodless Terms• Some LOINC categories do not have
methodless terms• Checking methodless only will remove these
from view on results grid• Checking additional box allows these to be
seen
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Setting Search Limits
Include Trial, Deprecated or Discouraged LOINC Codes with
Returned Terms
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Include Deprecated LOINC Terms
Deprecated LOINC Terms appear as Strikethrough Text with a “Do Not”
Symbol
• You cannot map to deprecated LOINC terms
• The map button is grayed out if one of these terms is selected
Discouraged LOINC Terms appear as an inverted triangle
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LOINC Hierarchies – Class Tree
Three top-level branches
Tree Navigation Buttons
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Before Class Restriction
Large number of candidate terms
Many terms have class of “CHAL”
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Search Trees
Restrict eligible tests to non-challenge
chemistry tests only
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Limiting Search by Subclass
Selecting subclass constrains search to all
members
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Component Hierarchy
Show the LOINC Codes associated with these
components
Click on details for more information about the
selection
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Tree Export Tools
Configure Export Format
Export according to Configuration
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RELMA - Tree Features
• All trees operate the same way• Shows terms spelled out• Can expand and collapse parts or all of tree.• Tree is string searchable • Search can be based on one or more
branches of a tree with or without other criteria
• Use “Clear Most Limits” button on Mapping Screen to remove all tree selections
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LOINC Part Search
• 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 search using "ClassList:<searchterm>" field
• Demo• Campylobacter fetus, not Ab
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LOINC Answer List Search
• Nominal LOINC terms are now “required” to be submitted with answer lists.
• Finding answer lists and the use of them can be done with “Answer List Search” tab
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Special Situations• Nursing Assessments• Radiology content• Document Ontology• Validated Instruments
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Document Ontology• Be aware of the Document Ontology model
Kind of Document
Setting
Subject Matter domain
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Status LOINC® and Nursing Content
• Many areas incomplete • Current work happening to determine gaps
• Physiologic Assessments• Basic Med/Surg Assessment Submitted
• Assessment Framework• New Nursing Judgment (Impression) LOINC
codes• Future Nursing LOINC Landing Page
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• Limit effort to one clinical section at a time and focus expertise
• Vitals, skin, wound assessments will be easiest• Map radiology by modality (constrain to that
modality)• Sample results give clue to property and scale• Consider prioritizing by frequency of use
LOINC Mapping Tactics
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Vreeman DJ, Finnell JT, Overhage JM. A Rationale for Parsimonious Laboratory Term Mapping by Frequency. AMIA Annu Symp Proc. 2007;:771-775.
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More LOINC Mapping Tactics• Try using method-less terms first
• Specific methods can be transmitted in:• OBX–17 (v2.x), Observation.methodCode (v3.0)
• Examine local units or real results to verify correct property and scale• Properties are rarely distinguishable in test names
• You don’t 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
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Common Mapping Issues
• Locally Defined Test Name Ambiguity• Reuse of local test code
• Incongruent Value sets (Scale ambiguity)• Result vs. Interpretation• Available LOINC Terms too Specific/General• LOINC not yet defined
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Using your Mapped Terms• Print results of LOINC Mapping• Export to File
Open Local Term File
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LMOF Export Configuration
Select Fields to Export
Select Export Format
Save Configuration and Export
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Print Mapped Terms from View/Add/Edit Menu
May highlight terms to be printed
Click Print button to Preview output
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Export Terms Dialog
Check Fields you wish to export
Select Delimiter
Select Term Set
Direct export to Excel
Select file location
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Panels, Forms and Survey Review
Review Panels, Forms and Surveys
Review Panels, Forms and Surveys
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Laboratory Panels
Expand category to see panels
Double-click panel test to see
components
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Search Hints and Tips• Keywords with zero frequency are ignored
• May need to rephrase – use synonym• Some causes for no returned terms
• Too many keywords in search – uncheck some• Limits applied that don’t 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 to
LOINC
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Proposing New Terms• Make sure the term is really needed
• Think of other names for the same concept• 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 within RELMA
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Required fields in red Navigate through
proposed termsCreate new term, save current term
or Exit form
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Review Proposed Terms
All proposed terms fully editable
Choose whether to send or postpone
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Susan A. Matney, PhD, RN-C
3M HIS
801-447-9294
801-447-9294
Direct submission via web
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Submit Proposed Terms
Add additional information, if
necessaryAdd attachments
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Submitting New Terms• Must supply name, organization, phone and
email of submitter• Must select at least one proposed term to
send• “Configure export” does not affect
submission output• Email resulting file to Regenstrief
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Use Existing Terms as Template
Select your closest match
Click the Propose Term button
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Where do LOINC and SNOMED Fit?
• 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)
Remember:
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Where do LOINC and SNOMED Fit?
• In an HL7 message, LOINC may be used:• 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 where
coded values are needed
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The code isfrom SNOMED
The code isfrom LOINC
OBX-5: DataA code for L.
monocytogenes
A code that identifies the data type in OBX-5 as a
coded element
OBX: With a Coded Value
OBX-3:A code that identifies the data in
OBX-5(Listeria culture)
OBX||CE|6609-2^Listeria ID^LN||36094007^L. monocytogenes^SCT
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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
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 Susceptibility Panel^ 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 Order OBR (Culture and ID)
First Result (Culture and ID)
First Result (Culture and ID)
Second Result(s) OBXs
First Result Value (SNOMED)
First Result Description OBX (LOINC)
Second Order OBR (Susceptibility)