An Introduction to

Clinical LOINC
Stanley M. Huff, M.D.
Intermountain Healthcare
stan.huff@imail.org

Outline
LOINC background and goals
LOINC structure and content
Clinical LOINC
Examples

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Important facts
LOINC version 2.50 (Dec 2014) contains 74,600 terms,
an increase of 711 since the June 2014 version

75% Lab LOINC codes

20% Clinical LOINC codes
1% Claims Attachment codes
4% Survey codes

LOINC is free for use

LOINC home page: http://loinc.org/
Download files and tools from Regenstrief Web Site
http://loinc.org/downloads
Reference manual, submission database, RELMA

RELMA a tool for mapping local codes to LOINC

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Coverage

Laboratory LOINC
All laboratory categories including genetic
testing , veterinary medicine testing

Clinical LOINC
Many routine measures, parts of H & P, EKG,
Cardiac echoes, OB ultrasound, Nursing survey
instruments, and much more

HIPAA attachments
(Content managed by HL7)

Survey Questions
Skilled nursing facility Minimum Data Set (MDS)
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The Messaging Paradigm

System
System
A
A

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System
System
B
B

HL7 Result Message (ORU)

MSH|^~\&|||||19981105131523||ORU^R01|
PID|||100928782^9^M11||Smith^John^J|
OBR||||Z0063-0^BP^LN|
OBX||CE|8361-4^POSITION^LN||SIT^Sitting|
OBX||NM|8479-8^SBP^LN||138|mmHg|
Segment

Data Field

Component

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OBX: a name-value pair approach

A code that
identifies the
datatype
of OBX-5

Other data fields include: date of

observation, identity of provider
giving observation, normal ranges,
abnormal flags

OBX-5: Data

Status

A code
OBX||NM|11289-6^^LN||38|C^^ISO+|||||F
that identifies
the data in
OBX-5
(Temp
Reading)

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A code that
identifies the units
of numerical data
in OBX-5
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OBX: with a coded value

A code that
identifies the
datatype as a
coded element

The code is
from LOINC

The code is
from SNOMED

OBX||CE|883-9^Blood Group^LN||58460004^Group O^SCT|

A code that
identifies the data in
OBX-5
(ABO Blood Group)

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OBX-5: Data
A code for Group O

So we are all using HL7, what is the problem?

Site 1:
OBX|1|CE|SysBP^Systolic BP||132||mmHg|

Site 2:
OBX|1|CE|SBP^Systolic BP||132||mmHg|

Site 3:
OBX|1|CE|BP^Combined BP||132/70||mmHg|

You and I may know that these are similar

results, but our computers will not.

The Goal
Site 1:
OBX|1|CE|8479-8^SysBP^LN||132||mmHg|

Site 2:
OBX|1|CE|8479-8^SBP^LN||132||mmHg|

Site 3:
OBX|1|CE|XXX-X^Combined BP^LN||132/70||mmHg|

Agree on a universal coding system for

clinical observations.
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How terminologies fit into the model

LOINC attributes/observables
SNOMED CT findings/values
(mostly) and observables (some)
First Data Bank - values
RxNORM - values

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Focus of LOINC
Value for Observation Identifier (Seq. #3) of OBX
Or the name of the observation in other standards, such
as DICOM, CDA, FHIR

Individual result names first, then panels

Panels are built based on the tests they contain
Panels can contain other panels

Name should facilitate automated or manual

matching (fully specified)
Create local labels as needed
Standard LOINC short names

One common identifier for tests that are clinically

the same
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Brief History of LOINC

Logical Observation Identifier Names and Codes
Organized by Clement McDonald, 1994
Supported by Regenstrief Institute and NLM
Create a universal language for observation
identifiers
Laboratory observations were created first
Creation of clinical observations began in 1996

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Approach
Collect result names and descriptions
IHC, VA, Regenstrief, Mayo Clinic, 3M, Vendors
Formulate a model to represent the individual pieces
of information in the name
Avoid strategies that lead to combinatorial explosion

Create fully specified names

Adjust model as needed
Do any distinct entities have the same name?
Do any entities that are the same have different names?

Repeat the process until no more adjustments are

needed
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LOINC makes names for things in use

We do not make all possible permutations that the six
axes would allow (no blind cross products)
We try to only make names and codes for things that
are real (exist in someones system)
We do make names that allow both atomic (post
coordinated) and molecular (pre coordinated) styles
Some people wish we would be more prescriptive
Name everything, let others dictate usage

We do object to violations of the HL7 model

No names that include post coordinated fields from other
parts of the HL7 message (status, priority, user role)
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Two LOINC committees

Laboratory LOINC
Clem McDonald, Chair
All aspects of tests/measurements done on specimens
Chemistry, Hematology, Microbiology, Histology, Cytology, etc.

