Beruflich Dokumente
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RELMA
OrIn Search of the Missing LOINC
Laboratory LOINC Meeting December 2016
Disclaimer
The views and opinions expressed do
not necessarily state or reect those of
the U.S. Government, and they may
not be used for adver?sing or product
endorsement purposes.
Acknowledgements
LOINC Development Team
LOINC CommiLee
Supporters
Overview of LOINC
Reviewing new RELMA features!
Installing RELMA
SePng personal preferences
Loading a Local Observa1on File (LMOF)
Searching for a LOINC Term
Preparing LMOF for Mapping
Review of Map Screen Func1ons
SePng Search Limits
Mapping Local Terms to LOINC
Viewing LOINC Term Details
Proposing/SubmiPng New LOINC Terms
Expor1ng/Prin1ng Mapped Terms
Mapping your own LMOF data
2016 Regenstrief Institute and James Case
Levels of Interoperability
Basic allows data to be exchanged between
computer systems
Comparability
Meaning of the data is consistent when shared
among dierent par1es
when standard
e.g. criteria for diagnosis o^en diers from the criteria
terminologies are used
for repor1ng
Detailed General
General Detailed
The Problem
In a9emp1ng to arrive at the truth, I have applied
everywhere for informa1on, but in scarcely an
instance have I been able to obtain hospital
records t for any purpose of comparison. If they
could be obtained, they would enable us to
decide many other ques1ons They would show
[subscribers] how their money was being spent
[and] what amount of good was really being done
with it
Florence Nightingale - Notes on a Hospital, 1873
Test comparisons
What you see in the order list
Lab A
Lab B
Why LOINC?
Within one laboratory, local jargon terms
may be used which are usually well
understood between colleagues, but
would not be suciently widely known for
communica1on with the outside world.
U. Forsum et al., Pure Appl. Chem 72:555-745, 2000 Proper3es and Units in the Clinical
Laboratory Sciences Part VII. Proper3es and Units in Clinical Microbiology
2016 Regenstrief Institute and James Case
LOINC 101
Emphasis on Laboratory
LOINC
5193-8
Hepa??s B virus surface Ab
ACnc
Component
Property Measured
Pt
Timing
Ser
System
Qn
Scale
EIA
Method
Tes1ng instrument
Specic details about the specimen
Priority (e.g. STAT)
Where tes1ng was done
Who did the test
Test interpreta1on
Pricing or cost
Anything not part of naming the test
Things from other elds in an HL7 ar1fact
2016 Regenstrief Institute and James Case
Component/Analyte
The substance or en1ty that is measured,
evaluated, or observed
- Sodium
- Glucose
- Brucella sp. organism
- Inuenza A Virus an1gen
- Cytomegalovirus Virus an1body
- Lipids.Total
5193-8:Hepatitis B virus surface Ab:ACnc:Pt:Ser:Qn:EIA
2016 Regenstrief Institute and James Case
Component Structure
Analyte Name^Challenge^Adjustments
Formal analyte name
Calcium
Specify subanalytes
May have subclasses
Challenge
Two parts separated
by post
Adjustments
Coronavirus Ag
Calcium.ionized
Adjusted to pH 7.4
2016 Regenstrief Institute and James Case
Property
the most dicult LOINC axis
Property
the most dicult LOINC axis
Ra?o = mul1ple analytes from same system
MCrto: BUN/Crea1nine in serum
Rela?ve Ra?o = measures from dierent system
RelRto: Albumin.pericard d/Albumin.SerPl
2016 Regenstrief Institute and James Case
PR (obsolete) vs PRID
Timing*
The interval of 1me over which the observa1on or
measurement was made
Direct 1ming
Pt - at a point in 1me
12H - a twelve hour collec1on
24H - a twenty four hour collec1on
48H^mean
System
The system (context) or specimen type upon
which the observation was made.
Ser
Ser/Plas
Bld
Ur
Flu
Tiss
XXX
serum
serum or plasma
whole blood
urine
body fluid
tissue
specified elsewhere or unknown
System Structure
System^Super System
Super System
818-5:A Ag:ACnc:Pt:RBC^BPU:Ord:
54417-1:ABO+Rh group:Type:Pt:Bld^fetus:Nom:
Scale
Qn
Quantitative
continuous numeric
can have operators (<,>)
Ord
Ordinal
Ranked set (1+, 2+, 3+)
Nom Nominal
unranked collection
Taxonomy (e.g. bacteria)
Nar
Narrative
Scale (Special)
OrdQn Ordinal or Quan1ta1ve
Method
Only needed if interpreta1on aected
Agglu1na1on
Enzyme Immunoassay
Probe with target amplica1on
5193-8:Hepatitis B virus surface Ab:ACnc:Pt:Ser:Qn:EIA
2016 Regenstrief Institute and James Case
Component|System
Separate download
What is in LOINC?
Content
Term structures
Submi9ed units, Example UCUM units
Synonyms
Answer lists (increasing number)
Text descrip1ons links to info sources
about individual tests
Panel structures
Foreign language transla1ons
RELMA
Purpose of Tutorial
Eliminate need to read the Users Manual
Become familiar with RELMA features
Provide some insight into mapping 1ps/pi{alls
Help begin the mapping process for your
ins1tu1on
Hang with some really cool folks
RELMA Functions
LOINC les and indexes
Manual and automated mapping func1ons
RELMA tools transform local words in local le
h9p://loinc.org/terms-of-use.
