Professional Documents
Culture Documents
2014
Overview
1. We love standards
2. We love our local terminology
3. Six lessons weve learned
Informatics Pioneers
40 years of EMR work
Indiana Network for Patient Care
A Humongous Database
200+ source systems
16+ million patients
5.6 billion results
164 million text reports
more than 1 million transactions/day
Data Standards R Us
Getting the data when and where it is needed
Long History
ASTM 1238-88
HL7 (O&O, V3, etc)
LOINC
UCUM
Collaborator with other SDOs
HL7, IHTSDO, RSNA, SCO
Logical
Observation
Identifiers
Names and
Codes
A universal code system that facilitates exchange,
pooling, and processing of clinical data.
4
5/ /24
6/ 24/ /19
2 1 9
6/ 3/ 99 5 |
1
7/ 28/ 99 5 | 11.0
1 1 5
9/ 4/ 99 | 1 .0a
12 15 19 5 | .0
/2 /1 95 1. b
8/ 4/2 1/1995 | 1 0c
.
1229/ 8/1 995 | 1 0d
/3 19 99 | .0e
/ 9 6 1
1/ 1996 | | 1 .0f
10 8 6 1. .0
/9 /19 | 1 0h g
(
5//19 997.0h 2)
2/ 1/197 | 1(3)
7/ 12 99 | 1 .0
. i
2
8/ 3/ /19 8 | 0j-a
6/ 19 99 1.0
2/ 19999 | 1 k
6/ 4/ 9 | 1 .0l
13 20 | 1 .0
1/ /2 00 .0mm
1/ 1/ 00 | 1 a
3 20 0 .0
7/1/2 01 | 1. n
0
0
1/1/2 01 | 2. 0
0
1 0
2/ /2 01 | 2. 0
2/ 1/ 00 | 2 01
19 20 2 .0
8/ /2 02 | 2. 3
0
0
9/1/2 02 | 2. 4
0
0
5/1/2 02 | 2. 5
10 1/ 00 | 2 06
/ 20 2 .0
1/1/2 03 | 2. 7
0
0
2/1/2 03 | 2. 8
12 1/ 00 | 2 09
2
12/1/ 004 | 2.10
/1 20 4 | .1
6/ /2 04 2. 1
12 1/ 00 | 2 12
/1 20 4 | .1
6 / 0 2 3
12 /1/200 5 | .14
/2 20 5 2.1
6/ 1/ 06 | 2 5
12 21 20 | .16
/0 /2 06 2.1
7/ 3/ 00 |2 7
.
2
1/10/ 007|2 19
07 10 20 7| .21
2
12/06/2008| .22
/3 /2 09 2.2
2/ 0/ 00 |2 4
.
2
6/26/ 009|2 26
12 15 20 9| .27
2
06/29/2010| .29
2
12/30/2010| .30
/3 /2 10 2.3
6/ 0/ 01 |2 2
12 30 20 1| .34
2
06/30/2011| .36
2
12/29/2012| .38
2
06/26/2012| .40
/2 /2 13 2.4
6/ 01 |2 2
20 3| .4
14 2.44
|2 6
.4
8
80,000
70,000
10,000
LOINC Codes
60,000
50,000
40,000
30,000
20,000
63%-88%
Concept Token
72%-90%
Lin MC, Vreeman DJ, McDonald CJ, Huff SM. A characterization of local LOINC mapping for laboratory tests in three large institutions. Methods Inf Med. 2011;50(2):105-14. doi:
10.3414/ME09-01-0072. Epub 2010 Aug 20. PubMed PMID: 20725694
St. Vincent
St. Francis
Global Patient
Index
IUMG
Concept
Dictionary
IU Health
Global Provider
Index
Community
Wishard Health
Public Health
Regenstrief Dictionary
Core interface terminology
HIE services and CPOE at one institution
Progenitor of LOINC
More than 43,000 terms
Questions, answers, and units
Term Attributes
ID
13793
Universal Name
CD3+CD4+ Cells
Description
Number of CD4 T-cells (T4 helper cells) per volume. Both CD3+
and CD4+ are required to identify T4 helper cells.
Units
#/mm3
Code (class)
Source
IU Spec Hem
Synonyms
Total T(T4); Abs T4; IU257; CD4 Abs (Helper T); Abs T (T4/CD4)
Mappings
Mapped to standard vocabularies
(ICD, LOINC, SNOMED CT, etc)
All source codes from local institutions
are mapped to Dictionary terms
Lessons Learned
Along the Way
photo via IMLS DCC
Lesson 1.
Life is messy.
Everything is an OBX.
Everything in the NTE.
Pathologist Name
FL
K/CMM
k/cmm
K/CU MM
K/CUMM
K/MCL
K/mcL
K/UL
k/uL
KU/L
K/MM3
K/mm3
LB
PLATELET CO
T/CMM
TH/MM3
th/mm3
TH/UL
THOU/CMM
thou/cmm
thou/mm3
THOU/UL
THOUS/CU.MM
THOUS/MCL
THOU/mcL
THOUS/UL
Thou/uL
THOUSA
THOUSAND
THOUSAND/UL
U
X 10-3/UL
X 10(3)/UL
X10 3
X10(3)
1000/UL
X10(3)/MCL
X10(3)/UL
X10(6)/MCL
X10*9/L
X10E3/UL
X1000
X10X3
X10^3/UL
x10
X10?3/ul
X10E3/UL
X10E3
K/A?L
K/B5L
Raebel MA, Haynes K, Woodworth TS, et al. Electronic clinical laboratory test results data tables: lessons from Mini-Sentinel. Pharmacoepidemiol Drug Saf. 2014 Jun;23(6):609-18.
Lesson 2.
Terminology management is hard.
A journey, not a
destination.
Lesson 3.
Clear descriptions are king.
Good Descriptions
Distinguishes this concept from others
Describes what the heck it is
What does it measure?
What is it used for?
What is the clinical relevance?
How is the test performed?
photo via _fxr
Lesson 4.
Sometimes we bend the rules.
Examples:
- Paul Dexter
Lesson 5.
Work smarter, not harder.
Pareto Principle
Not every term has equal value
Cumulative Laboratory Observation Volume (%)
100%
90%
80%
70%
In INPC, 80 codes
60%
50%
40%
30%
20%
10%
0%
500
1000
1500
2000
2500
3000
3500
4000
Vreeman DJ, Finnell JT, Overhage JM. A rationale for parsimonious laboratory term mapping by frequency.
AMIA Annu Symp Proc. 2007 Oct 11:771-5. PubMed PMID: 18693941.
Upstream standardization.
Ask instrument or test kit
manufacturers.
photo via Fishking_1
Lesson 6.
Standards that get used get better.
Sharing is Caring
Standards will get better if users help
improve them through new term requests.
We built this concept into LOINC license & culture from the beginning.
Pros
Hugely valuable
1. Ultimate control
2. Single code system for
applications across all
content domains
Cons
1. Expensive
2. Cant easily use tools from
others
3. Others cant use our innovation
applications as easily
We love standards!
danielvreeman.com/speaking