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8/11/2019 2014 09 14 - LOINC Tutorial - Documents
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Daniel J. Vreeman, PT, DPT, MScAssociate Research Professor
, Indiana University School of Medicine
Associate Director for Terminology Services, Regenstrief Institute, Inc
2014
Documents
Clinical LOINC Meeting
2014 09 04
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Overview
1. Origins of a Document Ontology
2. HL7/LOINC Model
3. Evaluation and Ongoing Development
4. Future Directions
photo via Vernio77
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http://loinc.org/slideshows
http://loinc.org/slideshows8/11/2019 2014 09 14 - LOINC Tutorial - Documents
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Origins of a DocumentOntology
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Local systems have idiosyncratic names
need a common, controlled vocabulary
OutpatientPain
Note
Dr.SmithsTues
PainClinic
ChronicPain
Clinic
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Development Milestones
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Document Type Codes
Provide consistent semantics for names of documentsexchanged between systems for any purpose
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.
Display Retrieval Organization Templates
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What is a Document?a collection of information
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an information collection
Title
Sections
Sentences
Sentences
Other content
http://www.flickr.com/photos/karenhorton/http://www.flickr.com/photos/karenhorton/http://www.flickr.com/photos/karenhorton/8/11/2019 2014 09 14 - LOINC Tutorial - Documents
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Different than a panelenumerated, discrete elements
an information collection
Title
Sections
Sentences
Sentences
Other content
http://www.flickr.com/photos/karenhorton/http://www.flickr.com/photos/karenhorton/http://www.flickr.com/photos/karenhorton/8/11/2019 2014 09 14 - LOINC Tutorial - Documents
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Clinical Notes
Clinical Note
Aclinicaldocument,producedbycliniciansspontaneouslyorinresponsetoarequestforconsultation.
Clinical Report
Aclinicaldocument,producedinresponsetoanorderforaprocedure.
Formal Document Ontology model and rules apply
to clinical notes, but not (yet) to reports.(although non-intuitively they are in CLASS:DOC.CLINRPT)
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ApproachEmpiric analysis of >2000 documentnames
Mayo, 3M/Intermountain, VA in SLC, VA in Nashville
Find the level of granularity that best
meets exchange use case
Photo via Jeffrey Beall
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Ultra-specific local
names Dr. Evils Friday Afternoon Pain
Clinic Note
Commonly understood
elements
Outpatient Pain Clinic Note
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Local Codes and Names
Still probably neededCan send both in HL7
Mapping to a standard enables:Interoperability
Aggregation
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Document Ontology Model
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Names are based on
expected informationcontent
NOTdocument format
http://www.flickr.com/photos/karenhorton/http://www.flickr.com/photos/karenhorton/http://www.flickr.com/photos/karenhorton/http://www.flickr.com/photos/karenhorton/http://www.flickr.com/photos/karenhorton/http://www.flickr.com/photos/karenhorton/8/11/2019 2014 09 14 - LOINC Tutorial - Documents
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Names Based on Content
Same LOINC code for
if information content is the same
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Not Part of the Name
AuthorLocation of service
Date of service
Status (e.g. signed, unsigned)
Security/privacy flags (e.g. protected)
Updates or amendments to a document
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Assume that these other
important attributes wouldbe sent in different fields of
the message (e.g. metadata)
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Domainofthecontentinthedocumente.g. Cardiology, Pediatric Cardiology, Physical Therapy
Subject Matter Domain
Authortraining/professionalclassification(not@subspecialty)e.g. Physician, Nurse, Case Manager, Therapist, Patient
Role
ModestextensionofCMSsdefinition(notequivalenttolocation)e.g. Hospital, Outpatient, Emergency Department
Setting
Serviceoractivityprovidedtopatiente.g. Consultation, History and Physical, Discharge Summary
Type of Service
Generalstructureofthedocumente.g. Note, Letter, Consent
Kind of Document
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Rules for
constructing
namesphoto via Robert S Donovan
http://www.flickr.com/photos/booleansplit/8/11/2019 2014 09 14 - LOINC Tutorial - Documents
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1. Enumerated List
Documentnamesareconstructedfromenumeratedlists of values for each axis.
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2. Document + One Other
NamesneedtospecifyaKind of Documentvalueandatleastone of the other four axes.
Component
Property
Find
System
Scale
Doc
Method
.
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3. Combinations
Combinationsfromwithinanaxisare allowedwheretheyarereasonable(SMD,Service).
Only a few examples currently:
Assessment+Plan note
Treatment plan+summary note
Hematology+Medical oncology
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Example LOINC Names
{Curly Braces} notation:sendthatcontentasaseparateiteminthemessage(fieldorsegment).
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LOINC Accessory FilesSpecial representations of LOINC content
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Accessory Files
LOINC Panels and Forms FileAn export of key panels, survey instruments, and forms in a
detailed data structure.
LOINC Multiaxial Hierarchy FileHierarchical organization of LOINC terms based on their axes.
DocOnt terms are organized by Component (Type of Service)
LOINC Document Ontology FileSpecial file for the detailed naming conventions for clinical
document titles (e.g. Discharge Summary, Progress Note, etc).
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Hierarchy in RELMA
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Document Ontology File
Links all Document Ontology terms to theirconstituent axis values
Axis values given unique Part identifierscategorized by axis
Available now!Downloads -> Accessory Files
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Evolution + EvaluationWere not done yet
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Iterative Evaluation
Case StudyNYPH-CUMC
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1. Expanded CDO is better
2. Many local documents map to 1 LOINC
3. Inter-rater reliability was good
Case Study
98.5%
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.
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Cross-site Mapping Study of DO AxesTerms whose titles specified this axis
1. Majority of titles map to at least one axis
2. Sites varied in how they specified titles; createsgranularity issues in cross-site aggregation
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 .
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The LOINC document ontology modelcan provide a robust representation of
clinical documents. This can beexploited to assist in common namingconventions, finding notes by
traversing the axis categories ofSubject, Setting, Role and Type ofService. However, the granularity of
representation can be an issue inmapping across sites.
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Other Evaluations
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Other Evaluations
Dugas M, Thun S, Frankewitsch T, Heitmann KU.LOINC codes for hospital information systems documentsJ Am Med Inform Assoc. 2009 May-Jun;16(3):400-3.
PMID: 19261942.
Hyrinen K, Mykknen J.
Mapping the Finnish National EHR to the LOINC.Stud Health Technol Inform. 2011;165:161-6.
PMID: 21685603.
Reeves RM, FitzHenry F, Brown SH, et al.
Who said it? Establishing professional attribution among authorsof Veterans' Electronic Health Records.
AMIA Annu Symp Proc. 2012;2012:753-62. Epub 2012 Nov 3.PMID: 23304349.
http://www.ncbi.nlm.nih.gov/pubmed/23304349http://www.ncbi.nlm.nih.gov/pubmed/21685603http://www.ncbi.nlm.nih.gov/pubmed/192619428/11/2019 2014 09 14 - LOINC Tutorial - Documents
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Still ongoing development
photo via shutterrunner
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The FutureGreat Scott!
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Future Directions
More v1 and v2 axis value harmonizationIdentifiers for the axis values
Axis definitions
Computable hierarchyExtension to other Kind of Documents
Empiric analysis of document contents
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