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Using

RELMA
OrIn Search of the Missing LOINC
Laboratory LOINC Meeting December 2016

James T. Case DVM, PhD, FACMI


Health Program Specialist, SNOMED CT
National Library of Medicine
Head of Terminology, IHTSDO

2016 Regenstrief Institute and James Case

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.

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Acknowledgements
LOINC Development Team

Clem MacDonald, Dan Vreeman, Ka1e Allen, Theresa


Prichard, Bri9ney Reid, Jami Deckard, Swapna
Abhyankar, Sara Armson, Mary Zabriske, Susan Korsak,
Steiner Voight

RELMA Development Team

John Hook, Shahid Khokhar, Michele Smith, Tim


Briscoe

LOINC CommiLee
Supporters

NLM, Regenstrief Ins1tute, Regenstrief Founda1on,


APTA, RSNA, the LOINC Premium Members and Donors
2016 Regenstrief Institute and James Case

What will we cover today?

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
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Why are we doing this?


Goals of Health Information Standards

Interoperability the ability to exchange


informa1on between organiza1ons
Comparability the ability to ascertain the
equivalence of data from dierent sources
Data Quality the measurement of
accessibility, completeness, accuracy and
precision (and more)

2016 Regenstrief Institute and James Case

Levels of Interoperability
Basic allows data to be exchanged between
computer systems

Word processing documents, text messages

Func?onal describes the standard syntax


(format) of the data

Document templates, forms, data structures


Message standards

Seman?c requires use of standardized


content (vocabularies) within the data
structure
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Comparability
Meaning of the data is consistent when shared
among dierent par1es

Erysipelas Human skin disease; Streptococcus Grp A


Erysipelas Animal Sep1cemia/derma11s; Erysipelothrix
rhusiopathiae

Common terminology required

Should work in the background

Words are not enough

Codes uniquely iden1fy terms


Vocabulary specialized, precise terms that remove
ambiguity
Ontology describes nature of en11es and their rela1ons
Classica1on groups related terms by category
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Potential Uses of Health Data are


Constrained by Data Quality Factors
Data quality issues

Dierent for client/pa1ent communica1ons vs.


clinical decision support vs. epidemiological
analysis
This is a problem even
O^en constrained by external forces

when standard
e.g. criteria for diagnosis o^en diers from the criteria
terminologies are used

for repor1ng

Unidirec1onal eect of data consolida1on

Detailed General
General Detailed

e.g. SNOMED CT to ICD-10 vs. ICD-10 to SNOMED CT


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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

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Test comparisons
What you see in the order list

Lab A

Lab B

Test Name: Lyme Disease Serology


Measures: B. burgdorferi Ab IgG
Method: ELISA
Scale: quan?ta?ve
e.g.: Titer 1:40

Test Name: Lyme Disease An?body


Measures: B. burgdorferi Ab IgM
Method: Immune blot
Scale: qualita?ve
e.g.: Posi?ve

LOINC Code = 5062-5

LOINC Code = 6321-4

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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
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LOINC 101
Emphasis on Laboratory
LOINC

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Anatomy of a LOINC Term


5193-8:Hepatitis B virus surface Ab:ACnc:Pt:Ser:Qn:EIA
LOINC Code

5193-8
Hepa??s B virus surface Ab
ACnc

Component
Property Measured

Pt

Timing

Ser

System

Qn

Scale

EIA

Method

There are six major LOINC axes


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NOT part of a LOINC Name


Reason for the test (why it was ordered or the disease it
diagnoses)

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
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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
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Component Structure

Analyte Name^Challenge^Adjustments
Formal analyte name

Calcium

Specify subanalytes
May have subclasses

1H post 100 g Glucose PO

Challenge
Two parts separated
by post

Adjustments

Coronavirus Ag
Calcium.ionized

<time delay>post<challenge type>

Adjusted to pH 7.4
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Property
the most dicult LOINC axis

The characteris1c or a9ribute of the analyte that is


measured, evaluated, or observed
Major Categories

Mass: Observa1ons reported with mass (milligrams, grams, etc.) in the


numerator of their units of measure
Substance: Observa1ons reported with moles or milliequivalents in the
numerator of their units of measure
Cataly?c ac?vity: Observa1ons that report enzyma1c ac1vity
Arbitrary: Results that report arbitrary units in the numerator of their units
of measure (slowly being re1red)
Threshold: Results that represent the rela1on between a value and some
established limit or cut-o
Number: Counts
5193-8:Hepatitis B virus surface Ab:ACnc:Pt:Ser:Qn:EIA

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Property
the most dicult LOINC axis

Combine Major Categories with Subtypes for Full Property

MCnc mass concentra1on (mass/unit vol; e.g. mg/dL)


