AMIA 2018 Annual Symposium | San Francisco, CA USA

Introduction to LOINC
The global vocabulary for identifying health measurements, observations, and documents

Daniel J. Vreeman, PT, DPT, MS, FACMI

Regenstrief-McDonald Scholar in Data Standards
Indiana University School of Medicine

Director, LOINC and Health Data Standards

@djvreeman Regenstrief Center for Biomedical Informatics

Swapna Abhyankar, MD
Associate Director for Content Development,
LOINC and Health Data Standards
@sa_abhyankar Regenstrief Center for Biomedical Informatics

© 2018 © 2018
 High Level Schedule

1. An overview of LOINC
2. The LOINC Concept Model and other
Data Structures
3. Implementing LOINC

📷 Vernio77 | cc-by-sa
 Slides available at:
https://danielvreeman.com/amia2018
 Session Objectives
1. Explain the LOINC development process
2. Apply key features of the LOINC concept model in
selecting appropriate codes
3. Design a query using metadata and relationships about
LOINC concepts beyond the concept name
4. Identify and select the key implementation tools
appropriate for their use case
5. Apply best practices for using LOINC
📷 Vernio77 | cc-by-sa
Disclosure
I’m President of Blue Sky Premise, LLC which published the book LOINC
Essentials.

I’m PI on a contract from bioMérieux for LOINC content development

(and many federal and non-profit funding sources for LOINC).

This material contains content from LOINC® (http://loinc.org). The LOINC Table, LOINC Table Core, LOINC Panels and
Forms File, LOINC Answer File, LOINC Part File, LOINC Group File, LOINC Document Ontology File, LOINC Hierarchies,
LOINC Linguistic Variants File, LOINC/RSNA Radiology Playbook, and LOINC/IEEE Medical Device Code Mapping Table are
copyright © 1995-2018, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC)
Committee and is available at no cost under the license at http://loinc.org/license.
Financial Support for LOINC
Regenstrief Institute AHIMA Foundation
Regenstrief Foundation Contract FORE-ASPE-2007-5
U.S. National Library of Medicine RTI International
Contracts NO1-LM-4-3510, N01-LM-6-3546, N01- Contract 0-312-0209853
LM-9-3517, and HHSN276200800006C,
John A. Hartford Foundation
HHSN276201400138P, HHSN276201400239P
Agency for Health Care Policy and Research
Office of the National Coordinator for Health Information
Technology (ONC) Grants HS 08750 and HS 07719-03
Contract 90AX0021 Centers for Disease Control and Prevention
U.S. Food and Drug Administration Grant and Contracts R13/CCR517099 and H75/CCH520501
Contract HHSF223201710178P, HHS223201810268P Centers for Medicare and Medicaid Services
American Physical Therapy Association Contract HHSM-500-2016-00040C
bioMérieux National Center for Advancing Translational Sciences
Indiana Clinical and Translational Sciences Institute Grant 3UL1TR001108-04S1
California Healthcare Foundation National Institute of Diabetes and Digestive and Kidney Diseases
Radiological Society of North America through the National Contract HHSN275201600752P
Institute of Biomedical Imaging and Bioengineering Members of the LOINC Community who have made donations or
Contract HHSN268201500247A became Premium Members
Before we jump in,
you might be wondering…

what’s with the pig?

 Let’s get a sense of who’s here

📷 Arran Moffat | cc-by

 https://danielvreeman.com/poll

What is your familiarity with LOINC?

Not much, I’m new

I’m relatively new
I’m an advanced LOINCer
 https://danielvreeman.com/poll

What is your clinical background?

Laboratory professional
Physician
Nurse
Other health professional
Just love working with Health IT / data
 https://danielvreeman.com/poll

What do you want to do with LOINC?

Data exchange
Analytics or quality metrics
App design or decision support
Research
Other
 Welcome to the
LOINC Community

📷 jamescridland | cc-by
Interoperability
Why it matters
Connecting Many Data Sources

Social and community determinants

Lifestyle and behavioral
Health history
Patient-generated
EHR/clinical
Genetics
Basic science
 The rain forest canopy is a seamless web
through which arboreal creatures efficiently
move to reach the edible fruits without any
attention to the individual trees.

McDonald et al. Canopy Computing: using the Web in Clinical Practice. JAMA. 1998;280(15):1325-1329.
Many forces converging on the need for
interoperable EHRs

21st Century Cures with TEFCA/USCDI (and ISA)

“Promoting Interoperability” and related programs ( superseding “Meaningful Use”)
Value-based healthcare
Precision medicine
Population health
Care coordination
Quality measurement
Person-centered care
Innovation
Reality:
patients move faster and further
than their health information
Interoperability
Why is it so hard?
 Interoperability is ultimately
about people who want (their
health IT systems) to work
together and understand
each other
📷 scarlatti2004_images | cc-by-sa
 Life without LOINC…
CODE NAME
AGTCE Angiotensin Converting Enzyme
5523 ACE SerPl Qn
ACE ACE
22441 AngioTens Conv Enz
99234 ACE (angiotensin)
25284D Angiotensin-1-Converting Enzyme
2737317 ACE (serum)
6881A Angiotensin Converting Enzyme, Ser
3800ACE ANGIOTENSIN CONVERTING ENZYME, S
77934A Angio Convt Enzym
919109 ACE, SERUM
34ACE Angiotensin Con. Enz
ANGCE Angiotensin CE
6621456 Angio. Conv. Enzyme
It's like, the
data
more money we
come across,

the more
problems we see
Problems
Health IT systems often lack common
mechanisms for exchanging data.

Even when they do, they use different ways

of identifying the same concept.
 Taming the “wicked”
interoperability problem
We need two different kinds of standards

📷 tgerus | cc-by-sa
Syntax Standards
Messages, Documents, APIs
HL7v2, C-CDA, FHIR

Semantic Standards
Vocabulary/code systems
LOINC, SNOMED CT, RxNorm, HPO, ICD, MONDO
The Superhero Origin Story
 meerkat meerkat mere cat meerkat

Similar name. Different Meaning.

📷 CaptionTime
 The universal standard for identifying health
measurements, observations, and documents.

