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Clinical LOINC Document Ontology Tutorial given by Daniel Vreeman
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LOINC Tutorial Documents
Daniel J. Vreeman, PT, DPT, MSc Assistant Research Professor, Indiana University School of Medicine
Research Scientist, Regenstrief Institute, Inc
Clinical LOINC Meeting
2013 02 14 © 2013 dvreeman@regenstrief.org
http://loinc.org/slideshows
Overview
photo via Vernio77
1. Origins of a Document Ontology
2. HL7/LOINC Model
3. Evaluation and Ongoing Development
4. Future Directions
Origins of a Document Ontology
Local systems have idiosyncratic names…
…need a common, controlled vocabulary
Outpatient Pain Note
Dr. Smith’s Tues Pain Clinic Note
Chronic Pain Clinic
06/2000 • Document Ontology
Task Force
09/2003 • First Axis Values and LOINC
Codes 06/2005 • Expanded SMD Domain
10/2007 • Revised Axis Value
Approval
Ongoing • Harmonization Efforts • New Content Creation
Document Type Codes
Provide consistent semantics for names of documents exchanged between systems
Frazier P, Rossi-Mori A, Dolin RH, Alschuler L, Huff SM. The creation of an ontology of clinical document names. Stud Health Technol Inform. 2001;84(Pt 1):94-8.
Retrieval
Organization
Display Preparation of Templates
What is a Document? a collection of information
photo via striatic
an information collection
Title
Sections Sentences
Sentences
Other content
photo via karen horton
Different than a panel enumerated, discrete elements
Clinical Notes
Formal Document Ontology model and rules apply to clinical notes, but not (yet) to reports. (although non-intuitively they are in CLASS:DOC.CLINRPT)
Clinical Note
A clinical document, produced by clinicians spontaneously or in response to a request for consultation.
Clinical Report
A clinical document, produced in response to an order for a procedure.
Approach Empiric analysis of >2000 document names
Mayo, 3M/Intermountain, VA in SLC, VA in Nashville
Find the level of granularity that best meets exchange use case
Photo via Jeffrey Beall
Ultra-specific local names • Dr. Evil’s Friday Afternoon Pain Clinic Note
Commonly understood elements • Outpatient Pain Clinic Note
Local Codes and Names Still probably needed
Can send both in HL7
Mapping to a standard enables: Interoperability
Aggregation
Document Ontology Model Multi-axial / Poly-hierarchical
Names are based on
expected information content
NOT document format photo via karen horton
Names Based on Content Same LOINC code for…
…if information content is the same
Not Part of the Name Author
Location of service
Date of service
Status (e.g. signed, unsigned)
Security/privacy flags (e.g. protected)
Updates or amendments to a document
Assume that these other important attributes would be sent in different fields of the message (e.g. metadata)
Model of Document Names
Subject Matter Domain • e.g. Cardiology, Pediatric Cardiology, Physical Therapy
Role • Author training/professional classification (not @ subspecialty) • e.g. Physician, Nurse, Case Manager, Therapist, Patient
Setting • Modest extension of CMS’s definition (not equivalent to location) • E.g. Hospital, Outpatient, Emergency Department
Type of Service • Service or activity provided to patient • Eg. Consultation, History and Physical, Discharge Summary
Kind of Document • General structure of the document • E.g. Note, Letter, Consent
Rules for Constructing Names
photo via Robert S Donovan
1. Enumerated List Document names are constructed from enumerated lists of values for each axis.
2. Document + One Other Document name needs specification of a Kind of Document value and at least one of the other four axes.
• <Type of Service> <Kind of Document> Component
• Find Property
• Pt Time
• <Setting> System
• Doc Scale
• <SMD>.<Role> Method
3. Combinations Combinations from within an axis are allowed where they make sense (SMD, Service).
Assessment + Plan
Example LOINC Names Component Prop Time System Scale Method
Group counseling note Find Pt Hospital Doc {Provider}
Evaluation and management note Find Pt Outpatient Doc {Provider}
Evaluation and management note Find Pt {Setting} Doc {Provider}
History and physical note Find Pt {Setting} Doc {Provider}
Initial evaluation note Find Pt {Setting} Doc Physician
{curly braces} notation: send that content as a separate item in the message (field or segment).