CoreComponent
Supersystem
Timemodier
2016 Regenstrief Institute and James Case
RELMA Highlights
Browse-able hierarchies of LOINC parts
Display search results in tree view
Enhanced details view of terms/parts
References
Descrip1ons
Sample units
Installing RELMA
Installation Steps
Requires Windows (or VM on a Mac)
Make sure you have enough free disk space!
2Gb is recommended
File Locations
Database and Ancillary Files
C:\Users\Public\Public Documents\RELMA\
Sample les
C:\Users\Public\Public Documents\RELMA\Samples\
Running RELMA
Version 6.16
Copyright Screen
All Spanish!
File Locations:
(See prior slide for location)
Startup Screen Preference
Importing Local
Terms into RELMA
Ba9ery/Panel Code
Ba9ery/Panel Descrip1on or Name
*Local Code
*Test Descrip1on or Name
**Units
Example Values
Laboratory Sec1on
Local Code
Local Descrip1on
Units (highly recommended)
2016 Regenstrief Institute and James Case
Manual Enter/Edit
View/Add/Edit Local Terms
Edit\Add\Delete Terms
Export Terms
User assigned tags
Text alignment option
Delimiters supported:
Tab, comma, semicolon, bar (|)
BUBPLAG
BUBONIC PLAGUE RRT PCR
Import Button
Fields Segregated
Ready to Import
Minimum assignments
Tag terms
Import tags
You can include tags in your import le
that allow you to categorize your local
terms
Import func1on allows one or more Tag
with assignments
Imported tags
OBR ID
OBR descrip1on
OBX ID
OBX descrip1on
Sample of results with
Real values
Units
Abnormal ags
Normal ranges
2016 Regenstrief Institute and James Case
Skip import of
sample values
Name the Local Term
File (working set)
Import_Sample_OBR.txt
Sample_HL7.HL7
WARNING on Ignore: If
selected that term
becomes permanently
unavailable for searching
Term Substitution
Comprehensive Search
Only Tool
Search Window
Help File
Enter Search
Terms
Limit to
SpeciZic Units
Use different
logic
Restrict Limits
Search Window
Context Menu
Restricting to Common
labs reZines further
Large number of
results
Keyword
ComponentWordCount
restricts word count
Answerlist details
Welcome Screen
Select the subset of terms to work with:
All
Mapped
Unmapped
Set your Search Limits
Bu9on
Customizable grid
View details of LOINC term
New! Add searchable tags to local term
Sort by column
Click column
Custom Sort
Mapping Screen
View or edit local term
User assigned tags
ConZigure Grid
Select elements to display
Reorder grid elements
Begin a search
(or hit enter)
EEK! Whatll I
do?!
Click to
show words
used in
search
2016 Regenstrief Institute and James Case
Use term
checkbox
Number of LOINC
terms containing
keyword
Battery terms
included in
search
Number of
matching
records found
Number of
matching
records found
Match units
selected
Navigate through
the local terms
Navigate to Functions
from Mapping Page
Tree View
Results displayed hierarchically
Tree View
Cannot map to
terms
representing
LOINC parts
(or doubleclick)
If comments
option is selected,
prompt appears
LOINC Term
Assigned
Panel Children
Output Options
Include
column headers
Save ConZiguration
and/or Export
LOINC code
AnswerListID
Answer String
Answer tab
More on Searching
Search Screen
Example
Deni?on
Inuenza virus A
AND
Morphine AND
Opiates
OR
Inuenza OR
Parainuenza
NOT
Gluc?se
(glucose,glucase)
Gluc*se
(glucose,
glucuronidase, etc.)
Search QualiZiers
Exclude Glucosidase
Descrip?on
( )
Fieldname:
Fieldname:()
{}, []
100 terms
33 terms
19 terms
2016 Regenstrief Institute and James Case
8 terms
2016 Regenstrief Institute and James Case
Limiting Searches
Toggle Buttons
Search Constraints
Attribute trees
Expanded predeZined,
general search constraints
Specimen
constraints
CSF
Enter default
Specimen
Exclude laterality
Exclude laterality
Laterality terms
Restrict to
common orders
Large number of
Common orders
candidates
rank
Methodless Terms
Restriction
Only Methodless
Terms Appear
2016 Regenstrief Institute and James Case
Differ in one or
more components
Conditional Methodless
More terms
returned
No method-less
term; all shown
Order or Observation
preference
Four top-level
branches
Tree Navigation
Buttons
Four top-level
branches
Tree Navigation
Buttons
System Hierarchy
Component Hierarchy
Click on details for more
information about the
selection
Extremely fast
Include and exclude criteria
Par1al string matching (using wildcards)
Vreeman DJ, Finnell JT, Overhage JM. A Rationale for Parsimonious Laboratory Term
Mapping by Frequency. AMIA Annu Symp Proc. 2007;:771-775.
2016 Regenstrief Institute and James Case
Common in Microbiology
2016 Regenstrief Institute and James Case
Excel Export
Export Terms to
Delimited File
Select Delimiter
Other RELMA
Features
2016 Regenstrief Institute and James Case
Double-click
panel test to see
components
Clinical Panels
35089-2, 35090-0
HIPAA Attachments
Select Propose a
new LOINC
Required Zields in
red
Navigate through
proposed terms
301-555-1314
NIH/NLM
301-555-1315
James.case@mail.nih.gov
X
X
X
Choose whether to
send or postpone
Direct submission
via web
All required
components Zilled in
The code is
from LOINC
The code is
from SNOMED
OBX-5: Data
A code for L.
monocytogenes
Q and A Session
Exercise
Map your own data