LOINC terms have the specificity to distinguish

between clinically important differences.
📷 puuikibeach | cc-by
No single vocabulary
standard covers it all
Observables (and collections of them): LOINC
Problems, Organisms, Conditions, etc: SNOMED CT, ICD, HPO
Medications: RxNorm, ACT
Reimbursement: National codesets (e.g. CPT)
 LOINC is a rich trove of 87,000+ standardized variables
Genetics Lifestyle

21654-9 CFTR gene targeted mutation analysis

41950-7 Number of steps in 24 hour Measured
24475-6 F2 gene c.20210G>A [Presence]
75296-4 Carbohydrate intake 24 hour Estimated
75547-0 Noninvasive prenatal fetal aneuploidy
and microdeletion panel based on Plasma cell- 82289-0 Rating of perceived exertion [Score]
free+WBC DNA by Dosage of chromosome-specific
circulating cell free (ccf) DNA 72166-2 Tobacco smoking status NHIS

82245-2 Chromosome region 22q11.2 deletion in 64098-7 Distance walked in 6 minutes

Amniotic fluid or CVS by FISH

Lab and clinical Environmental

82464-9 Mosquito count [#] in Environmental specimen

4548-4 Hgb A1c MFr Bld 67784-9 Individuals below poverty line Neighborhood

8462-4 Diastolic blood pressure 63736-3 Materials to which you were exposed in your
work or daily life
24725-4 Head CT
63805-6 How long did you handle paints or solvents
57021-8 CBC W Auto Differential panel - Blood yourself?

8633-0 QRS duration 67640-3 My teachers believe that I can do well in my

school work

📷 glasgowamateur | cc-by-sa
📷 unamid-photo | cc-by-nd
Codes for individual observations
6690-2 Leukocytes [#/volume] in Blood by Automated
2339-0 count
Glucose [Mass/volume] in Blood
29463-7 Body weight
55423-8 Number of steps in unspecified time Pedometer

Codes for collections (panels and documents)

57021-8 CBC W Auto Differential panel - Blood
34565-2 Vital signs, weight and height panel
44249-1 PHQ-9 quick depression assessment panel
36813-4 CT Abdomen and Pelvis W contrast IV
18842-5 Discharge summary
Structured Answer Lists

LOINC Answer Lists LOINC Answers

ID (contains “LL” prefix) ID (contains “LA” prefix)
Can be defined as enumerated or pointers String-based, not truly “concept” based
Contains extra attributes about the package Have some mappings to external codes (e.g. SNOMED CT)
LOINC Distribution
Major releases twice per year
Many release artifacts
Online and desktop browser, API (via FHIR)
Documentation
A freely available global standard

delivered with a rich set of implementation tools…

used by a diverse global community…

who propel its continuous development.

LOINC makes health data
more portable and
understandable to different
computer systems.
Our vision is for LOINC
to be integrated into
every clinical information
system that shares or
aggregates data.
 Taking a deeper
LOINC dive
Where to use LOINC codes
Key features of LOINC’s development approach
Where to use LOINC terms
 {
"resourceType": "Observation",
"id": "body-height",
"meta": {…},
"text": {…},
"status": "final",
"category": [
{

LOINC is designed for

"coding": […],
"text": "Vital Signs"
}
],

Observations (and Orders)

"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8302-2",
"display": "Body height"
}
],
"text": "Body height"

It works equally well in HL7

},
"subject": {
"reference": "Patient/example"
},

v2, CDA, FHIR, or CDMs

"effectiveDateTime": "1999-07-02",
"valueQuantity": {
"value": 66.899999999999991,
"unit": "in",
"system": "http://unitsofmeasure.org",
"code": "[in_i]"
}
}
HL7 v2 Lab Standards Quartet: LRI, LOI, ELR, eDOS
Observation Identifier (OBX-3) and Universal Service ID (OBR-4)
LOINC shall be used as the standard coding system for this field if an appropriate LOINC code exists,
i.e., the LOINC concept is available in the LOINC database, accurately represents the observation, and has
a status that allows its use…If a local coding system is in use, a local code should also be sent to help
with identification of coding issues. When no valid LOINC exists the local code may be the only code sent.

Producer’s Obs ID (OM1-2), Other Obs ID (OM1-7) Obs in an ordered

test (OM5-2), Clinical Info Request (OMC-4)
The laboratory’s local test code and coding system shall be used to identify the orderable test in its
electronic Directory of Services. LOINC shall be used as the standard alternate vocabulary to identify
an orderable test. The performing laboratory makes the determination of an applicable LOINC order
code. When no applicable LOINC code exists, the local code may be the only code defined in the eDOS.

📷 beatlesmania11 | cc-by
 Using LOINC in HL7 version 2.x

NM (numeric) means the

answer will be a numeric value Result Value
OBX||NM|26453-1^RBC # Bld^LN||4.82|10*6/uL|

LOINC Units
Argonaut Project FHIR IG / US Core IG
Data element query of the ONC Common Clinical Data Set and Document query

Observation.code

Each observation must have a LOINC code, if available. Other

(e.g. local) codes allowed if no suitable LOINC exists

DocumentReference.Type, SmokingStatus Observation.Code, VitalSigns

All bound to value sets of LOINC codes
C-CDA 2.1
Result Observation

Other uses
All Document type codes
All Section codes
Vital sign observations
ADL result type
Food and Nutrition and anthropometric variables
Skin and wound measurements
Same idea with CDMs
PCORnet
OHDSI
Mini-Sentinel
But I LOVE maintaining my local dictionary!
📷 Jonathan McIntosh | cc-by-sa
 Relax…

OBX||NM|123^RBC^MyHosp^26453-1^RBC # Bld^LN||4.82|10*6/uL
Local term LOINC term

📷 Julien Haler | cc-by

 LOINC Development
Let’s focus on the key features

📷 jurvetson | cc-by
LOINC is free,
but invaluable
LOINC License
No cost use
Worldwide
In perpetuity
Commercial or noncommercial
Encourages translation
One major prohibition…
CANNOT use any Licensed
Material to develop or
promulgate a different standard
for orders or observations.
Read more about
Regenstrief’s approach
to licensing LOINC
danielvreeman.com/licensing-loinc
 Major releases twice
per year
(June and December)

📷 striatic | cc-by
 0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
90,000
1.
0
1.
0a
1.
0b
1.
0c
1.
0d
1.
0e
1.
0f
1.
1. 0g
0h
(
1. 2)
0h
(3
)
LOINC Terms

1.
0
1. i
0j
-a
1.
0k
1.
Only Lab LOINC Terms

0l
1.
0m
1.
0m
a
1.
0n
1.
00
2.
00
2.
01
2.
03
2.
04
2.
05
2.
06
2.
07
2.
08
2.
09
2.
10
2.
11
2.
12
2.
LOINC Terms Over Time

13
2.
14
2.
15
2.
16
2.
17
2.
19
2.
21
2.
22
2.
24
2.
26
2.
27
2.
29
2.
30
2.
32
2.
34
2.
36
2.
38
2.
4
2.
42
2.
44
2.
46
2.
48
2.
50
2.
52
2.
54
2.
56
2.
58
2.
61
2.
laboratory terms only

63
2.
64
 There will come a time
when you believe
everything is finished.