Hierarchy Made a 1st pass Component hierarchy
– Based on Type of Service Axis
– Ignored Kind of Document
Multi-axial hierarchy is auto-generated – Available as a separate download
Custom hierarchies (e.g. context-specific) ones are easily imagined
Hierarchy in RELMA
Evolution, Evaluation We’re not done yet
Evolution Ongoing evaluation and evolution Exceptional contributions from Columbia University and the VA
Major Focus: Expanded original SMD values with ABMS specialty names and iterative discussion
More ontology additions from submissions
Iterative Evaluation Case Study NYPH-CUMC
Case Study
Hyun S, Shapiro JS, Melton G, Schlegel C, Stetson PD, Johnson SB, Bakken S. Iterative evaluation of the Health Level 7--Logical Observation Identifiers Names and Codes Clinical Document Ontology for representing clinical document names: a case report. J Am Med Inform Assoc. 2009 May-Jun;16(3):395-9.
SMD Role Setting Type Service Kind of Doc Overall Distinct Original
CDO
26.7% 99.9% 99.9% 43.5% 100% 23.4%
(n=894)
7.9%
Expanded
CDO
98.6% 100% 100% 99.9% 99.9% 98.5%
(n=935)
39.1%
1. Expanded CDO is better
2. Many local documents map to 1 LOINC
3. Inter-rater reliability was good
Nursing
Hyun S, Shapiro JS, Melton G, Schlegel C, Stetson PD, Johnson SB, Bakken S. Iterative evaluation of the Health Level 7--Logical Observation Identifiers Names and Codes Clinical Document Ontology for representing clinical document names: a case report. J Am Med Inform Assoc. 2009 May-Jun;16(3):395-9.
SMD Role Setting Type Service Kind of Doc Overall Distinct SMD +
CDO
74% 100% 100% 100% 100% 74.5%
(n=94)
33%
Cross-site Mapping Study of DO Axes Terms whose titles specified this axis
Li L, Morrey CP, Baorto D. Cross-mapping clinical notes between hospitals: An application of the LOINC Document Ontology. AMIA Symp Proc; 2011:;777-783.
SMD Role Setting Type of Service None West Campus (n=1644)
67.6% 34.6% 28.9% 59.4% 8.2%
East Campus (n=1124)
69.1% 56.0% 12.7% 69.0% 7.1%
1. Majority of titles map to at least one axis
2. Sites varied in how they specified titles; creates granularity issues in cross-site aggregation
Cross-site Mapping to LOINC Using LOINC v2.34
Li L, Morrey CP, Baorto D. Cross-mapping clinical notes between hospitals: An application of the LOINC Document Ontology. AMIA Symp Proc; 2011:;777-783.
Combination of LOINC DO axes (null values allowed)
West Campus mapping rate
East Campus mapping rate
Subject Matter Domain, Type of Service, Role, and Setting
22.3% (n=367) 18.7% (n=210)
Subject Matter Domain, Type of Service, and Role
30.8% (n=506) 22.6% (n=254)
Subject Matter Domain and Type of Service
46.9% (n=771) 39.2% (n=441)
1. Majority of titles map to at least one axis
2. Documents assigned LOINC codes were less specified than those in their EHR
The LOINC document ontology model can provide a robust representation of clinical documents. This can be exploited to assist in common naming conventions, finding notes by traversing the axis categories of Subject, Setting, Role and Type of Service. However, the granularity of representation can be an issue in mapping across sites.
“
Case Study German University Hospital
German University Hospital
86 Document Types (1.2 mil documents)
44%
44%
12% Mapped to LOINC
Not specific enough mapping
No LOINC match
Dugas M, Thun S, Frankewitsch T, Heitmann KU. LOINC codes for hospital information systems documents: a case study. J Am Med Inform Assoc. 2009 May-Jun;16(3):400-3.
Used LOINC v2.24 (original DocOnt terms)
German University Hospital
LOINC codes that existed for documents in their set (by volume)
Ongoing Development
A Work-in-Progress
LOINC User’s Guide is definitive source for current policy
Collaboration/discussion Clinical LOINC Meetings
HL7 SDTC
Online
The Future Great Scott!
Future Directions More v1 and v2 axis value harmonization
Identifiers for the axis values
Explicit linkage of DocOnt parts to LOINCs
Axis definitions
Computable hierarchy
Extension to other Kind of Documents
Empiric analysis of document contents
photo via milos milosevic
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