MCnt mass content (mass/unit mass; e.g. mg/Kg)
NCnc number concentra1on (number/unit vol; e.g. num/mL)
TmStp 1me
CCnc cataly1c concentra1on (ac1vity; e.g. kat/L)
Prid presence or iden1ty
Imp impression/interpreta1on
Find subjec1ve or objec1ve observa1on
Type Kind-of
5193-8:Hepatitis B virus surface Ab:ACnc:Pt:Ser:Qn:EIA

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Common Property Issues


Fraction versus Ratio
Frac?on = Part/Whole
NFr: % Eosinophils / leukocytes
SFr: % HGB which is A2


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
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Important property information


ACNC always intended to be a placeholder

For P/N results, changed to Threshold


Addi1onal migra1ons occurring gradually
LOINC IDs being retained

Flavors of Threshold Property

ThrSCnc Threshold Substance Concentra1on


ThrMCnc Threshold Mass Concentra1on
ThrACnc Threshold Arbitrary Concentra1on
PrThr Presence or threshold (new!)

PR (obsolete) vs PRID

Presence or absence of an analyte now represented as PrThr


For nominal results, property is s1ll PRID

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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

Indirect 1ming (examples)

Stdy dura1on of study


Enctr dura1on of encounter
RptPeriod Repor1ng period
*non-Pt 1mings are usually associated with Rate Property
5193-8:Hepatitis B virus surface Ab:ACnc:Pt:Ser:Qn:EIA

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Time Aspect ModiZier

Op1onal subpart of the 1me component


Qualica1on of dened 1mes (not Pt)
Includes Min, Max, First, Last, Mean
Example: Mean heart rate over 48 heart
rate monitoring

48H^mean

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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

photo via AlishaV

5193-8:Hepatitis B virus surface Ab:ACnc:Pt:Ser:Qn:EIA



2016 Regenstrief Institute and James Case

System Structure
System^Super System

Super System

Pa1ent is the default


Used to indicate

blood product unit


bone marrow donor
fetus

818-5:A Ag:ACnc:Pt:RBC^BPU:Ord:
54417-1:ABO+Rh group:Type:Pt:Bld^fetus:Nom:

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photo via Xurble

Scale
Qn

Quantitative
continuous numeric
can have operators (<,>)

Ord

Ordinal
Ranked set (1+, 2+, 3+)

Nom Nominal

photo via puuikibeach

unranked collection
Taxonomy (e.g. bacteria)

Nar

Narrative

5193-8:Hepatitis B virus surface Ab:ACnc:Pt:Ser:Qn:EIA



2016 Regenstrief Institute and James Case

Scale (Special)
OrdQn Ordinal or Quan1ta1ve

Primarily used for an1microbial observa1ons e.g.


MIC reported as resistant, intermediate, suscep1ble
or as the mm diameter of the inhibi1on zone
Use is discouraged in other contexts

Mul1 structured text globs

e.g. chromatography output


Use is discouraged

Doc Clinical documents


Set Clinical a9achments (headers)
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Method
Only needed if interpreta1on aected

Dierent normal ranges


Test sensi1vity/specicity

Generally listed at the generic


level

Agglu1na1on
Enzyme Immunoassay
Probe with target amplica1on
5193-8:Hepatitis B virus surface Ab:ACnc:Pt:Ser:Qn:EIA

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LOINC Parts and Hierarchies


LOINC Class

One arbitrarily assigned per term

Hierarchy for each LOINC axis


Derived mul1-axial hierarchy

Component|System
Separate download

LOINC parts are NOT intended for


standalone use
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Mapping Terms to LOINC


Things to Remember

The thing ordered is not always the thing measured:

Blood Culture live organism(s) iden1ed


VDRL Treponema pallidum Ab
Urinalysis lots of dierent things

You must know the specics of the component being


tested for (what actually being measured?)
The ques1on (what am I measuring? e.g. Glucose) is
not the answer (e.g. 90 mg/dl)

You are mapping the ques1on, not the answer!

Need to get the observa1on/result boundary correct.

Sample values help substan1ally


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What is in LOINC?
Content
Term structures
Submi9ed units, Example UCUM units

aiming toward preferred units sor1ng

Synonyms
Answer lists (increasing number)
Text descrip1ons links to info sources
about individual tests

Panel structures
Foreign language transla1ons

And much more


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RELMA

Regenstrief LOINC Mapping Assistant

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Download of latest version


The latest version of the installa1on le
may be downloaded from:
h9ps://loinc.org/relma

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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

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RELMA Functions
LOINC les and indexes
Manual and automated mapping func1ons
RELMA tools transform local words in local le

User creates le of local term/name and codes

Assigns LOINC term to local test/ba9ery code


Common tests subset to speed mapping
Context sensi1ve hierarchies for local use.
Flexible Google-like search func1ons
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New in Version 6.14 (June 2016)


RELMA terms of use updated.

h9p://loinc.org/terms-of-use.

