Evoluzione e interoperabilit tecnologica del Fascicolo Sanitario Elettronico Sorrento, Italy

a universal catalog of laboratory and clinical observations

Daniel J. Vreeman, PT, DPT, MSc
Assistant Research Professor, Indiana University School of Medicine Associate Director for Terminology Services, Regenstrief Institute, Inc

2013.10.11

loinc@loinc.org

2013

Strong evidence that smart EHRs can improve healthcare quality and efciency
I can help!
Chaudhry B, Wang J, Wu S, et al. Systematic review: impact of health information technology on quality, efciency, and costs of medical care. Ann Intern Med 2006;144.

Patients move faster and further than their health information

Fundamental challenge:
Local systems have different ways of identifying the same concept. And, things that appear to be the same really are not.

What you see in the test catalog

Lab A
Test Name: Lyme Disease Serology

Same or Different?
Lab B

Test Name: Lyme Disease Antibody

What you see in the test catalog

Lab A
Test Name: Lyme Disease Serology Measures: B. burgdorferi Ab IgG Method: ELISA Scale: quantitative e.g.: Titer 1:40

Same or Different?
Lab B

Test Name: Lyme Disease Antibody Measures: B. burgdorferi Ab IgM Method: Immune blot Scale: qualitative e.g.: Positive

LOINC Code = 5062-5

LOINC Code = 6321-4

Only way to corral the innite variations is with standards

photo via pfarrell95

Logical Observation Identiers Names and Codes

A universal code system that facilitates exchange, pooling, and processing of results

MEASUREMENTS R US
photo via puuikibeach

Born in 1994 by Regenstrief Institute. Worldwide distribution at no cost. Copyrighted, but open license. Released twice per year.

Born in 1994 by Regenstrief Institute. Worldwide distribution at no cost. Copyrighted, but open license. Released twice per year.
Its free, but invaluable.

Born in 1994 by Regenstrief Institute. Worldwide distribution at no cost. Copyrighted, but open license. Released twice per year.
Its free, but invaluable.

Just dont use it to make another standard!

10,000
LOINC Codes Only Lab LOINC Codes

20,000

30,000

40,000

50,000

60,000

70,000

80,000

LOINC Codes Over Time by Release

laboratory terms only

not a lab cliff, just no data available

4 5/ /24 6/ 24/ /19 2 1 9 6/ 3/ 99 5 | 2 1 5 1 7/ 8/ 99 | 1 .0 1 1 5 . 9/ 4/ 99 | 1 0a 12 15 1995 | .0b /2 /19 5 1.0 4 8/ /2 1/1 95 | 1. c 0 2 12 9/ 8/1 995 | 1. d /3 19 99 | 1 0e /1 96 6 .0 1 9 | |1 f 10 /8/ 96 1.0 .0g /9 19 | 1 h( . 2 / 5/ 19 9970h( ) 2/ 1/197 | 1 3) 7/ 12 99 | 1. .0i 0 2 / 8/ 3/ 19 8 | 1 j-a 6/ 19 99 .0 2/ 19999 | 1. k 6/ 4/ 9 | 1 0l 13 20 | 1 .0m 1/ /2 00 .0m 1/ 1/ 00 | 1 a 31 20 0 | .0 7/ /2 01 1.0 n 1 0 1/ /2 01 | 2.00 1 0 2/ /2 01 | 2.00 2/ 1/ 00 | 2 1 19 20 2 | .0 8/ /2 02 2.03 1 0 9/ /2 02 | 2.04 1 0 5/ /2 02 | 2.05 10 1/ 00 | 2 6 /1 20 2 | .07 1/ /2 03 2.0 1 0 2/ /2 03 | 2.08 12 1/ 00 | 2 9 2 4 . 12/1/ 00 | 2 10 /1 20 4 | .11 6/ /2 04 2.1 12 1/ 00 | 2 2 /1 20 4 | .13 6 /2 0 2 12 /1/ 005 | 2.14 /2 20 5 | .1 6/ 1/ 06 2. 5 12 21 20 | 2 16 /0 /2 06 .1 7/ 3/ 00 |2. 7 1 2 7 1 1/ 0/ 00 |2. 9 07 10 20 7|2 21 0 12/06/20 8|2.22 /3 /2 09 .2 2/ 0/ 00 |2. 4 2 2 9 2 6/ 6/ 00 |2. 6 12 15 20 9|2 27 1 06/29/20 0|2.29 1 12/30/20 0|2.30 /3 /2 10 .3 6/ 0/ 01 |2. 2 12 30 20 1|2 34 1 06/30/20 1|2.36 /2 /2 12 .3 9/ 01 |2 8 20 2| .40 13 2.4 |2 2 .4 4

Data standards are like telephones. They require a critical mass of users before they become useful.
- Clem McDonald, MD 1998

photo via iboy_daniel

26,000+ users in 156 countries

loinc.org members
25,000 20,000 15,000 10,000 5,000 0

8 1 2 8 1 2 3 9 0 9 0 0 1 1 0 1 1 1 0 1 0 1 / / / / / / / / / / / 6/1 12/1 6/1 12/1 6/1 12/1 6/1 12/1 6/1 12/1 6/1

loinc.org members
25,000 20,000 15,000 10,000 5,000 0

Doubled in 19 months!

18 new members per day 550 new members per month

8 1 2 8 1 2 3 9 0 9 0 0 1 1 0 1 1 1 0 1 0 1 / / / / / / / / / / / 6/1 12/1 6/1 12/1 6/1 12/1 6/1 12/1 6/1 12/1 6/1

LOINC Translators

22 organizations. Currently translations into 17 variants of 11 languages

Vreeman DJ et al. Enabling international adoption of LOINC through translation. J Biomed Inform 2012 Aug;45(4):667-73. doi: 10.1016/j.jbi.2012.01.005. Epub 2012 Jan 21. PubMed PMID: 22285984

Vreeman DJ et al. Enabling international adoption of LOINC through translation. J Biomed Inform 2012 Aug;45(4):667-73. doi: 10.1016/j.jbi.2012.01.005. Epub 2012 Jan 21. PubMed PMID: 22285984

Adopted as National Standard

Australia Austria Belgium Brazil Canada Cyprus Estonia Finland France Germany Iceland Mexico Mongolia The Netherlands New Zealand Philippines Portugal Rwanda Slovakia Slovenia Spain Thailand Turkey United States

In USA, major driver of eHealth standards adoption is

EHR Incentive Program

a.k.a. Meaningful Use
Blumenthal D, Tavenner M. The "meaningful use" regulation for electronic health records. N Engl J Med. 2010 Aug 5;363(6):501-4. Epub 2010 Jul 13. PubMed PMID: 20647183.

Stage 1
2011-2012 Data capture and sharing

Stage 2
2014 Advance clinical processes

Stage 3
2016 Improved care outcomes

progressive requirements for data standards

Stage 2
starting 2014

LOINC adopted for:

View, download, transmit data to third party 2. Cancer case reporting to state registry 3. Send/receive electronic lab results in ambulatory settings 4. Provide a care summary at care transition 5. Provide clinical summaries for patients 6. Submit reportable lab results to public health
1.

Lab reporting to EHRs

Use in Quality Measures

LOINC Adopted For

Patient Characteristics [Non-lab] Diagnostics studies Patient experience Family history Functional status Health record component Interventions (that produce an assessment or measured results) Laboratory tests Physical exam Patient preference Risk evaluation System resources (healthcare resources)

An Example Quality Measure

National Committee for Quality Assurance

Diabetes: Hemoglobin A1c Poor Control

Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period.

Find HbA1c in the EHR with LOINC

photo via milos milosevic