That will be the

beginning.
Louis L’Amour
novelist
from “Lonely on the Mountain”

📷 Wikipedia | cc-by-sa
 Lots cooking…
Always new lab tests
Public health: emergent issues, surveillance, case reports
Document titles
Patient reported outcomes
Cardiovascular and other clinical measurements
New data models for genetics [HL7]
Patient reported outcomes [PCORI]
Social determinants of health [many]
MANY active collaborations with other orgs…
📷 liber | cc-by
Vocabulary standards grow
because USERS ask
(we don’t need to invent new standards)

Medicine keeps evolving

If we’re missing content, just ask: loinc.org/submissions
New Term Requests:
Submissions from 160+ organizations in 15 countries in last 2 years
loinc.org/submissions/stats/
https://loinc.org/submissions/queue/
Many Active Collaborations
HL7
IEEE
SNOMED International
RSNA

CDISC
IICC
DICOM
A small taste of
LOINC usage
70,000+ registered users from 173 countries
 Registered Users
70,000
65,000
60,000 De-dupe & Purge!
55,000
search.loinc.org
50,000 login requirement

45,000
40,000
35,000
30,000
25,000
20,000
15,000
10,000
5,000
0
/0 8 / 08
/0 9 / 09
/1 0 / 10
/1 1 / 11
/1 2 / 12
/1 3 / 13
/1 4 / 14
/1 5 / 15
/1 6 / 16
/1 7 / 17
/1 8
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
6/ 12 / 6/ 12 / 6/ 12 / 6/ 12 / 6/ 12 / 6/ 12 / 6/ 12 / 6/ 12 / 6/ 12 / 6/ 12 / 6/1 1 1 1 1
Registered Users: Last 24 Months
70,000

65,000

60,000

55,000

50,000

45,000

40,000

35,000
/ 16 /1 7
/1 7
/1 7 / 17 /1 8
/1 8
/1 8 / 18
/1 / 1 / 1 / 1 /1 / 1 / 1 / 1 /1
10 1 4 7 10 1 4 7 10

This pace is about 11,500 new users per year

Many kinds of LOINC Users
Referral / reference labs and radiology centers
Health-related federal agencies
Care organizations
Professional societies
Health information exchange networks
Insurance companies
Health IT vendors
Instrument manufacturers
Health app developers
Translations into 18
variants of 12 languages
Canada

Canada Health Infoway

Curate pCLOCD subset of LOINC codes (incl fr-CA translation)

Province-wide lab data repositories throughout the country

Clinical Data Repositories using document and other LOINC terms

https://www.ehealthontario.on.ca/en/

https://infocentral.infoway-inforoute.ca/en/standards/international/loinc
France

Public Health Code for Practice of

Laboratory Medicine in France
Adopts the French specification of IHE XD-LAB profile, including HL7
CDA for format and structure and LOINC for lab test identification

https://www.legifrance.gouv.fr/affichTexte.do?cidTexte=JORFTEXT000031922237&categorieLien=id

http://esante.gouv.fr/sites/default/files/CI-SIS_CONTENU_VOLET-CR-BIOLOGIE_v1.2.0.0.pdf
Austria

National Patient Health Record

(ELGA)
Uses LOINC for laboratory tests, documents, and sections

LOINC value set for laboratory tests is maintained and updated in

coordination with the laboratory community.

Seerainer C, Sabutsch SW. eHealth Terminology Management in Austria. Stud Health Technol Inform. 2016;228:426-30. PubMed PMID: 27577418.
Netherlands

Nictiz
Many national projects are using LOINC

Nationwide surveillance network for bacterial typing and antibiotic resistance

National laboratory code list (selected by NVKC and NVMM societies)
National special test registry (WieDoetWat-database)

Nictiz is a LOINC Premium Member

https://www.rivm.nl/Documenten_en_publicaties/Algemeen_Actueel/Nieuwsberichten/2018/Vijf_labs_operationeel_bij_Eenheid_van_Taal_in_antibioticaresistentie

http://www.cchi.gov.sa/en/Projects/SHIP/Pages/Dictionary.aspx
Qatar

Supreme Council of Health

Mandated LOINC as the national standardized laboratory coding

system in the State of Qatar.

http://www.sch.gov.qa/announcements/announcement-details?item=257&backArt=180&page=1
Brazil

Ministério da Saúde Brasil

Official adoption of LOINC for laboratory test reporting

Used in São Paulo regional data exchange project for many years

Instituto HL7 Brasil has organized the Portuguese (Brazil) translation

http://bvsms.saude.gov.br/bvs/saudelegis/gm/2011/prt2073_31_08_2011.html
Malaysia

Ministry of Health
National Health Informatics Committee and Ministry pathologist
adopted LOINC for lab data standardization (in LIS’s)

Malaysian Health Data Warehouse national analytics project

https://myhdw.moh.gov.my/public/documents/20186/169489/MyHDW+2015-2016/86b7603a-eab4-40c0-aa94-35ded673838d

https://myhdw.moh.gov.my/public/home
Turkey

Turkish Ministry of Health

General Directorate of Health Services mandates LOINC

for lab results in public, university, and private facilities

Maintain a Turkish translation of LOINC and mapping to national billing

codes (plus online search/mapping tool).

http://www.cchi.gov.sa/en/Projects/SHIP/Pages/Dictionary.aspx
China

China
EHRSC Interoperability Profile: Clinical Laboratory Test Results Sharing adopted LOINC; used in
several regional health information sharing projects

Integrated disease surveillance system in Beijing with lab data standardized with LOINC

Experts from six AAA-level hospitals in Zhejiang mapped province social insurance codes to
LOINC in this interoperability framework

National Health and Family Planning Commission (NHFPC) evaluated LOINC use

Used in National Rare Diseases Registry System of China (NRDRS)

Jun Liang, MeiFang Xu, LiZhong Zhang, LanJuan Li, XiaoLin Zheng, DeRen Chen, ShengLi Yang, BaoLuo Li, Ou Jin, Zhou Ji, JunXiang Sun. Developing Interoperable Electronic Health Record Service in China. International Journal of Digital Content Technology and its Applications. 2011 (5):4 pp 280-295.

Xiaohui Zhang, Yun Ding, Zhijue Chen, Charles Schable. Development of an Integrated Surveillance System for Beijing. Advances in Disease Surveillance 2007;2:127
International Collaborations

International Patient Summary (IPS)

A non-exhaustive patient summary, specialty-agnostic, condition-
independent, but readily usable by clinicians for the cross-border
unscheduled care of a patient.