Answer List Search two columns added

"score" and "descrip1on".

LOINC PART descrip1ons in "detail" pages


enhanced.

Descrip1ons reviewed and tailored for relevancy and


usefulness
Includes the PART name and a hyper-link to the
"detail" page for the PART itself.
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New in Version 6.14 (June 2016)


Menu changes:

"Check the Test Names in Local Term Submission


renamed to "Check the Test Names in Local Term
File" for consistency.
"Check the Units names in Local Term Submission"
renamed to "Check the Units names in Local Term
File
"Check the Test Names in Local Term File" and
Dene Word Subs1tu1ons for Local Term
Vocabulary" func1ons enhanced to support mul1word subs1tu1ons.
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New in Version 6.14 (June 2016)


"Dene Word Subs1tu1ons for Local Term
Vocabulary" re-factored

Re-sizable and more user friendly.

Double clicking a row in the "View all local


terms" grid opens the local term editor.
Filtering user tags in the "View all Working
Set" grid now supports a logical 'NOT'
operator.

Allows display of local codes that do NOT have one


or more specic tags.
2016 Regenstrief Institute and James Case

New in Version 6.14 (June 2016)


Can now map local terms directly on the "View
all Working Set Terms" grid

"Map to LOINC bu9on.

New "Comment" bu9on on mapping screen.

Mapping comments stored in the COMMENTS eld for the


local terms.

HIPAA a9achments display modied to support


the new version of C-CDA (R2.1) documents.

Select the C-CDA version from the drop down list at


the top of the screen.
2016 Regenstrief Institute and James Case

New in Version 6.14 (June 2016)


New search restric1on on general
"Hierarchy & Search limits" screen.

Checking the "Exclude non-rou1ne challenge tests


op1on eliminates challenge tests not in the
CHAL.ROUTINE LOINC class from the search results.
Alterna1vely: -nonrou1nechallenge:true.

New command line search elds

CoreComponent
Supersystem
Timemodier
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New in Version 6.17 (Dec 2016)


LOINC details: "Created On" replaced with "First
Released in Version" eld.
"HIPAA A9achments" screen has been
enhanced.

Addi1on of a new tab "Valid A9achment Requests"

Lists LOINC terms payers may send when reques1ng


addi1onal informa1on.
Labels updated for consistency with HL7 terminology.
Pressing F1 key on page shows help specic to the HIPAA
a9achments.

"Common Tests" search restric1on added


"Clinical Terms Only" op1on.
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LOINC Web Site

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Whats available to download?

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RELMA Highlights
Browse-able hierarchies of LOINC parts
Display search results in tree view
Enhanced details view of terms/parts

References
Descrip1ons
Sample units

Empirically-derived common test list


Empirically-derived common order list
Special features for panels/forms
Enhanced export/copy-paste op1ons
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Installing RELMA

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Installation Steps
Requires Windows (or VM on a Mac)
Make sure you have enough free disk space!

2Gb is recommended

From CD - Start Run <drive>:\RELMA\Setup


Specify installa1on directory

Life will be easier if you accept the default

Two database les installed

RELMA.MDB LOINC Terms Database


LMOF3.MDB Local Master Observa1on File

Two sample les included


Run from Start (All) Programs Regenstrief RELMA
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File Locations
Database and Ancillary Files

C:\Users\Public\Public Documents\RELMA\

Sample les

C:\Users\Public\Public Documents\RELMA\Samples\

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Running RELMA
Version 6.16

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Copyright Screen

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Join the LOINC Community

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Main Menu/Welcome Screen

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Set Preferred Language


Click File, Set Preferred
Language

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Select Linguistic Variant(s)


Selecting a translation may
require indexes to be built

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LOINC Terms with Spanish Linguistic Variant

All Spanish!

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Setting User Preferences

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Set User Preferences


Select User Preferences
From the File Menu

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Set User Preference Dialog


Local Term Backup Tab

File Locations:
(See prior slide for location)
Startup Screen Preference

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User Map Screen Preferences


Click Map Screen Tab
Auto create search terms
Include/Exclude Battery
Terms
Add comments on Mappings

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User Detail Pages Preferences


Download detail pages from LOINC.org

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Request Submission Preference


Preferred method of request
submission

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Local Backup Preferences

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Importing Local
Terms into RELMA

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5 Ways to Load LMOF Files


Direct entry into LMOF from within RELMA (painful)

Handy for individual entries/edits

Create an Access table that mimics the LMOF structure


(less painful but tedious)
Create a delimited ASCII le from your local test
catalog (good choice)
Import Excel le
Load directly from HL7 v2.x messages

Pulls data from OBR and OBX segments


Stores NTE segment data
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Constructing a Local Dataset