Clinical LOINC
Stan Huff, Chair
All aspects of tests/measurements on a patient
Vital signs, Hemodynamic measurements, Physical findings,
Radiology, Ultrasound, etc.

Both committees meet at least 2 times each year

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Current and Former Clinical LOINC Members

James Barthel , Dean Bidgood, Bruce Bray, Bill
Francis, Alan Golichowski, Daniel Vreeman,
Karl Hammermeister, Anders Thurin, Barry
Gordon, Warren Williams, James Campbell,
Jim Cimino, Sue Bakken, Pat Wilson, Stan
Huff, Doug Martin, Clem McDonald, Dan
Pollock, Angelo Rossi Mori, Susan Matney,
Jeff Suico, Wayne Tracy, Pavla Frazier, Pat
Wilson, Lee Min Lau, Shawn Shakib, Bill
Karitis, Thomas White, Steven Steindel,
Elizabeth King, Loren Stevenson, Sundak
Ganesan, Ted Klein, Vivian Auld
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Clinical LOINC Subject Areas

Vital Signs

EKG (ECG)

Hemodynamics

Cardiac Ultrasound

Fluid Intake/Output

Obstetrical Ultrasound

Body Measurements

Discharge Summary

Operative Notes

History & Physical

Emergency Department

Pathology Findings

Respiratory Therapy

Colonoscopy/Endoscopy

Documents (collections)

Radiology reports

Standard survey
instruments

Clinical Documents

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Tumor Registry
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LOINC Mascot

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Outline
LOINC background and goals
LOINC structure and content
Clinical LOINC
Examples

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General Form of Clinical LOINC Names

LOINC codes are created systematically
using a six axis model
<component> : <property> :
<timing> : <system> :
<scale> : <method>
8331-1 Body Temperature :TEMP :PT :MOUTH :QN

The first 5 parts are mandatory, but method is

optional. Subparts of the six axes are created as
needed in specific subject areas.
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Summary of the six primary axes (clinical)

Component
Ejection fraction, heart beats, cardiac output, circumference

Kind of property
Angle, area, length, mass, pressure, temperature

Timing
Point in time, study minimum, maximum in 8 hours

System
Head of fetus, tricuspid valve, ventilator setting

Scale
Quantitative, ordinal, nominal (coded), narrative

Method
Stated, measured, estimated, ultrasound, spirometry
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Component
The substance or entity that is measured,
evaluated, or observed.

RR INTERVAL
ORIFICE (OF A HEART VALVE)
EJECTION FRACTION
HEART BEATS
BREATHS
CARDIAC OUTPUT
SEGMENTAL WALL MOTION
PROSTHETIC VALVE TYPE
FLUID INTAKE

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Subtypes period as a separator

CAPACITY.VITAL.FORCED
GRADIENT.MAX (as across a valve)
INTERNAL DIAMETER.MINOR
AXIS.SYSTOLE
BIRTHS.TERM
GLASGOW SCORE.VERBAL
R' WAVE AMPLITUDE.LEAD II
ST SEGMENT AXIS.HORIZONTAL PLANE
PHYSICAL FINDINGS.SENSATION
CALORIE INTAKE.TOTAL
TIDAL VOLUME MAX.SETTING

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Challenge/Pre condition - ^ as a separator

FLUID OUTPUT.URINE ^ POST VOID
FRACTIONAL COLLAPSE ^ INSPIRATION
BREATHS ^ AT MAX VOLUNTARY
VENTILATION
RR INTERVAL ^ AT TRICUSPID FLOW
MEASUREMENT
GAS FLOW.MIN ^ PRE THERAPY
FLOW ^ AT 25-75% OF FORCED EXPIRATION
INTRAVASCULAR DIASTOLIC ^ STANDING
NEONATAL APGAR ^ 5M POST BIRTH
MULTISECTION ^ WITH ANESTHESIA
BODY WEIGHT ^ WITH CLOTHES
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Adjustments - ^ ^ as a separator
DIFFUSION CAPACITY.CARBON
MONOXIDE ^ ^ ADJUSTED FOR
HEMOGLOBIN
DIFFUSION CAPACITY ^ ^ ADJUSTED TO
BODY CONDITIONS

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

TYPE selection of subtype (nominal items)

PRID presence or identified (nominal items)
TIME duration of time
COLOR color
ANGLE degrees of arch
APER appearance
AREA - area
ELPOT voltage
LEN length
MASS mass
MRAT mass rate (gm/hr)
PRES pressure
TEMP temperature
FCN function (of a body part or system)

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Timing
The interval of time over which the observation
or measurement was made.