Coordinated with the IPS project mandated to CEN TC 251 by the

European Commission.

Uses LOINC for:

Document type, sections, lab results, other clinical observations, and radiology reports

http://international-patient-summary.net
And so many more…
Current U.S. Landscape
Brief Summary of LOINC Adoptions
ONC

Health IT Certification Criteria

21st Century Cures Act
Interoperability Standards Advisory
FDA
Requiring LOINC for lab test data in studies
starting after 2020 (see Data Standards Catalog)

Strong support of LOINC to identify IVD tests;

helped inspire LIVD*

Broad vision towards using real-world evidence in

post market surveillance

*also recommended by CLIAC, now under ballot as FHIR IG

CDC
Longtime users of LOINC: electronic lab reporting, case reporting,
immunization messaging, National EMS Info System, National Trauma
Data Standards, vital statistics, etc

CMS
Many eCQM definitions expressed with LOINC (per HITSC advice)

Under Impact Act 2014, all CMS-required patient assessment

instruments are standardized in LOINC
Nursing Association Support

American Nurses Association

Recommends LOINC for nursing assessments and outcomes

American Academy of Nursing

Recommends LOINC as national standard for clinical data

Alliance for Nursing Informatics

Recommends LOINC for assessments and outcomes

https://www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/id/Inclusion-of-Recognized-Terminologies-Supporting-Nursing-Practice-within-Electronic-Health-Records/

https://www.nursingoutlook.org/article/S0029-6554(13)00247-9/pdf

https://www.allianceni.org/statements-positions
Real world LOINC use (U.S.)
Reference labs have mapped observations
Orders are a work in progress

The big research networks use it in CDMs: OHDSI, PCORnet, Mini-Sentinel, etc.
PCORnet reports 94% LOINCed lab results in its network

On-the-wire coded results are widespread, but less frequent

Diameter Health (200+ orgs) reports 51% LOINC lab results

Emerging ecosystem of knowledge products leveraging LOINC

Smart on FHIR apps, Infobutton-powered decision support), etc
 Everyone loves LOINC

📷 mccaughan | cc-by-sa
Q & A
 AMIA Annual Symposium 2018 | San Francisco, CA USA

LOINC Workshop Part 2:

The LOINC concept model and other attributes,
domain specializations, query syntax, and more!

Saturday, November 3, 2018

Swapna Abhyankar, MD
Associate Director for Content Development
Part 2 overview
• LOINC concept model
• Other LOINC data structures and ancillary data
• LOINC content domains
• Domain specializations
• Query design
• Q&A
Anatomy of a LOINC term
LOINC term = LOINC code + LOINC name

80618-2 Zika virus IgM Ab [Units/volume] in Cerebral spinal fluid by

Immunoassay
=
80618-2
+
Zika virus IgM Ab [Units/volume] in Cerebral spinal fluid by Immunoassay
The LOINC code
• Unique, permanent numeric code
• Sequential
• LOINC code value can help determine when code was created
• No intrinsic structure except last character is a mod 10-check digit
• Once officially released, a code is never removed from the LOINC distribution
Each LOINC concept is defined by 6 Parts
Part Description
Component The analyte being measured
Property The dimension of the analyte that is being measured
Time aspect Whether the analyte is measured at a moment in time or over a specific
period of time
System The type of sample
Scale A general classification of the result type, whether quantitative,
qualitative, narrative, etc.
Method How the analyte was measured
*The Method is the only major axis that does not have to be populated for
every LOINC term
Component
The analyte being measured or reported
• Sodium
• HIV 1 p24 antigen
• Body weight
• Diameter.end diastole
• Bispectral index
• Note
• Cytology report
Component subparts
Challenge: a chemical or physiologic stimulus given to a
patient before the analyte is measured (also called a “loading”
or “tolerance” test)
• 2H post 100 g glucose PO
• post exercise
st nd
• 1 specimen/2 specimen
Adjustment: correction of a measured value
• adjusted to pH 7.4
• corrected for nucleated erythrocytes
Sequence when reporting multiple results (rarely used)
Property
The dimension of the analyte that is being measured
• Mass concentration
• Titer
• Presence or Threshold
• Length
• Angle
• Location
• Date
Time aspect
Whether the analyte is measured at a moment in time or over
a specific period of time
• Point in time
• 24 hours
• 7 days
• 1 year
• Study maximum
• Reporting period
• Lifetime
System
The type of sample/specimen
• Blood
• Serum or Plasma
• Urine
• Synovial fluid
• Mitral valve
• Elbow
• Device
Super System
The source of the sample if the source is not the patient
• ^Fetus
• ^Mother
• ^Father
• ^Family member
• ^Guardian or legally authorized representative
• ^BPU (blood product unit)
• ^Donor
Scale
A general classification of the result type
• Quantitative
• Ordinal (qualitative, can be ordered)
• Nominal (qualitative, cannot be ordered)
• Narrative
• Document
Method
How the analyte was measured or the information was
obtained
• {null} (no method specified)
• Immunoassay
• Sequencing
• Invasive
• X-ray
• MRI
• Reported
• Observed
 Putting the Parts together
Component Property Time aspect System Scale Method