Create extract of your test catalog with:

Ba9ery/Panel Code
Ba9ery/Panel Descrip1on or Name
*Local Code
*Test Descrip1on or Name

Include Method if Important

**Units
Example Values
Laboratory Sec1on

*Required for import


**Strongly recommended for import
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Creating Delimited ASCII File


RELMA cant parse free text

Need to create separate elds

Can use any of these delimiters

Tab, Semicolon, Comma, Space


Can dene your own

Fields can be in any order


Minimum required elds

Local Code
Local Descrip1on
Units (highly recommended)
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Entering New Local Terms


into RELMA

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Manual Enter/Edit
View/Add/Edit Local Terms

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Edit Term Dialog

Edit\Add\Delete Terms
Export Terms
User assigned tags
Text alignment option

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Print Preview List

Export Local Term File

Export to Microsoft Excel


or Text File
Export assigned tags

Delimiters supported:
Tab, comma, semicolon, bar (|)

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Add Local Term


MICRO

BUBPLAG
BUBONIC PLAGUE RRT PCR

Click to Add to Current


Working File

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Search Local Term File

Tags panel only appears if


tags have been assigned
Enter Keyword from any
Open or close tag list
Field
Return to Full List
Filter options
include logical not

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Steps to Import Local Terms


1. Click Import Local Terms Bu9on from Main Menu
a) File>Import Local Terms from Delimited File or Excel
Spreadsheet

2. Locate your local terms text le


3. Name your Working Set (Mandatory)

a) LMOF database can contain mul1ple work sets

4. Dene default sec1on (Op1onal)


5. Iden1fy le delimiter
6. Assign elds to LMOF a9ributes
a)
b)

Ignore elds you dont need


Combine elds if needed

7. Check Case-sensi1ve if needed


8. Click Import.
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Example Tab-Delimited File

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Importing Local Files


Select - Import Local
Terms from Delimited
File or Excel Spreadsheet

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Navigate to File Location


Select File and Click Open
Sample Ziles stored in
RELMA Directory

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Open File in RELMA


Name your working set.
RELMA allows multiple sets in
LMOF database

Select your delimiter

Import Button

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Fields Segregated

Assign working set name

Assign LMOF Attribute

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Working set import


LOINC Workshop OBR

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Ready to Import
Minimum assignments

Tag terms

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Now you can click the


Import button!

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

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Tagged local terms

Imported tags

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Post-Processing of Local File


A^er import, RELMA Searches for terms
(words) that it does not recognize
Stored in a le for future reconcilia1on

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Importing Excel Zile

Excel Ziles now appear


along with text Ziles

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Excel format for import

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Change Local Term File


Select the Working Set
Current mapping status

Can delete local term set; not


the active one

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Alternative Pragmatic Way


Use large set of HL7 messages
Automa1cally make dataset of:

OBR ID
OBR descrip1on
OBX ID
OBX descrip1on
Sample of results with

Real values
Units
Abnormal ags
Normal ranges
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Generate Local term Zile from HL7 messages

Select Import Terms from


HL7 File

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Select File to Import

Select HL7 File

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Specify HL7 File Name and Sample Size

Skip import of
sample values
Name the Local Term
File (working set)

Select the number of


sample values
Select which codes to store

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HL7 Messages Data Statistics

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New Terms added to LMOF

Click on Edit Term to see


Sample Data

New Battery Code

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Sample Results for Observation


New Test Code

Sample Values from


Messages

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Lenny LOINC says:


Load the Sample Files
Into RELMA now!
Import the two sample les
provided

Import_Sample_OBR.txt

Contains ba9ery code and


descrip1on

Sample_HL7.HL7

Contains test code and


descrip1on and sample values

Create 2 working sets


Load your personal data set
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Cleaning your data

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Preparing your Data for Mapping


Improve mapping success by:
Expanding abbrevia1ons
Standardizing colloquial terms
Ignoring administra1ve terms
Standardizing 1me references

Can be done prior to impor1ng


Be9er to use tools built into RELMA
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RELMA Cleaning Tools


Use this tool to edit
unknown terms
Only available if no
language variant selected

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Review Unknown Local Terms


May Re-Scan File for
Unknown Terms

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Replace Local Terms

Assign LMOF Attribute


Replacement Options

WARNING on Ignore: If
selected that term
becomes permanently
unavailable for searching

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RELMA Cleaning Tools


Use this tool to make
global substitutions

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Term Substitution

Save this global substitution


for only this working set
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Lenny LOINC says:


Begin to clean your
data now!

