NAHDO 23rd Annual Conference - October 26 & 27, 2008 Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis

NAHDO 23rd Annual Conference - October 26 & 27, 2008

Florida Agency for Health Care AdministrationFlorida Center for Health Information and Policy Analysis

The Use of LOINC in the AHRQ “Adding Clinical Data

to Administrative Data” Project

Christopher B. Sullivan, Ph.D.Agency for Health Care Administration

National Association of Health Data Organizations23rd Annual Conference - October 26 & 27, 2008



Logical Observation Identifiers Names and Codes

Under the sponsorship of the National Library of Medicine and other government and private organizations, the Regenstrief Institute for Health Care developed the Logical Observation Identifiers Names and Codes standard (LOINC) and the Regenstrief LOINC Mapping Assistant (RELMA®).

The User’s guides and relevant documents and files are available at

http://www.regenstrief.org/loinc

Products are available for use at no cost.



Why Use LOINC?

Currently, many laboratories use different coding dictionaries to send laboratory results electronically to clinical care systems in hospitals.

Receiving medical informatics systems cannot fully figure out the results.

The LOINC database provides a set of universal names and ID codes for identifying laboratory and clinical test results.



LOINC Sections

The LOINC database is divided into four categories: Laboratory portion Clinical Attachments Surveys



LOINC Sections

Laboratory portion

• Standard test names and codes• Includes chemistry, hematology, serology,

microbiology (including parasitology and virology), toxicology

• Drugs and cell counts for blood smears and cerebrospinal fluids

• Antibiotic susceptibilities



LOINC Sections

Clinical portion

• Vitals signs, hemodynamics, intake/output, ECG, obstetric ultrasound, cardio echo, urologic imaging, pulmonary ventilator management, survey instruments, and others



Examples of the Lab and Clinical Portions

Abbreviation Laboratory Term Class

ABXBACT Antibiotic susceptibility

ALLERGY Response to antigens

BLDBK Blood bank

Abbreviation Clinical Term Class

ART Antiretroviral Therapy

BDYCRC.ATOM Body circumference atomic

BDYCRC.MOLEC Body circumference molecular



LOINC Record Content Codes are unique and have no meaning. Each LOINC record corresponds to a single test result

or panel. The record includes fields for specifying: Component name (analytic) Property measured Timing The type of sample The type of scale The method used to produce the result or other

observation



Major "Parts" of a Test/Observation Name

The fully specified name of a test result or clinical observation has five or six main parts. Example:

<Analyte/component>:<kind of property of observation or measurement>:<time aspect>:<system (sample)>:<scale>:<method>



Divisions Within The Fields Component Name can be hierarchically divided into 3

subparts delimited by (^):

1. Name and modifier further subdivided into 3 more levels of taxonomic specification, separated by dots (.):

<[analyte].[subclass].[sub-subclass]> ^

2. Information about challenge:

<[time delay] post [amount] [substance] [route])> ^

3. Adjustments/corrections:

<adjustment>



Divisions Within The Fields

Timing and system/sample can be divided into 2 subparts delimited by (^).

Time: 2nd subpart identifies max, min, mean, etc.

Specimen: 2nd subpart identifies source if not

the patient (e.g. fetus).



General Naming Conventions

Place Identifier of substance measured first

Use generic name of drug

Use full taxonomic name of organism or virus

Name vitamins by chemical name

Rules for species and groups of species

Avoid direct, indirect; conjugated, unconjugated

Use platelets not thrombocytes

Use noun form of target of antibody



Examples of Naming Conventions

total, not tot

fraction, not frac

alpha, not A- etc.

oxygen, not O

dextro, not d-



What is Not Part of Name Instrument used in testing

Fine details about sample or site of collection

Priority of testing (stat or routine)

Who verified result

Size of sample collected

Place of testing



Broward Health Lab Codes Sample Clinical Data Elements Abbreviation Low High Units

Aspartate Aminotransferase AST 5 40 units/L

Creatine Kinase MB CK MB 0 10.4 ng/mL

Potassium LevelPotassium Lvl 3.6 5 mmol/L

Sodium Level Sodium Lvl 137 145 mmol/L

Troponin-I Troponin-I 0 0.4 ng/mL

pH Capillary pH Cap 7.35 7.45

P O2 Arterial pO2 Art 60 90 mmHg



Example of Inbound Extract

Orderable Test Interface Code

Orderable Test Name

Result Interface Code

Result Name

Specimen Type

Result Type

Units of Measure

BLGASBLOOD GAS ANALYSIS O2HB O2HB SYR N %

BLGASBLOOD GAS ANALYSIS HCO3 HCO3 SYR N mEq/L

BLGASBLOOD GAS ANALYSIS PCO2 PCO2 SYR N mmHg



Example of Outbound Report

Orderable Test Interface Code

Orderable Test Name

Result Interface Code

LOINC Code

LOINC representation

BLGASBLOOD GAS ANALYSIS O2HB 2714-4

Oxyhemoglobin/Hemoglobin.total:MFr:Pt:BldA:Qn:

BLGASBLOOD GAS ANALYSIS HCO3 1963-8

Bicarbonate:SCnc:Pt:Ser:Qn:

BLGASBLOOD GAS ANALYSIS PCO2 2019-8

Carbon dioxide:PPres:Pt

:BldA:Qn:



Summary

The LOINC codes are not intended to transmit all possible information about a test or observation.

They are only intended to identify the test result or clinical observation.



Summary of LOINC Benefits

Normalizes lab data codes.

In the AHRQ pilot project, Adding Clinical Data to Administrative Data, the standardization of lab terminology allows records from different hospital systems to be grouped into datasets that span hospitals.

Standardization of lab codes allows for more comprehensive analyses of the data.



Christopher B. Sullivan, Ph.D.Bahia N. Diefenbach, Ph.D.

Agency for Health Care AdministrationFlorida Center for Health Information

and Policy Analysis2727 Mahan Drive

Tallahassee, FL [email protected] [email protected]

Documents

NAHDO 23rd Annual Conference - October 26 & 27, 2008 Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis