Workshop on LOINC and its use in the Catalan Health System | Barcelona, Spain

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

© 2018 © 2018
 Welcome to the
LOINC Community

📷 jamescridland | cc-by
 High Level Outline

1. Origin and purpose of LOINC

2. Concept and data model
3. Resources for implementers

📷 Vernio77 | cc-by-sa
Slides available at:
https://danielvreeman.com/
ticsalutsocial
Interoperability
Why it matters
Connecting Many Data Sources

Social and community determinants

Lifestyle and behavioral
Health history
Patient-generated
EHR/clinical
Genetics
Basic science
Reality:
patients move faster and further
than their health information
 Interoperability is about
people who want (their
health IT systems) to work
together and understand
each other
📷 scarlatti2004_images | 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
 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
 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
Units of measure: UCUM
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
LOINC is famous for lab test content,
but you still might not know about…

Newborn screening
Full set of terms, included in HL7 IG Lab Results Interface (LRI)

Genetic reporting
2000+ tests, including collections for structured reporting of simple variants, structural and copy number variants, complex variants,
and pharmacogenomic studies. [PMID: 25656513] See HL7 LRI and the developing FHIR CG IG.

Orders
Not only single tests, but 1,000+ order panels and a consensus-vetted list of 1,500 order codes covering 95% of common volume. See
loinc.org/usage/orders

Public health
Close work with CDC on emerging diseases and reportable conditions
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)
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.
Before we jump in,
you might be wondering…

what’s with the pig?

 Taking a deeper
LOINC dive
The LOINC Concept Model
Where to use LOINC codes
Key features of LOINC’s development approach
 The LOINC Concept Model
The Fully Specified Name is the key

📷 quinnanya | cc-by-sa
 LOINC Term
A representation of a question about a clinical
phenomenon that can be observed or measured.

Two essential attributes:

LOINC Code
LOINC Fully Specified Name
 LOINC Code
18262-6

The unique, permanent identifier that serves as a

computer processable representation of a LOINC Term

Sequential hints at relative age

Penultimate dash
Final character is Mod-10 check digit
Carries no intrinsic meaning
Once released, never removed
 Official LOINC Name Types
Fully-Specified Name (FSN)
Mapping

Long Common Name (LCN)

Primary display name

Short Name
Column header, old-school systems with character limits

Display Name
New provider-friendly display name (rules are still under development)
 Example LOINC Names
Fully-Specified Name (FSN)
Urea nitrogen:MCnc:Pt:Ser/Plas:Qn:

Long Common Name (LCN)

Urea nitrogen [Mass/volume] in Serum or Plasma

Short Name
BUN SerPl-mCnc

Display Name
Urea nitrogen [Mass/Vol]
 LOINC Fully Specified Name
Includes the info necessary to distinguish among
clinically important differences

Defines the essential uniqueness of each term in LOINC

Recommended name to help you choose the right

LOINC term
 !
NOT part of a LOINC Name
Reason for the test (disease it diagnoses)
Testing instrument
Specific details about the specimen
Priority (e.g. STAT)
Where testing was done
Who did the test
Test interpretation
Anything that is not part of naming the test
 Anatomy of a LOINC Term
18262-6:Cholesterol.in LDL:MCnc:Pt:Ser/Plas:Qn:Direct assay

LOINC Code 18262-6

Component Cholesterol.in LDL

Property MCnc

Timing Pt

System Ser/Plas

Scale Qn

Method Direct assay

There are six major LOINC name axes

 Component
The substance or entity that is measured,
evaluated, or observed

Examples
Component
Sodium
Glucose
Brucella sp. identified
HIV 1 p24 antigen
Cytomegalovirus antibody
Body weight

Cholesterol.in LDL:MCnc:Pt:Ser/Plas:Qn:Direct assay

 Property
The characteristic or attribute of the analyte that is
measured, evaluated, or observed.

Examples
LOINC Abbreviation Property Example units
MCnc Mass concentration mg/dL
SCnc Substance concentration umol/L
MCnt Mass content mg/g
CCnc Catalytic concentration U/L
Prid Presence or identity

Cholesterol.in LDL:MCnc:Pt:Ser/Plas:Qn:Direct assay

 Timing
The interval of time over which the observation was made

Examples
LOINC Abbreviation Time Aspect
Pt Point in time
12H 12 hour collection
24H 24 hour collection
7D 7 days (look back period)

Tip: If Timing != Pt, Property is often a “Rate”

Cholesterol.in LDL:MCnc:Pt:Ser/Plas:Qn:Direct assay
 System
The system (context) or specimen type upon which the
observation was made.

Examples
LOINC Abbreviation System
Bld Whole blood
Ser/Plas Serum or plasma
Tiss Tissue
Unknown, unspecified in the test name, and/
XXX
or specified in another part of the message

*See LOINC Users’ Guide for further discussion

Cholesterol.in LDL:MCnc:Pt:Ser/Plas:Qn:Direct assay
📷 AlishaV | cc-by
 Scale
A classification of the result type

Examples
LOINC Abbreviation Scale
Qn Quantitative * can have operators
Ord Ordinal
Nom Nominal
Nar Narrative
Doc Document

Cholesterol.in LDL:MCnc:Pt:Ser/Plas:Qn:Direct assay

📷 puuikibeach | cc-by
 Method
A classification of how the analyte was measured or the
information was obtained

Method is an optional axis. Only needed if interpretation affected.

different normal ranges, test sensitivities, etc
Specified at a generic level

LOINC Abbreviation Method

IA Immunoassay
LC/MS/MS Liquid Chromatography-Tandem Mass
Molgen Spectrometry
Molecular genetics
CT Computed tomography
Estimated Estimated
Cholesterol.in LDL:MCnc:Pt:Ser/Plas:Qn:Direct assay
📷 dfataustralianaid | cc-by
 The LOINC fully specified term
name is key for mapping local
terms to LOINC

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

📷 jdhancock | cc-by
 Local tests names are:
Notoriously short
Lacking info needed for mapping

Don’t make assumptions, but…

Use all available contextual clues

📷 paurian | cc-by
An example: AFP

Quick search in RELMA turns up 40

candidate LOINCs
 Differences in System
AFP

Maternal screen, Chromosome

study, CNS Tumor dx?

We confirm that this is part of

the 2nd trimester quad screen
(maternal serum)
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"

It works equally well in:

}
],
"text": "Body height"

HL7 v2, CDA, FHIR

},
"subject": {
"reference": "Patient/example"
},
"effectiveDateTime": "1999-07-02",
"valueQuantity": {
Or any structure with a two part "value": 66.899999999999991,
"unit": "in",

(observation, observation value) data model

"system": "http://unitsofmeasure.org",
"code": "[in_i]"
}
}
If your system stores a
“master file” or dictionary of
Observations or Orders,
use LOINC there as an index
 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
 Relax…
You can still use local terms too

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

📷 Julien Haler | cc-by

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
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
Key IHE Profiles with
LOINC support
Laboratory Analytical Workflow (LAW)
Laboratory Testing Workflow (LTW)
Laboratory Code Sets Distribution (LCSD)

Sharing Laboratory Reports (XD-LAB)

Cross-Enterprise Document Sharing (XDS*)
 LOINC Development
Let’s focus on the key features

📷 jurvetson | cc-by
Regenstrief Institute, Inc
A non-profit organization driven by a mission to connect and innovate for better health

Long history of developing, applying, and scaling health information technology solutions

Creator, owner, and steward (i.e. Standards Development Organization) for two key
interoperability standards: LOINC and UCUM

LOINC Committee
Advisory body to Regenstrief that sets naming conventions and development policies

Open, international membership

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
Translations into 18
variants of 12 languages
 ISO 3166-2:ES

Spanish (Spain) Linguistic Variant

Translation into Spanish by the Clinical Laboratory
Committee of SERVICIO EXTREMEÑO DE SALUD with
the support of BITAC MAP.


Current version contains translations for 54,000+ terms
https://search.loinc.org
LOINC Distribution
Major releases twice per year
Many release artifacts
Online and desktop browser, API (via FHIR)
Documentation
 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
 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
Many Active Collaborations
HL7
IEEE
CDISC
IICC
DICOM

SNOMED International
RSNA
Using LOINC and SNOMED CT Together
Collaboration agreement endorses using both
IHTSDO endorses the use of LOINC Codes for representation of orders and
observations in countries where LOINC has been adopted.

How?
LOINC provides codes that represent the names of information items (e.g.
questions) and SNOMED CT provides codes that may represent nominal and
ordinal values (e.g. answers) for these named information items.
Using LOINC and SNOMED CT
In an HL7 version 2 message

CE (coded
element) answer Observation: LOINC

OBX||CE|625-4^Bacteria Stl Cult^LN||5933001^Clostridium

difficile (organism)^SCT|

Result Value:
SNOMED CT
Vocabulary standards grow
because USERS ask
(broad user community drives new content)

Medicine keeps evolving

If we’re missing content, just ask: loinc.org/submissions
New Term Requests:
Submissions from 110+ organizations in 19 countries in last 2 years
loinc.org/submissions/stats/
https://loinc.org/submissions/queue/
Thank You!
 Workshop on LOINC and its use in the Catalan Health System | Barcelona, Spain

LOINC Use Around the World Today

A brief tour of LOINC implementations and a few tips for success

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

© 2018 © 2018
 High Level Outline

1. Summary of LOINC user community

2. Brief tour around the world with LOINC
3. Closing recommendations

📷 Vernio77 | cc-by-sa
71,000+ registered users from 174 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

Overall loinc.org traffic (YTD)
Overall loinc.org traffic (YTD)
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
Official national standard in 30+ countries
A small taste of
LOINC usage
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
International Telecommunication Union

ITU-T H.860 (04/2014)

Multimedia e-health data exchange services: Data schema and supporting services

specifies a common health schema for health systems – e.g., clinical and wellness – and
describes the supporting services and systems architecture for a health data exchange

https://www.itu.int/ITU-T/recommendations/rec.aspx?rec=12163&lang=en
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
https://esante.gouv.fr/sites/default/files/asset/document/20150504_etude_terminos_phase2_diagnostic.pdf
Belgium

Federal Public Service Public Health, Food

Chain Safety and Environment of Belgium
LOINC is the basis for ‘Reference Table Management' (ReTaM), the national
Belgian laboratory subset developed by the Terminology Center of the FPS.

We publish a French (Belgium) translation, and ReTaM has names in French,

German, and Dutch.

https://www.health.belgium.be/nl/terminologiecentrum-terminologie-en-condestelsels-retam
Portugal

Serviços Partilhados do Ministério da

Saúde
Developed Catálogo Português de Análises de Laboratório (CPAL), which is
based on LOINC and also includes a mapping to national billing codes, and a
Portuguese translation

CPAL will be implemented in ministry hospitals and private labs

http://www.ctc.min-saude.pt/category/catalogos/cpal/
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.
Italy

President of the Council of Ministers

(Ministry of Health)
LOINC is mandatory for reporting laboratory test results in the
national EHR project (Fascicolo Sanitario Elettronico)

https://www.fascicolosanitario.gov.it/sistemi-codifica-dati/informazioni/loinc
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
Russia

St. Petersburg Medical Information Analytical Center

Large regional health data exchange
~300 organizations, 85 labs

Standardized lab test catalog based on LOINC and a laboratory result interface bus
using HL7 FHIR
Now, ~450k tests per month flowing
Delivering results to patient’s “personal office”

Kopanitsa G. Application of a Regenstrief RELMA V.6.6 to Map Russian Laboratory Terms to LOINC. Methods Inf Med. 2016;55(2):177-81. Epub 2015 Dec 15. PubMed PMID: 26666563.

http://www.iksmedia.ru/articles/5434116-Prakticheskaya-polza-informatizacii.html
India

Ministry of Health and Family Welfare

Adopted LOINC as standard for identifying tests, measurements, and

observations in national guidelines for EHR standards

Implementation Guideline: LOINC coding is to be used for processing results

and reports with Laboratory and Imaging Information Systems.

https://www.nhp.gov.in/NHPfiles/EHR-Standards-2016-MoHFW.pdf

https://www.nhp.gov.in/categories-for-adoption-of-standards_mtl
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
Thailand

Thai Health Information Standards

Development Center

The study shows that LOINC can be used and should be adopted in Thailand.

Adoption of LOINC will facilitate electronic health record interoperability in Thailand.

http://www.this.or.th/files/interopbook.pdf

Pontongmak W, Kijsanayotin B, Min Thit W, Looareesuwan P. Mapping Thai local laboratory codes with LOINC: the preliminary report. Journal of the Thai Medical Informatics Association. 2015; 1: 44-50.

Pontongmak W, Kijsanayotin B, Rattanapradit A, Min Thit W. Mapping local clinical chemistry code with LOINC. Journal of the Thai Medical Informatics Association. 2015; 1: 38-43.
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
Saudi Arabia

Saudi Arabia ’s Council of Cooperative Health

Insurance

Providing all 12 million beneficiaries with insurance services and

improving information exchange between various stakeholders
(beneficiaries, companies, and health providers).

Adopted LOINC for lab orders/results

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

Hong Kong Hospital Authority

LOINC for laboratory tests in public health system covering 40+ hospitals
and 100+clinics. Have mapped tests from 16+ labs and made available in
central EHR system

In early 2018, Hong Kong Adventist Hospital became first private hospital in
Hong Kong using LOINC as its standard terminology for laboratory test
results sharing to EHR

https://loinc.org/adopters/hong-kong-hospital-authority/

https://www.ehealth.gov.hk/en/publicity_promotion/ehealth_news_09/u_lab_test_code_system.html
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
And many more…
 Everyone loves LOINC

📷 mccaughan | cc-by-sa
Current U.S. Landscape
Brief Summary of LOINC Adoptions
Office of the National Coordinator for Health IT

Health IT Certification Criteria

21st Century Cures Act
Interoperability Standards Advisory
Food and Drug Administration
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

Centers for Disease Control & Prevention
Longtime users of LOINC: electronic lab reporting, case reporting,
immunization messaging, National EMS Info System, National Trauma
Data Standards, vital statistics, etc

Centers for Medicare and Medicaid Services

Many quality measure definitions expressed with LOINC

Under Impact Act 2014, all CMS-required patient assessment

instruments are standardized in LOINC
National Animal Health Laboratory
Network (NAHLN)

USDA
Animal and Plant Health Inspection Service (APHIS)
National Institute of Food and Agriculture (NIFA)

American Association of Veterinary Laboratory

Diagnosticians

Part of a nationwide strategy to enhance early detection of,

response to, and recovery from animal health emergencies
that threaten the Nation’s food supply and public health

NAHLN labs uses LOINC to identify lab tests

https://www.nahln.org
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 all 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
A sample of LOINC-powered
informatics innovations
Based on the Argonaut FHIR profile
https://www.apple.com/healthcare/health-records/

https://support.apple.com/en-us/HT208647
 Collect once. Use many.
Clinical care, public health reporting, quality management, clinical and
epidemiological research, etc…

📷 pagedooley | cc-by
If this, then that…

If {symptomatic pregnant woman <12 weeks after onset}

Then
Order {81154-7 Dengue & Chikungunya & Zika virus pane}
Population Health Analytics

WHO Zika Strategic Response Plan Quarterly Update: July-September 2016

Same data for…
Informing clinical care
Population health analytics / registry
Electronic quality measure analysis
Observational/epidemiological research
Some Recommendations
for Implementing LOINC
Ideas for smart LOINCing
Summary Lessons from the International Community

1. Identify and involve key stakeholders: clinical leaders,

professional societies, government agencies, etc
2. Big wins first: large, central sources
3. Create national subsets (and translations if necessary)
4. Leverage mappings to national reimbursement codes
5. Identify key use cases that align with national
priorities
Bonus Tips
 Go upstream
Map more efficiently and consistently by getting
LOINC coding recommendations from lab test
manufacturers

📷 Fishking_1 | cc-by
https://ivdconnectivity.org/livd/
https://usdiagnostics.roche.com/en/documentation.html#/q/loinc/s/SCORE_DESC
Use LOINC’s many implementation resources

“Raw” release artifacts

Online and desktop browser (RELMA)
API (via FHIR)
Documentation: Microbiology Guide, LOINC Essentials eBook, etc
Community resources
 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
Main message:
When clinical data is coded with LOINC, health IT
applications can understand and interact with it for
the benefit of many in the health ecosystem.

I look forward to seeing your successes!

Happy LOINCing!
Q & A