Sodium SCnc Pt Urine Qn

2955-3 Sodium [Moles/volume] in Urine

Sodium SCnc Pt CSF Qn

2948-8 Sodium [Moles/volume] in Cerebral spinal fluid

Body weight Mass Pt ^Patient Qn

29463-7 Body weight

Body weight Mass Pt ^Fetus Qn US+Estimated from AC

11728-3 Fetal Body weight estimated from Abdominal circumference on US
 LOINC names
• Fully Specified Name (FSN) Sodium: SCnc: Pt: CSF: Qn:
Six axes (“Parts”) separated by a colon
• Long Common Name (LCN) Sodium [Moles/volume] in
Programmatically generated, unique, human-readable Cerebral spinal fluid
• Shortname
Programmatically generated, ≤ 40 characters Sodium CSF-sCnc
• Display NameNEW!
Programmatically generated, unique, human-friendly Sodium Molar conc (CSF)
(So far, only for Laboratory terms)
Other attributes of a LOINC
term
LOINC term attributes
• Remember, the 6 Parts define a given LOINC concept
• However, each LOINC has lots of other information associated
with it
• Attributes have many different purposes
• To help users understand the meaning of the term
• To organize terms and make them easier to find
• To provide metadata, such as the version in which the concept was first
published or most recently updated
• To provide information surrounding the use of a term, such as copyright
information
 Attribute examples 1
Attribute Description Examples
2
Units Example units of measure associated with mg/dL, kg, cm/s, mm
the result, including submitted units and
UCUM units
Formula The calculation used to determine the result Ejection fraction=[(LV end-diastolic volume-LV end-
systolic volume)/LV end-diastolic volume]*100
Type General classification of the type of 1 (Laboratory), 2 (Clinical), 3 (HIPAA Attachments), 4
observation (Survey)
TypeName Name of the classification Laboratory, Clinical, Attachment, Survey
Class More specific classification within a type Microbiology, Chemistry, Cardiology, Radiology,
PROMIS surveys
Status The state of the term Active, Discouraged, Deprecated, Trial
Order/Obs Whether a term is an order, observation, or Order, Observation, Both
both
 Attribute examples 2
Attribute Description Examples
Related Names Synonyms or other names that are related X-ALD (for Lysophosphatidylcholine)
to a given concept (e.g., disease name, f434 (for Malus domestica recombinant)
allergen code) to help with searching
Answer list For qualitative results, an enumerated list LL1927-4 (for RAST class)
or pointer to such a list of possible results
Answer list type The binding of an answer list to a term Example, Preferred, Normative
Survey question The original question text from a validated In the past 7 days - Stress disturbed my sleep
text survey instrument (from PROMIS sleep item bank)
External Copyright information for terms that have a COPYRIGHT
rd
copyright link 3 party copyright Organization: Kansas City Cardiomyopathy
Questionnaire
Copyright: Copyright © 1996-2005 John Spertus,
MD, MPH.
Terms of Use: Used with permission.
URL: www.http://cvoutcomes.org/
 Attribute examples 3
Attribute Description
VersionLastChanged The release in which a term was
last changed (or created)
Chngtype How the term changed in the
version last changed
Description Information at both the Part and Stroke volume is the volume of blood pumped from
term level
Examples
2.64, 2.58
ADD, DEL, UND, NAM
one ventricle of the heart during a single beat. It is the
difference between the volume at the end of diastole,
at which point the ventricle is done filling and is at its
maximum volume (also known as maximum end-
diastolic volume), and the end of systole, at which
point the ventricle has finished pumping but has not
yet started filling (also known as minimum end-
systolic volume).
 Attribute values are available in several
places
• In RELMA and http://search.loinc.org:
• On the Search screen
• On the details pages
• In the LOINC table
• In various ancillary files, such as
• LoincAnswerListLink
• Linguistic variants
• PanelsAndForms
All of a term’s attributes are on its details page
LOINC content domains…not
just for lab anymore
 LOINC Content Types
Type Name Description
1 Laboratory Concepts from a variety of laboratory domains

2 Clinical All non-laboratory measurements, clinical information, documents, and radiology

and other procedures
3 HIPAA Attachments Concepts that identify the kinds of information communicated between payers
and providers for electronic claims
4 Survey Standardized assessment measures, including government forms and validated
survey instruments
Laboratory term classes
• Allergy • Fertility
• Blood bank • Genetics
• Cell markers • Hematology
• Challenges • HLA
• Chemistry • Microbiology
• Coagulation • Pathology
• Cytology • Serology
• Drug/tox • Urinalysis
Types of lab tests
• Routine testing
• Inpatient hospital lab
• Outpatient lab
• Testing done in providers’ offices
• Tests performed by patients in their homes
• Specialized laboratory testing (“sendout”)
• Newborn screening
• Veterinary
• Public health/Epidemiology
Laboratory – continuously evolving
• Emerging diseases
• Clinical human genetics
• Molecular testing for microorganisms and resistance
mechanisms
• Plasma cell-free DNA
• Veterinary medicine
• Drug tests for synthetic (“designer”) drugs
• New methodologies
• MALDI-TOF
• Immunofluorescent Cell-binding assay
Clinical terms
• LOINC type 2 terms include all types of measurements,
procedures, documents, and other clinical information that are
not in the laboratory domain
• Anthropomorphic measurements
• Vital signs
• History and physical exam findings
• Procedures
• EKG
• Echocardiography
• Radiology
• Ophthalmology
• OB ultrasound
• Documents
Clinical terms – I&O, Nutrition
HIPAA Attachments
• Work closely with the HL7 Attachments Work Group (AWG)
to support the use of LOINC codes for electronic claims
transactions between payers and providers
• Attachment specifications use LOINC codes to:
• Identify the specific kind of information being communicated in both a
request and response (e.g., a discharge summary or diagnostic imaging
report)
• Specify certain optional modifier variables for fulfilling the request for
information (e.g. variables that indicate a modification to the default
time period).
• Identify the attachment (document) type, sections, and sometimes the
individual entries (tests or observations) in structured attachment
responses using HL7 CDA
Survey Terms
• LOINC type 4 terms include patient-reported outcomes and provider
completed forms
• Include
• Functional assessments/symptom indexes
• Government required forms
• Behavioral health/Psychiatry/Substance abuse assessments
• Many of the LOINC panel attributes were created for survey panels,
including observation ID in form, override display name, and skip logic
• Other LOINC attributes commonly used in survey terms include
Answer lists, survey question text, and copyright information
LOINC panels
What is a LOINC “panel”?
• A collector (“parent”) term that contains an enumerated set of
discrete elements (“children”)
• The parent and children are all valid LOINC terms
Panels in LOINC
• We use the word “panel” as a generic concept that is synonymous
with battery, form, data set, etc. in other domains
• Naming conventions
• Most include “panel” in the Component
• If defined by an authoritative body, we tend to use the official name
• If child elements vary on axis values (e.g. Property), the panel term value for
that axis is a dash “-”
• PanelType field in the LOINC table categorizes panel terms as
• Panel (most common): a group of concepts that are ordered/resulted together
• Convenience group: a group of related concepts that serve a common purpose
but would not be ordered/resulted together
• Organizer: groups together subsets of terms in a panel, like headings on a form
PanelType = Panel
PanelType = Convenience group
PanelType = Organizer
What Defines a Panel?
• Panels are defined by the enumeration of child elements
• Conditionality for child elements:
Required (R) – Always expected to be present
Required with alternatives (R-a) – Always expected to be present, but a specific alternate
term may be used (typically a pair)
Optional (O) – May or may not be reported with panel depending on policy
or capabilities of reporting institution
Conditional (C) – Should be included if a specific condition is met (e.g., based on patient age or
diagnosis)
Reflex (Rflx) – Included if it satisfies a reflex condition based on another result in the panel
Null () – Undeclared. Typically used in “convenience” panel or when panel elements vary
across laboratories or hospitals

• We are moving away from specifying conditionality due to the variability across
institutions and impracticality of keeping up with panel definitions, except in
certain situations, e.g., a clinical guidelines, regulations
Attributes Assigned at the Term Level
• Most attributes of a given term apply to the term whether it is
on its own or within a panel
• Units of Measure (UCUM)
• Term description/definition
• Term status
• External Copyright
• Terms of Use
Attributes Assigned at the Panel Level
• Some attributes can be assigned to a term within the context of
a panel
• Display name override
• Form coding instructions
• Form context
• Cardinality
• Observation ID in form
• Skip logic
• Override answer list
• Images
Where to get LOINC panels
• LOINC detail pages in RELMA and http://search.loinc.org
• Show the full panel structure ± details about panel children
• Comprehensive details pages have info about children; Simple pages don’t
• Panels and forms file (https://loinc.org/downloads/accessory-files/)
• Contains the full panel structure for all panels in LOINC
• Use together with the LOINC table, AnswerList file, and LOINCAnswerListLink
file
• RELMA “Export full panel structure”
• Export a single panel with all of its attributes from RELMA
• 4 tabs that include all of the information about the panel structure, LOINC
terms, Answer lists, and links between LOINCs and Answer lists included in
that panel
A closer look at LOINC
Document Ontology
The Problem
Local systems have idiosyncratic names...

Dr. Smith’s
Outpatient
Silver Spring Pediatrics
Pediatrics
Peds Office Clinic Note
Note
Note
…that make it difficult to exchange and organize
documents across systems
The Solution
A common, controlled vocabulary for
representing clinical documents

Display Retrieval Organization Templates

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.
Names are based on
expected information
content, NOT on document
format
NOT part of a LOINC document name
• Author name
• 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)
Document Ontology attributes (axes)
Attribute Description Examples
Kind of General structure of the document; types Note
Document are defined based on the need to define Flowsheet
distinct document headers Report
Type of Characterizes the kind of service or activity Counseling
Service provided to/for the patient Discharge summary
Referral
Setting Where the service was provided Emergency department
Patient’s home
Subject A field of study or a branch of knowledge Psychology
Matter Pediatric cardiology
Domain Physical therapy
Role Profession or occupation Attending
Social worker
Constrained list of values
• Each Document Ontology axis has a
constrained set of values
• Values have been approved by the LOINC
Clinical Committee/Document Ontology
Subcommittee
• Requests for new values in any of the axes
have to be approved by the LOINC
Document Ontology Subcommittee

https://loinc.org/document-
ontology/current-version/
Rules for creating document terms
• Different combinations of values from each axis = unique LOINC
terms
• Terms must have Kind of Document + ≥ 1 other axis value
• Combinations are only created if they make sense clinically
• Can have more than one value within an axis (not common)
• Evaluation+Plan note
• Plan of care+summary note
• Hematology+Medical oncology
Cross-mapping between LOINC Document
Ontology and non-document parts
LOINC non-document part LOINC Document Ontology part
Component Type of Service + Kind of Document
System Setting
Method Subject Matter Domain + Role
Subject Matter Domain.Role
 Putting the Doc Ontology parts together
Component Property Time aspect System Scale Method

Note Find Pt {Setting} Doc Psychiatry.Case manager

83881-3 Psychiatry Case manager Note
Plan of Care note Find Pt {Setting} Doc Child and adolescent
psychiatry
77446-3 Child and adolescent psychiatry Plan of care note
Letter Find Pt Hospital Doc Pediatric surgery
68803-6 Pediatric surgery Hospital Letter
Asthma action plan Find Pt {Setting} Doc {Role}
69981-9 Asthma action plan
The LOINC/RadLex Unified
Model
Unified model overview
• Both the LOINC Radiology and RSNA RadLex Playbook were
designed to represent radiology orderables, results, and their
attributes
• Multi-year collaboration to combine and unify the useful aspects
of both models
• The unified model consists of a set of attributes and sub-
attributes that comprise every term
Attributes and sub-attributes
View Pharmaceutical
View.Aggregation Pharmaceutical.Substance given
View.View type Pharmaceutical.Route
Guidance Anatomy
Guidance for.Presence Anatomic Location.Region imaged
Guidance for.Approach Anatomic Location.Imaging focus
Guidance for.Action Anatomic Location.Laterality.Presence
Guidance for.Object Anatomic Location.Laterality
Reason for Exam Subject
Timing Modality
Maneuver Modality.Modality type
Maneuver.Maneuver type Modality.Modality subtype
View
<View descriptor> <View Aggregation> <View type>

Examples
View descriptor View, Multisection
Aggregation 2, greater than 3 (GT3)
View type AP, lateral, oblique
Guidance
Guidance for <Approach> <Action> of <Object>

Examples
Approach percutaneous, deep
Action aspiration, placement, drainage
Object cyst, catheter, abscess
Reason for exam
Indication or purpose of study

Examples
for shunt patency, for vertebral fracture
Timing
<Timing>
Used with both maneuver and pharmaceutical

Examples
Timing W, WO, WO & W
Maneuver
<Timing> <Maneuver>

Examples
Maneuver type flexion, extension, standing
Pharmaceutical
<Timing> <Pharmaceutical> <Route>

Examples
Pharmaceutical contrast, 18-F FDG
Route IV, PO, via nephrostomy
tube, intra fistula
Anatomy
<Region imaged> “>” <Imaging focus>
laterality attached as appropriate

Examples
Region imaged head, abdomen, lower extremity
Imaging focus brain, clavicle, liver, thigh, ankle
Laterality.Presence true, false
Laterality right, left, bilateral, unspecified
Subject

When study is focused on something other than the

patient
Equivalent to Super system in other parts of LOINC

Examples
fetus, surgical specimen
Modality
<Modality>.<Modality subtype>

Examples
Modality XR, CT, MR, NM,
US, PT, MG, RF
Modality subtype angio, densitometry,
spectroscopy, tomography
 Cross-mapping between LOINC radiology and
non-radiology parts
LOINC non-radiology part Unified model attribute (LOINC radiology part)
Component – 1st part View
Guidance
Reason for exam
Component – 2nd part (challenge) Timing + Maneuver
Timing + Pharmaceutical
System Anatomy (Region imaged, Imaging focus, Laterality)
Subject
Method Modality
Relationship of unified model to LOINC and
Playbook concepts

Unified
LOINC model RadLex
RadLex
LOINC non- attributes Playbook
attributes
term radiology (LOINC concept
(RID)
parts radiology (RPID)
parts)
Examples
Phew - we’re almost
done with Part 2!
Are you ready to do
some hands-on
LOINCing?
LOINC Query Design
• Tools
• RELMA
• http://search.loinc.org
• Search based on
• LOINC 6-part concept model
• Other attributes
• Search syntax
• AND (implied)
• OR
• *
• {Attribute}:
Query #1
How do I find all terms added in the latest version of LOINC?

Versionfirstreleased:2.64

Alternatively,
Versionlastchanged:2.64 Chngtype:Add
Query #2
How do I find all terms updated in the latest version of LOINC?

Versionlastchanged:2.64 – Chngtype:Add

(Remember, Versionlastchanged:2.64 Chngtype:Add

got you all terms added in the latest version)
Query #3
How do I find all Radiology terms that are mapped to RadLex
Playbook codes?

Relatedcodes:RPID*

Query #3a
How do I find all terms mapped to RadLex Playbook MR or CT codes?

Relatedcodes:RPID* Method:(CT or MR)

Query #4
How do I find all LOINC terms having to do with Influenza virus
testing in CSF?

Component:Influenza System:CSF

Note 1 – if you search for Component:flu* System:CSF, you will

also get Haemophilus influenzae and Parainfluenza virus terms
Note 2 – if you search for Component:flu* by itself, in addition to
Haemophilus influenzae and Parainfluenza virus, you will also get terms
for Fluoride, Fluconazole, Guidance for aspiration of fluid, and many
more
Query #5
How do I find all terms asking about anxiety that have an answer list?

Component:anxiety Answerlist:true

Note – if you don’t include Component: your search will return any
terms with “anxiety” in any of the Parts or in the Related Names for
one of the Parts
Query #6
How do I find all panels that contain glucose in the name?

Component:glucose Orderobs:order

Alternatively,

Component:glucose panel
 Part 3:
Implementing LOINC
many tools for implementers
 Part 3 Overview

1. Overview of key resources

2. General approach to mapping
3. What is possible when you’re done
4. Best practices and recommendations

📷 Vernio77 | cc-by-sa
Many free resources
loinc.org/downloads

“Raw” release artifacts

Online and desktop browser (RELMA)
API (via FHIR)
Documentation
Community resources

Most require a free loinc.org account

https://loinc.org/downloads/loinc/

Formats for
importing into
Health IT
applications
Accessory Files
LOINC Part File
LOINC Answer File
LOINC Panels and Forms File
LOINC Document Ontology File
LOINC Multiaxial Hierarchy File
LOINC/IEEE Medical Device Code Mapping File
LOINC/RSNA Radiology Playbook File
LOINC/SNOMED CT Expression Association and Map Sets
LOINC Display Name File
LOINC Linguistic Variants
LOINC Group File we’ll come back to this one

Each has a detailed ReadMe and Release Notes

RELMA: the gold standard mapping tool

Browse LOINC database

Map local codes to LOINC
import/export
translate local words to LOINC-speak
powerful searching capabilities
review all the details about a LOINC term
Maintain your mappings
Submit new LOINC term requests
Need a loinc.org account
Need Windows
Need admin privileges
Install RELMA!
https://loinc.org/relma/mac
RELMA Search Screen
 View (LOINC Term) Details

!
Open the Encyclopedia of LOINC

Two ways
Context menu
Hit the View Details button

For most purposes I recommend the

Comprehensive view.

Also available from search.loinc.org

Example Details Page
My favorite LOINC easter egg…
loinc.org/86944-6
 Loading local
codes into RELMA

📷 john_fielding | cc-by
Creating your source file
for mapping to LOINC
danielvreeman.com/source-file

a sample section from LOINC Essentials

 Observation Source File
Basic Format

Panel Code Panel Description Test Code Test Description Units Tag

GLUCWB GLUCOSE WHOLE BLOOD GLUCWB GLUCOSE WHOLE BLOOD MG/DL chem

BGART BLD GAS ART PCO2 PCO2 MMHG chem

BGART BLD GAS ART PH PH chem

BGART BLD GAS ART PO2 PO2 MMHG chem

CBCDF CBC+DIFF HCT HEMATOCRIT % hem

CBCDF CBC+DIFF HGB HEMOGLOBIN G/DL hem

Ready to rock?
 The Mapping Screen
Working Set Navigation Local Term and Mapping Detail

Search Results Grid

 Extracting your mappings
from RELMA
Actually, it’s pretty easy

📷 dvids | cc-by
 Export Options
File -> Export Local Terms and Their LOINC Mappings to
Delimited File

Choose Term File

Choose Format

Choose Stuff
 Oh no, roadblock!
Can’t install RELMA?

📷 brizo_the_scot | cc-by
https://search.loinc.org
Other Implementation Resources
API, Documentation, Community
FHIR Terminology Services with
LOINC enable an exciting set of
capabilities that were much
harder before!
https://loinc.org/fhir
Enhanced LOINC features now available in HAPI FHIR
Get info about your favorite
LOINC term
https://fhir.loinc.org/CodeSystem/$lookup?system=http://
loinc.org&code=4544-3
Every Answer List is available
as a ValueSet
Get a particular Answer List as a ValueSet

https://fhir.loinc.org/ValueSet/?
url=http://loinc.org/vs/LL1162-8
Get the LOINC to IEEE
Mapping
https://fhir.loinc.org/ConceptMap/?url=http://loinc.org/cm/
loinc-to-ieee-device-codes
Get some help from
trusted friends…
 https://loinc.org/guides/micro

FDA-funded development of
Guide for Using LOINC
Microbiology Terms

Our first (but hopefully not last) “Implementation Guide”

Grant HHSF223201710178P and HHS223201810268P from U.S. Food and Drug Administration
What LOINC Essentials covers…
LOINC basics

A framework and techniques for picking out the subtle but important
distinctions between LOINC terms

Step by step guidance for mapping with RELMA

Best practices in LOINC mapping and how to set yourself up for success in
the long run
This tutorial is based on content from the book
 https://loinc.org/members

An exceptional value

Takes as input
Local test codes, names, units, and mappings

Returns
Spreadsheet with issues detected by the evaluation process
 Sample of Evaluation Rules
Unknown local units
Deprecated LOINC
Discouraged LOINC
Property/units mismatch
Scale/units mismatch
Concentration missing denominator
Many ways to learn more and
participate in LOINC Community

Mailing list
User Forum
In-person LOINC Conferences
Special Topics Workgroups
Committees
Adopter directory
General Approach to Mapping
 The LOINC term name is key

📷 quinnanya | cc-by-sa
LOINC Fully Specified Name
Includes the info necessary to distinguish among clinically
important differences

Defines the essential uniqueness of each term in LOINC

Body height:Len:Pt:^Patient:Qn:
 Local tests names are:
Notoriously short
Lacking info needed for mapping

Don’t make assumptions, but…

Use all available contextual clues

📷 paurian | cc-by
 Scan LOINC axes to notice the
differences needing closer inspection

📷 jdhancock | cc-by
 "
For qualitative tests, use
LOINC Answer Lists to
inform your mapping
Mapping Exercise
Your turn!
 https://danielvreeman.com/poll

Which LOINC term is the best match for

Systolic Blood Pressure?