PT - at a point in time
STDY^MIN minimum over the period of a study
24H - a twenty four hour shift
10H^MEAN mean value for a ten hour period
8H^MAX maximum value in an eight hour
period

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System
The system (context) or body part about
which the observation was made.

YOLK SAC^FETUS
UPPER GI TRACT
TRICUSPID VALVE^PATIENT
TRICUSPID VALVE^FETUS
SYNOVIAL SPACE
HEART.VENTRICLE.RIGHT
VENTILATOR
ARTERIAL SYSTEM
BLADDER
EYE.LEFT

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Patient, Control, or Donor (as part of system)

CONTROL
PATIENT
DONOR
BABY
FETUS
Non-patient values for this axis should be used
with care, or combinatorial explosion could result
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Scale
QN - quantitative
4, 7.4, 1:8

ORD - ordinal, the answers can be ranked

+/-, 1+, 2+, 3+ .
mild, moderate, severe
none, rare, few, moderate, many, loaded

NOM - nominal, answers are coded but unranked

Stool appearance liquid, formed
Skin color pink, dusky, cyanotic
Chest tube type

NAR - answer is a two or more words of natural

language, or as much as a paragraph of text
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Method
Procedure used to make the measurement or
observation. Only used when it makes an
important distinction in sensitivity or specificity.

STATED reported verbally

MEASURED actually observed

CALCULATED numeric calculation

US ultrasound

EKG electrocardiogram

ESTIMATED an educated guess at the real value

HELIUM REBREATHING helium rebreathing

SPIROMETRY spirometry

MANUAL done by hand

AUTOMATED used an instrument

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Putting it all together

Code

Component

Prop

TIME

System

Scale

8302-2 BODY HGHT

LEN

PT

^PATIENT

QN

3140-1 BODY SURF

AREA PT

^PATIENT

QN

8331-1 BODY TEMP

TEMP PT

MOUTH

QN

8319-6 BODY TEMP

TEMP 12H^MIN

XXX

QN

8629-8 Q WAVE DPT

ELPOT PT

HEART

QN

EKG

8632-2 QRS AXIS

ANGLE PT

HEART

QN

EKG

8642-1 PUPIL DIA

LEN

PT

EYE.RIGHT

QN

AUTO

21611-9 AGE

TIME

PT

^PATIENT

QN

EST

21612-7 AGE

TIME

PT

^PATIENT

QN

REPORT

19867-1 CAPACITY.VITAL VOL PT

RESP SYS

QN

9279-1 BREATHS

NRAT PT

RESP SYS

QN

11882-8 GENDER

FIND

^FETUS

NOM

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PT

Method
DERIVED

US
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Use of XXX and {} (curly braces)

Old style
8319-6 BODY TEMP TEMP 12H^MIN XXX

QN

New style
8319-6 BODY TEMP TEMP 12H^MIN {Body Loc} QN

LOINC codes of these styles imply that the code may

be used in post-coordinated expressions

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More complex examples

9273-4 NEONATAL APGAR^2M POST BIRTH FCN PT
^PATIENTORD
9192-6 FLUID OUTPUT.URINE
TRACT QN

VRAT 24H

URINARY

11892-7 GESTATIONAL AGE

TIME PT
^FETUS
QN US.ESTIMATED FROM AC.HADLOCK84
10105-5 ST SLOPE.LEAD V6
HEART QN
EKG

ELPOTRAT PT

8431-9 INTRACHAMBER SYSTOLIC PRES PT

HEART.VENTRICLE.LEFT.OUTFLOW TRACT QN
8283-4 CIRCUMFERENCE.MAX LEN PT
QN
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CALF.RIGHT

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Literature References

McDonald CJ, Huff SM, etal. LOINC a universal standard

for identifying laboratory observations a 5-year Update.
Clinical Chemistry, 2003

Huff SM, Rocha RA, McDonald CJ, De Moor GJE, etal.

Development of the LOINC (Logical Observation Identifier
Names and Codes) Vocabulary. Journal of American Medical
Informatics Association, 1998, 5:276-292.

Dolin RH, Huff SM, Rocha RA, Spackman KA, Campbell, KE.
Evaluation of a Lexically Assign, Logically Refine Strategy
for Semi-Automated Integration of Overlapping Terminologies.
Journal of American Medical Informatics Association, 1998,
5:203-213.

Forrey AW, McDonald CJ, DeMoor G, Huff SM , Leavelle D,

Leland Fiers DT, Charles L, Griffin B, Stalling F, Tullis A,
Hutchins K, Baenziger J. Logical Observation Identifier Names
and Codes (LOINC) Database: A public use set of codes and
names for electronic reporting of clinical laboratory test results.
Clinical Chemistry, 1995.

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