Using the OBR sample le or


your own data, take 15-20
minutes to clean up these
unrecognized terms

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Searching for LOINC Terms

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Comprehensive Search
Only Tool

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Search Window
Help File

Enter Search
Terms

Limit to
SpeciZic Units

Use different
logic

Restrict Limits

New Clinical terms only option

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Search Window

Common Tests selected

Common Tests rank

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RELMA Search HelpZile

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Context Menu

Right click to bring


up context menu

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Search function Max words

Restricting to Common
labs reZines further
Large number of
results

Keyword
ComponentWordCount
restricts word count

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Search function - Answerlist

Restricting to terms that


have associated answer lists

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Answerlist details

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Advanced search syntax


Paneltype
Categorizes LOINC panel term as Panel, Organizer or
Convenience group

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Advanced search syntax


LForms
This true/false eld indicates whether or
not the LOINC term is available for viewing
in the LForms data widget tool.

Restricting to terms that


have answer lists

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Lforms widget demo


Note: You must be logged in to access this demo

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Advanced search syntax


AssociatedObservations
Addi1onal terms that are related to a order
term.

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Mapping Local Terms

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Mapping Local Terms


Select your Working Set to Map
File>Map local terms to LOINC
Select Map Local Terms to LOINC from

Welcome Screen
Select the subset of terms to work with:
All
Mapped
Unmapped
Set your Search Limits

Set Search Limits

Bu9on

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Standard Mapping Window Features

Customizable grid
View details of LOINC term
New! Add searchable tags to local term
Sort by column

Click column
Custom Sort

Print or export results grid


Spell check squiggly line to signify words
not known to RELMA
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Mapping Screen
View or edit local term
User assigned tags

Enter local term number

Quick select button list


New: Comment button

Custom Grid ConZiguration

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ConZigure Grid
Select elements to display
Reorder grid elements

Visually resize elements


Reset Default ConZiguration

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Quick choice buttons

Viewing LOINC term detail

2016 Regenstrief Institute and James Case

View Local Term Details


Can scroll down a single
formatted page
Select level of detail to
display

Can scroll through


returned subset of
terms

Change text size

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Details Text Size


Select text size

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Select detail display level

Select level of detail to


display

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Standard Mapping Screen

Begin a search
(or hit enter)

EEK! Whatll I
do?!

2016 Regenstrief Institute and James Case

Standard Mapping Screen

Click to
show words
used in
search
2016 Regenstrief Institute and James Case

Initial Mapping Results

Use term
checkbox

Number of LOINC
terms containing
keyword

2016 Regenstrief Institute and James Case

Battery terms
included in
search

Revised Mapping Results

Number of
matching
records found

2016 Regenstrief Institute and James Case

Re-revised Mapping Results

Number of
matching
records found

Match units
selected

2016 Regenstrief Institute and James Case

Standard Mapping Screen

CANINE DISTEMPER VIRUS IF

Enter keywords here


Clear all
input Zields

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Standard Mapping Screen

Navigate through
the local terms

2016 Regenstrief Institute and James Case

Tabbed Access to Functions

Navigate to Functions
from Mapping Page

Switch between Grid and


Tree Views

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Tree View
Results displayed hierarchically

Dened by the mul1-axial hierarchy in search


restric1ons (covered later)

Map to a term in tree by clicking Map bu9on


or double clicking term

Only to rows that have LOINC Codes

2016 Regenstrief Institute and James Case

Tree View
Cannot map to
terms
representing
LOINC parts

Can map to terms


with LOINC Codes
Tree Navigation
Buttons

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Assigning a LOINC Map

Click Map Button


Highlight correct
term

(or doubleclick)

2016 Regenstrief Institute and James Case

Adding Mapping Comments

Check with Frank in Chemistry

If comments
option is selected,
prompt appears

2016 Regenstrief Institute and James Case

Assigning a LOINC Map

LOINC Term
Assigned

2016 Regenstrief Institute and James Case

View Panel Children

Select View Panel Children


from context menu
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Panel Children

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ConZigure Export Options

Output Options
Include
column headers

Save ConZiguration
and/or Export

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Excel Export Format

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Linked answer lists


Adds answer list IDs to the answer tab of a
panel export
Allows linkage using the AnswerlistID with
the LOINC codes and the answer to see
which answers go with a specic LOINC

2016 Regenstrief Institute and James Case

Search for a panel and export panel details

Search for panel or


LOINC code

Export the full panel


structure

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Detailed answer data

LOINC code

AnswerListID

Answer String

Answer tab

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More on Searching
Search Screen

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Basic Search Syntax


Special
Character(s)

Example

Deni?on

Inuenza virus A

Linked terms must appear together

AND

Morphine AND
Opiates

Both terms must appear in the search result


term

OR

Inuenza OR
Parainuenza

Either or both terms must appear in the


search result term

NOT

Inuenza NOT equine

Excludes terms with the word following the


NOT. Cannot be used alone.

Gluc?se
(glucose,glucase)

Subs1tutes a single character in the string.


