4. Introduction
• Regenstrief’s 35-year history
• Indiana Network for Patient Care
– A working HIE for 15 years
– 200+ source systems
– 10.5 million patients, 3 billion results
– Regenstrief: 3rd party convener
• A fundamental challenge
– Local systems use idiosyncratic codes
• Vocabulary standards
– Provide the lingua franca of information exchange
6. LOINC Background
• Logical Observation Identifiers Names and Codes
• Organized by Regenstrief Institute in 1994
– Ongoing support from NLM and Regenstrief
• Covers domain of Clinical Observations
– Laboratory Observations (since 1995)
– Clinical Observations (since 1996)
• A universal code system that facilitates
exchange, pooling, and processing of results
7. LOINC’s General Role
• If an observation is a question, and the
observation value an answer:
– LOINC provides codes for the questions {OBR-4, OBX-3}
– Other systems (eg SNOMED) provide codes for the answers
What is my patient’s hemoglobin level?
718-7:Hemoglobin:MCnc:Pt:Bld:Qn
How fast does my patient usually walk?
41959-8:Walking speed:Vel:1W^mean:^Patient:Qn:Calculated
8. Indiana Network for Patient Care
HL7 v.2.X Message
MSH|^~&|HOSPITAL_A|SAMPLE_HOSPITAL_A|||$YearMonthDay|||||||||||||||
LocalCode^LocalName^CodeSystem^LOINCcode^LOINCname^CodeSystem
PID|||$patientId$||$patientName$||||||||||||||||||||
PV1|||||||$attendingDoctor$||$consultingDoctor$||||||||
OBR|1|||012^CBC/Auto Diff^HSPA^57021-8^CBC W Auto Diff^LN||$reqDate|||||||||
OBX|2|ST|123^WBC^HSP_A^26464-8^Leukocytes [#/volume] in Blood^LN||10.8|K/MM3|||||F|
OBX|3|ST|234^RBC^HSP_A^26453-1^Erythrocytes [#/volume] in Blood^LN||4.82|MIL/MM3|||||F|
OBX|4|ST|345^HGB^HSP_A^718-7^Hemoglobin [Mass/volume] in Blood^LN||15.7|GM/DL|||||F|
OBX|5|CE|456^HCT^HSP_A^20570-8^Hematocrit [Volume Fraction] of Blood^LN||45|%|||||||F|
A
A
12. A Highly ‘Open Source’ Model
• LOINC (the database) and RELMA (the
mapping program) are available freely
worldwide for nearly any purpose
• Much work is done by volunteers
• Content additions are end-user driven
13. LOINC codes over time by release
70,000
LOINC Codes
Lab Codes
60,000
Slope = 2200
50,000
40,000
Slope = 600
30,000
20,000
Laboratory
terms
only
(estimate)
10,000 data
prior
to
2000
not
available
0
14.
15. loinc.org members
8000
7000
6000
5000
4000
3000
10 new members per day
2000
300+ new members per month
1000
0
26. Existing Translations
• Spanish
– BiTAC (Spain); 39,000 terms
– Conceptum Medical Terminology Center; 38,000 terms, Users’ Guide
– Mexican Institute of Social Security; Users’ Guide
• French
– Canada Health Infoway; 38,000 terms
• pan Canadian Laboratory Observation Code Database (pCLOCD)
– Société Française d'Informatique de Laboratoires; 4,400 terms
• Simplified Chinese
– Bethune International Peace Hospital; 38,000 terms, Users’ Guide,
tutorial
• Korean
– Korean Ministry for Health, Welfare and Family Affairs; 27,000 terms
27. Existing Translations
• German
– DIMDI; Companion website, Users’ Guide
• Estonian
– Estonian LOINC working group of the Estonian Society for Clinical
Chemistry; Users’ Guide, Tutorial
• Portuguese
– Brazilian Federal Agency for Health Plans and Insurance,
Brazilian Clinical Analysis Society, Brazilian Clinical Pathology
Society, and Diagnóstico das Américas (DASA); 2,800 terms
• German, French, Italian, Spanish
– CUMUL (Switzerland); 5000 common terms
28. In-progress Translations
• French: Assistance Publique-Paris Hospitals
PMID: 18999107
• Estonian: University of Tartu; Lab terms
• Dutch: SKML (the Dutch Foundation for Quality
Assessment in Medical Laboratories); Lab terms
• Catalan: BiTAC; Lab terms
• Russian: Donetsk National Medical University, corTTex
• German: DIMDI; lab terms
• Italian: HL7 Italia; lab terms
• Greek: Efstratia Kontaxi; Top 300 lab orders
34. Large-scale Implementations
• SIGA Saúde project- São Paulo city, Brazil
– 25+ million lab tests per year
• Canada (with Canada Health Infoway)
– Electronic Child Health Network (Ontario)
• 100+ hospitals, community centers, offices
– Ontario Laboratories Information System
• Phase I: 4 hospitals + 3 reference labs
• European Patients Smart Open Services
– European-wide large pilot of patient
summaries and e-prescriptions
35. Large-scale Implementations
• Assistance publique - Hôpitaux de Paris
– 44 hospitals, largest system in Europe
• Spanish Adoption
– Red Agrolab
• Network of 49 labs in Spain
• Quality, food safety, and animal health
– Many regional HIE’s via BiTAC
• Hong Kong Hospital Authority
– 41 hospitals, 48 specialty clinics, 16 clinical
laboratories
37. Consolidated Health Informatics
• CHI Goal:
– Adopting interoperability standards for all federal
health agencies
• Adopted LOINC as standard
– Laboratory result names (2003)
– Laboratory test order names (2006)
– Meds: structured product labeling sections (2006)
– Federally-required patient assessment instruments
with functioning and disability content (2007)
38. Other Key US Adoptions
• HITSP
– C80: vital signs, lab results, lab orders, genetic results, other results
– C83: Patient assessment instruments (sections, questions, answers)
– IS92: newborn screening
• eLINCS
– Messaging standard for results delivery from LIS to an EHR
• NAACCR
– Volumes II (Data Standards/Dictionary) and V (Path Lab e-Reporting)
• CDISC
– Pharmaceutical research specs
• NCQA/HEDIS
– Used by 90% of US health plans to measure quality
39. Other Key US Adoptions
• HL7 – many implementation guides, CDA, etc
• HIPAA Claims Attachments
• Many Regional HIEs
– Maine Health InfoNet
– Florida Health Information Network
– Vermont Information Technology Leaders
• Many large care delivery organizations
– Intermountain Healthcare, Kaiser Permanente
• Insurance Companies
– UnitedHealth Group, Anthem, etc
40. EHR “Meaningful Use”
• Health Information Technology for Economic
and Clinical Health Act (HITECH Act) in ARRA
• CMS authorized to give reimbursement
incentives for eligible providers/hospitals who
become “meaningful users” of certified EHR
technology
• LOINC chosen as standard for Lab Results
– Phase I: when received from lab and for patient
summaries
– Phase II: LOINC