8480-6 Systolic blood pressure

8481-4 Systolic blood pressure 1 hour maximum

8512-6 Radial artery Systolic blood pressure

60984-2 Aorta Systolic blood pressure

 https://danielvreeman.com/poll

Which LOINC term is the best match for

Inpatient Discharge Summary?

68823-4 Pediatrics Hospital Discharge summary

34105-7 Hospital Discharge summary

84321-9 Physical therapy Outpatient Discharge summary

18842-5 Discharge summary

 https://danielvreeman.com/poll

Which LOINC Property is consistent with the

units of measure “mg/dL”?

ACnc
MoM
MFr
MCnc
 https://danielvreeman.com/poll

Which LOINC term is the best match for

LDL Cholesterol (Direct) in mg/dL?
57698-3 Lipid panel with direct LDL - Serum or Plasma

69419-0 Cholesterol in LDL [Moles/volume] in Serum or Plasma by Direct assay

18262-6 Cholesterol in LDL [Mass/volume] in Serum or Plasma by Direct assay

2089-1 Cholesterol in LDL [Mass/ volume] in Serum or Plasma

 https://danielvreeman.com/poll

Which LOINC term is the best match for

Cytochrome P450 3A5 (CYP3A5) Genotype (star allele notation)?

79717-5 CYP3A5 gene product metabolic activity interpretation in Blood

or Tissue Qualitative by CPIC
72697-6 CYP3A5 gene c.6986A>G(*3) [Presence] in Blood or Tissue by
Molecular genetics method
81139-8 CYP3A4 gene mutations found [Identifier] in Blood or Tissue by
Molecular genetics method Nominal
81140-6 CYP3A5 gene mutations found [Identifier] in Blood or Tissue by
Molecular genetics method Nominal
 https://danielvreeman.com/poll

Which LOINC term is best match for

JAK2 V617F Mutation Analysis, Quantitative (%)?

JAK2 gene targeted mutation analysis in Blood or Tissue by

48726-4
Molecular genetics method Narrative
JAK2 gene.p.Val617Phe mutant/Normal in Blood or Tissue by
53761-3
Molecular genetics method
JAK2 gene p.Val617Phe [Presence] in Blood or Tissue by
43399-5
Molecular genetics method
JAK2 gene p.Val617Phe [Presence] in Bone marrow by Molecular
72333-8
genetics method
 Collect once. Use many.
Clinical care, public health reporting, quality management, clinical and
epidemiological research, etc…

📷 pagedooley | cc-by
75856-5
#Falls in past 1Y

66247-8
Sit to stand [30 sec]

8454-1
DBP - standing

8460-8
SBP - standing
If this, then that…

If {# Falls in last year} > 0

Then
initiate {gait, strength, balance evaluation}
Reporting / Analytics
% patients 65 years of age and older who were screened for future fall risk

75856-5 Number of falls in the past 12 months [Reported]

59460-6 Fall risk total [Morse Fall Scale]

66247-8 Sit to stand 30 seconds

52552-7 Falls in the past year [CMS Assessment]

83280-8 Has the patient had any falls since admission [CMS Assessment]

71949-2 Falls Behavioral Scale for Older People [FaB]

…
Same data for…
Informing clinical care
Population health analytics / registry
Electronic quality measure analysis
Observational/epidemiological research
A sample of LOINC-powered
informatics innovations
Hall PL, Marquardt G, McHugh DM, et al. Postanalytical tools improve performance of newborn screening by tandem mass spectrometry. Genet Med. 2014 Dec;16(12):889-95. Epub 2014 May 29. PubMed PMID: 24875301.
Based on the Argonaut FHIR profile
https://www.apple.com/healthcare/health-records/

https://support.apple.com/en-us/HT208647
New and Noteworthy
LOINC Groups
LOINC Groups
loinc.org/groups
A flexible, computable tool for rolling up groups of LOINC codes that can
be considered equivalent for a particular purpose
LOINC Groups content also
available via FHIR
Get a specific LOINC Group as a ValueSet

https://fhir.loinc.org/ValueSet/$expand?url=http://
loinc.org/vs/LG9568-9
https://loinc.org/groups/community/
 Come see LOINC Groups in action
AMIA 2018 Session
LOINC Groups: A novel tool for data aggregation
Monday Nov 5, 10:30 AM–12:00 PM
Yosemite A/B

📷 brett-sayer | cc-by-nd
Top 3 Tips for Using LOINC
Key principles for smart LOINCing
 Not all juice is worth the squeeze
What do you really need to standardize?

Pareto principle
A few tests account for most volume
70% of tests take 30% of mapping time

Vreeman DJ, Finnell JT, Overhage JM. A rationale for parsimonious laboratory term mapping by frequency. AMIA Annu Symp Proc. 2007 Oct 11:771-5. PMID: 18693941.
📷 elwillo | cc-by http://www.himss.org/news/interoperability-not-all-juice-worth-squeeze-0
 Go upstream
Map more efficiently and consistently

📷 Fishking_1 | cc-by
Trust, but verify
Don’t make assumptions…

No Specimen? Don’t guess.

Validate missing information in SOPs, package
inserts, or consulting experts

Got to have units (Qn) or look at sample answers (Ql)

Bonus Tip
 Bonus Tip:
Stay up to date

📷 Arul Irudayam | by-nd

LOINC recommends that
users update to the current
version within 90 days of its
publication.
 Identify Replacement Terms
Tools -> Find Local Terms Mapped to Deprecated LOINCs

Map when ready

Review commentary

Check the alternatives

 #
Other Updates to Your Terms

Your testing may have changed

Your codes may have changed

Watch changes to codes, names, or units
A journey, not a destination.

Across many INPC institutions, in

2 years after go live we saw half
as many new local terms appear as
what we started with.
Vreeman DJ, Stark M, Tomashefski GL, Phillips DR, Dexter PR. Embracing change in a health information exchange. AMIA Annu Symp Proc. 2008 Nov 6:768-72. PMID: 18999242
Take home lesson:
When clinical data is coded with LOINC, diverse IT
applications can understand and interact with it for
the benefit of many in the health ecosystem.

It’s your turn: begin.

 Happy LOINCing!

P.S. We’re both Regenstrief “Treasures” so come find

us when you’re playing the game
Q & A