Cannot be used as the rst character; cannot
be used in phrases

Gluc*se
(glucose,
glucuronidase, etc.)

Subs1tute mul1ple characters in the string.


Cannot be used as the rst character; cannot
be used in phrases

2016 Regenstrief Institute and James Case

Search QualiZiers

Detailed help available


Includes Glucuronidase,
Glucosidase,
Glucosylceramidase, etc.

2016 Regenstrief Institute and James Case

Combining Search Terms

Exclude Glucosidase

Reduced number of terms

2016 Regenstrief Institute and James Case

Advanced Search Syntax


based on Google-like search syntax
Parameter

Descrip?on

Term must be included in search

Term must be excluded from the search

( )

Group terms for subquery (i.e. A OR B; A AND B)

Fieldname:

Limit term search to the associated eld (e.g. Component: glucose)

Fieldname:()

Group mul1ple terms in a single eld

Fuzzy search (e.g. Hemoilus~)

Proximity search for mul1ple terms (e.g. func1on panel~1)

{}, []

Upper and lower bounds; {} exclusive, [] inclusive

Special character escape

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Applying advanced search

100 terms

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Applying advanced search

33 terms

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Applying advanced search

19 terms
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Applying advanced search

8 terms
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Limiting Searches

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Setting Search Limits


Narrows search to specic subset of LOINC terms
Reduces number of candidate terms
Limits can be applied to all components
Component a9ribute can be further restricted by
number of words
Tree structure allows for hierarchical constraints

2016 Regenstrief Institute and James Case

General Search Constraints


Controls features including:

Limit to LOINC terms compa1ble with submi9ed units


Forced match with any specimen contained in name
Method-less terms only
Restrict by class type
Remove lateralized terms

Use carefully or search may not be successful


(Note parallel control switches at bo9om of screen)

2016 Regenstrief Institute and James Case

Setting Search Limits

Click Hierarchy & Search


Limits Tab
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Setting search limits


Can also set most of them by toggling bu9ons
at the bo9om of the screen

Toggle Buttons

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Search Constraints
Attribute trees

Limit to LOINC terms


consistent with local units

Expanded predeZined,
general search constraints

2016 Regenstrief Institute and James Case

Terms Consistent with Units

Only terms consistent


with mmol/L appear

2016 Regenstrief Institute and James Case

Setting Search Limits

Specimen
constraints

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Terms Consistent with Specimen

CSF

Enter default
Specimen

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Terms Consistent with Specimen

Only CSF Terms


are returned
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Setting Search Limits

Exclude laterality

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Exclude laterality

Laterality terms

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Setting Search Limits

Restrict to
common orders

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Restriction to common orders

Large number of
Common orders
candidates
rank

2016 Regenstrief Institute and James Case

Setting Search Limits

Methodless Terms
Restriction

Override Methodless Terms


Restriction

2016 Regenstrief Institute and James Case

Limit to Methodless Terms

Both method and


method-less terms
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Limit to Methodless Terms

Only Methodless
Terms Appear
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More on Methodless Terms


Some LOINC categories do not have
methodless terms
Checking methodless only will remove these
from view on results grid
Checking addi1onal box allows these to be
seen

2016 Regenstrief Institute and James Case

No search constraints applied

All terms returned

2016 Regenstrief Institute and James Case

Methodless Only Checked


Only Methodless
terms returned

Differ in one or
more components

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Conditional Methodless
More terms
returned

No method-less
term; all shown

2016 Regenstrief Institute and James Case

Setting Search Limits

Include Trial, Deprecated or


Discouraged LOINC Codes with
Returned Terms
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Include Deprecated LOINC Terms

You cannot map to


deprecated LOINC terms
The Map button is
grayed out if one of these
terms is selected

Discouraged LOINC Terms appear as an


inverted triangle

Deprecated LOINC Terms appear as


Strikethrough Text with a Do Not
Symbol
2016 Regenstrief Institute and James Case

Favor Property Restriction

Order or Observation
preference

Favor one type of


property over others

All other components


being equal MCnc
only will be displayed

2016 Regenstrief Institute and James Case

LOINC Hierarchies Class Tree

Four top-level
branches
Tree Navigation
Buttons

2016 Regenstrief Institute and James Case

Lab Hierarchy expanded

Four top-level
branches
Tree Navigation
Buttons

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System Hierarchy

2016 Regenstrief Institute and James Case

Component Hierarchy
Click on details for more
information about the
selection

Show the LOINC Codes


associated with these
components

2016 Regenstrief Institute and James Case

Details Screen LOINC Part

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Show Associated LOINCs

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LOINC Term Details Screen

2016 Regenstrief Institute and James Case

RELMA - Tree Features


All trees operate the same way
Shows terms spelled out
Can expand and collapse parts or all of tree.
Tree is string searchable
Search can be based on one or more
branches of a tree with or without other
criteria
Use Clear Most Limits bu9on on Mapping
Screen to remove all tree selec1ons
Results of tree search can be exported

2016 Regenstrief Institute and James Case

LOINC Part Search


Same look as term search
Uses same Google-like query language

Extremely fast
Include and exclude criteria
Par1al string matching (using wildcards)

LOINC CLASS values may now be search


using "ClassList:<searchterm>" eld

2016 Regenstrief Institute and James Case

LOINC Answer List Search

Nominal LOINC terms are now required


to be submi9ed with answer lists.
Finding answer lists and the use of them
can be done with Answer List Search tab

2016 Regenstrief Institute and James Case

Answer List Search

New Zields added

Answer Lists containing


search term

2016 Regenstrief Institute and James Case

Navigating through the


Mapping Process

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LOINC Mapping Tactics


Limit eort to one lab sec1on at a 1me and
focus exper1se
Chemistry and hematology will be easiest
For manufactured assays, use package insert as
source informa1on
Sample results give clue to property and scale
Consider priori1zing by frequency of use

2016 Regenstrief Institute and James Case

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

More LOINC Mapping Tactics


Try using method-less terms rst

Specic methods can be transmi9ed in:

OBX17 (v2.x), Observa1on.methodCode (v3.0)

Examine local units or real results to verify


correct property and scale

Proper1es are rarely dis1nguishable in test names

You dont have to do it all at one siPng

Use the Unmapped func1on to return where you


le^ o

With every release - Update previous mappings


to iden1fy deprecated terms
2016 Regenstrief Institute and James Case

Common Mapping Issues


Locally Dened Test Name Ambiguity

Reuse of local test code

Analyte-free Local Test Names

(Miscellaneous serology, PCR)

Incongruent Value sets (Scale ambiguity)


Result vs. Interpreta1on
Available LOINC Terms too Specic/General
Panel vs. Discrete Test

Common in Microbiology
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Using your Mapped Terms


Print results of LOINC Mapping
Export to File

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ConZigure Export Format

Context Sensitive Export


ConZiguration

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LMOF Export ConZiguration

Select Export Format

Select Fields to Export


Save ConZiguration and
Export

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Print Mapped Terms from View/Add/Edit Menu

May highlight terms to be


printed

Click Print button to Preview


output

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Formatted Report Output

Click Print button to output


formatted report

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Excel Export

2016 Regenstrief Institute and James Case

Lab Auto Mapper

Run in batch mode to nd N- closest terms


Can then use this output to do nal mapping
Again units are VERY important
Can pick all limits available to regular mapping

2016 Regenstrief Institute and James Case

Picking the Lab Auto Mapper

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Lab Auto Mapper Start Screen

Maximum number of terms


to return

Can restrict search to


common tests

2016 Regenstrief Institute and James Case

Lab Auto Mapper Start Screen

Local test code

Terms used for


mapping
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Lab Auto Mapper - Mapping Screen

2016 Regenstrief Institute and James Case

Exporting Mapped Terms

Export Terms to
Delimited File

2016 Regenstrief Institute and James Case

Export Terms Dialog


Select Term Set
Direct export to
Excel

Select Delimiter

Check Fields you


wish to export
Select Zile location

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Other RELMA

Features
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Panels, Forms and Survey Review


Review Panels, Forms and
Surveys

Review Panels, Forms and


Surveys

2016 Regenstrief Institute and James Case

Panels, forms and surveys


revised display
Expand category to
see panels

Double-click
panel test to see
components

2016 Regenstrief Institute and James Case

Expanded Panel Detail

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Expanded Clinical Panel

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Clinical Panels

35089-2, 35090-0

Find where a term has


been used

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LOINC Term Panel Usage

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HIPAA Attachments

View Various HIPAA


Attachments

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HIPPA Attachment Tree


Now supports CDA R2.1

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Expanded Attachment Data

2016 Regenstrief Institute and James Case

Cant Zind the


term you
want?

2016 Regenstrief Institute and James Case

Search Hints and Tips


Keywords with zero frequency are ignored

May need to rephrase use synonym

Some causes for no returned terms

Too many keywords in search uncheck some


Limits applied that dont make sense

E.g. Method-less tests plus Method tree set to EIA

Did not nd and revise words not in RELMA

Local units not in RELMA

Units are GREAT discriminators


You may have tests that need to be added to
LOINC
2016 Regenstrief Institute and James Case

Proposing New LOINC Terms

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Proposing New Terms


Make sure the term is really needed

Think of other names for the same concept


Avoid detailed methods or localiza1ons
Is the dis1nc1on really important?

Supply sucient annota1on to jus1fy the new term

Package inserts, sample reports (email to Regenstrief)


The more the be9er!

Construct new terms within RELMA

File>Propose a new LOINC

Linked to the trees to allow browsing

Can review and submit them to LOINC from within


RELMA
2016 Regenstrief Institute and James Case

Propose new LOINC terms

Select Propose a
new LOINC

2016 Regenstrief Institute and James Case

Required Zields in
red

Navigate through
proposed terms

2016 Regenstrief Institute and James Case

Create new term,


save current term
or Exit form

Preview Proposed Terms

Review your new


terms

2016 Regenstrief Institute and James Case

Review Proposed Terms


James T. Case DVM, PhD

301-555-1314

NIH/NLM

301-555-1315
James.case@mail.nih.gov

X
X
X

Choose whether to
send or postpone

All proposed terms


fully editable

Direct submission
via web

2016 Regenstrief Institute and James Case

Submit Proposed Terms


Add additional
information, if
necessary
Add attachments

2016 Regenstrief Institute and James Case

Submitting New Terms


Must supply name, organiza1on, phone
and email of submi9er
Must select at least one proposed term to
send
Congure export does not aect
submission output
Email resul1ng le to Regenstrief

2016 Regenstrief Institute and James Case

Use Existing Terms as Template


Click the Propose
Term button

Select your closest


match

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Use Existing Terms as Template

All required
components Zilled in

2016 Regenstrief Institute and James Case

Using LOINC and SNOMED


Together

2016 Regenstrief Institute and James Case

Where do LOINC and SNOMED Fit?


Remember:
LOINC represents the ques1on:

Is there any Botulism toxin in my specimen?


(33708-9)
Organisms iden1ed in specimen? (634-6)

SNOMED represents the answer:

Nega1ve (SCTID 260385009)


E. coli O157:H7 (SCTID 103429008)

2016 Regenstrief Institute and James Case

Where do LOINC and SNOMED Fit?


In an HL7 message, LOINC may be used:

In OBR-4 (Universal Service Iden1er)


In OBX-3 (Observa1on Iden1er

SNOMED may be used:

In OBX-5 (where nominal values are needed)


Almost anyplace else in an HL7 message where
coded values are needed

2016 Regenstrief Institute and James Case

OBX: With a Coded Value


A code that
identiZies the
data type in
OBX-5 as a
coded element

The code is
from LOINC

The code is
from SNOMED

OBX||CE|6609-2^Listeria ID^LN||36094007^L. monocytogenes^SCT

OBX-3:A code that


identiZies the data in
OBX-5
(Listeria culture)

OBX-5: Data


A code for L.
monocytogenes

2016 Regenstrief Institute and James Case

HL7 2.5 Example (ER-7 format)


MSH|^~\&| LABGL1|| DMCRES|| 199812300100|| ORU^ R01|
LABGL1199510221838581| P| 2.3||| NE| NE
PID||| 6910828^First Order OBR
Y^ C8|| Newman^ Alfred^ E|| 19720812| M|| W| 25 Centscheap Ave^^
Whatmeworry^(Culture and ID)
UT^ 85201^^ P||(
773789090
555) 777- 6666|( 444) 677- 7777|| M||
First Result Value
(SNOMED)
OBR|| 110801^ LABGL| 387209373^ DMCRES|634-6^Bacteria XXX Aerobe Cult
^LN||| 199812292128||||||||Stool| IN2973^ Schadow^ Gunther^^^^ MD^
Second Order OBR
UPIN|||||||||||||||| CA20837^ Spinosa^ John^^^^ MD^ UPIN
(Susceptibility)
OBX|| CE| 634-6^Bacteria XXX Aerobe Cult^ LN||50136005^Salmonella typhimurium
^SCT|||||| F||| 199812292128|| CA20837
OBR|| 110801^ LABGL| 387209373^ DMCRES| 29567-9^Bacterial Susceptibility
First Result Description
Second Result(s)
First Result

Panel^
LN||| 199812300934||||||||Bacterial
isolate| IN2973^ Schadow^
OBX (LOINC)

(Culture and ID)
OBXs
MD^ UPIN||||||||| Salmonella typhimurium ||||||| CA20837^ Spinosa^
Gunther^^^^
John^^^^ MD^ UPIN
OBX|| CE|23631-5^Trimethoprim/Sulfasoxazole^ LN||264841006^Intermediate
^SCT|||||| F||| 199812300934|| CA20837
OBX|| CE|18967-7^Penicillin^LN||30714006^Resistant^SCT|||||| F||| 199812300934||
CA20837
OBX|| CE|18928-2^Gentamicin^ LN||131196009^Susceptible^SCT|||||| F|||
199812300934|| CA20837

2016 Regenstrief Institute and James Case

Q and A Session

2016 Regenstrief Institute and James Case

Exercise
Map your own data

2016 Regenstrief Institute and James Case