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Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis The Use of LOINC in the AHRQ “Adding Clinical Data to Administrative Data” Project National Association of Health Data Organizations 23 rd Annual Conference - October 26 & 27, 2008 Christopher B. Sullivan, Ph. D. Agency for Health Care Administration NAHDO 23 rd Annual Conference - October 26 & 27, 2008

Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Logical Observation Identifiers Names and Codes ¢ Under the sponsorship of the National Library of Medicine and other government and private organizations, the Regenstrief Institute for Health Care developed the Logical Observation Identifiers Names and Codes standard (LOINC) and the Regenstrief LOINC Mapping Assistant (RELMA®). ¢ The User’s guides and relevant documents and files are available at http: //www. regenstrief. org/loinc ¢ Products are available for use at no cost. NAHDO 23 rd Annual Conference - October 26 & 27, 2008

Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Why Use LOINC? ¢ Currently, many laboratories use different coding dictionaries to send laboratory results electronically to clinical care systems in hospitals. ¢ Receiving medical informatics systems cannot fully figure out the results. ¢ The LOINC database provides a set of universal names and ID codes for identifying laboratory and clinical test results. NAHDO 23 rd Annual Conference - October 26 & 27, 2008

Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis LOINC Sections ¢ The LOINC database is divided into four categories: l Laboratory portion l Clinical l Attachments l Surveys NAHDO 23 rd Annual Conference - October 26 & 27, 2008

Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis LOINC Sections ¢ Laboratory portion • Standard test names and codes • Includes chemistry, hematology, serology, microbiology (including parasitology and virology), toxicology • Drugs and cell counts for blood smears and cerebrospinal fluids • Antibiotic susceptibilities NAHDO 23 rd Annual Conference - October 26 & 27, 2008

Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis LOINC Sections ¢ Clinical portion • Vitals signs, hemodynamics, intake/output, ECG, obstetric ultrasound, cardio echo, urologic imaging, pulmonary ventilator management, survey instruments, and others NAHDO 23 rd Annual Conference - October 26 & 27, 2008

Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Examples of the Lab and Clinical Portions Abbreviation ABXBACT Laboratory Term Class Antibiotic susceptibility ALLERGY Response to antigens BLDBK Abbreviation ART Blood bank Clinical Term Class Antiretroviral Therapy BDYCRC. ATOM Body circumference atomic BDYCRC. MOLEC Body circumference molecular NAHDO 23 rd Annual Conference - October 26 & 27, 2008

Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis LOINC Record Content ¢ Codes are unique and have no meaning. ¢ Each LOINC record corresponds to a single test result or panel. The record includes fields for specifying: l Component name (analytic) l Property measured l Timing l The type of sample l The type of scale l The method used to produce the result or other observation NAHDO 23 rd Annual Conference - October 26 & 27, 2008

Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Major "Parts" of a Test/Observation Name ¢ The fully specified name of a test result or clinical observation has five or six main parts. Example: <Analyte/component>: <kind of property of observation or measurement>: <time aspect>: <system (sample)>: <scale>: <method> NAHDO 23 rd Annual Conference - October 26 & 27, 2008

Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Divisions Within The Fields ¢ Component Name can be hierarchically divided into 3 subparts delimited by (^): 1. Name and modifier further subdivided into 3 more levels of taxonomic specification, separated by dots (. ): <[analyte]. [subclass]. [sub-subclass]> ^ 2. Information about challenge: <[time delay] post [amount] [substance] [route])> ^ 3. Adjustments/corrections: <adjustment> NAHDO 23 rd Annual Conference - October 26 & 27, 2008

Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Divisions Within The Fields ¢ Timing and system/sample can be divided into 2 subparts delimited by (^). ¢ Time: 2 nd subpart identifies max, min, mean, etc. ¢ Specimen: 2 nd subpart identifies source if not the patient (e. g. fetus). NAHDO 23 rd Annual Conference - October 26 & 27, 2008

Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis General Naming Conventions ¢ Place Identifier of substance measured first ¢ Use generic name of drug ¢ Use full taxonomic name of organism or virus ¢ Name vitamins by chemical name ¢ Rules for species and groups of species ¢ Avoid direct, indirect; conjugated, unconjugated ¢ Use platelets not thrombocytes ¢ Use noun form of target of antibody NAHDO 23 rd Annual Conference - October 26 & 27, 2008

Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Examples of Naming Conventions ¢ total, not tot ¢ fraction, not frac ¢ alpha, not A- etc. ¢ oxygen, not O ¢ dextro, not d- NAHDO 23 rd Annual Conference - October 26 & 27, 2008

Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis What is Not Part of Name ¢ Instrument used in testing ¢ Fine details about sample or site of collection ¢ Priority of testing (stat or routine) ¢ Who verified result ¢ Size of sample collected ¢ Place of testing NAHDO 23 rd Annual Conference - October 26 & 27, 2008

Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Broward Health Lab Codes Sample Clinical Data Elements Abbreviation Low High Units Aspartate Aminotransferase AST 5 40 units/L Creatine Kinase MB CK MB 0 10. 4 Potassium Level Sodium Level Troponin-I p. H Capillary P O 2 Arterial Potassium Lvl 3. 6 5 mmol/L Sodium Lvl 137 145 mmol/L Troponin-I 0 0. 4 ng/m. L p. H Cap 7. 35 7. 45 p. O 2 Art 60 90 mm. Hg NAHDO 23 rd Annual Conference - October 26 & 27, 2008 ng/m. L

Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Example of Inbound Extract Orderable Test Interface Orderable Code Test Name Result Interface Code Result Name BLGAS BLOOD GAS ANALYSIS O 2 HB SYR N BLGAS BLOOD GAS ANALYSIS HCO 3 SYR N m. Eq/L BLGAS BLOOD GAS ANALYSIS PCO 2 SYR N mm. Hg Specimen Result Type NAHDO 23 rd Annual Conference - October 26 & 27, 2008 Units of Measure %

Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Example of Outbound Report Result Orderable Test Interface Code Name Code BLGAS LOINC Code LOINC representation BLOOD GAS ANALYSIS O 2 HB BLOOD GAS ANALYSIS HCO 3 Oxyhemoglobin/ Hemoglobin. total 2714 -4 : MFr: Pt: Bld. A: Qn: Bicarbonate: SCn 1963 -8 c: Pt: Ser: Qn: BLOOD GAS ANALYSIS PCO 2 Carbon dioxide: PPres: Pt 2019 -8 : Bld. A: Qn: NAHDO 23 rd Annual Conference - October 26 & 27, 2008

Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Summary ¢ The LOINC codes are not intended to transmit all possible information about a test or observation. ¢ They are only intended to identify the test result or clinical observation. NAHDO 23 rd Annual Conference - October 26 & 27, 2008

Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Summary of LOINC Benefits ¢ Normalizes lab data codes. ¢ In the AHRQ pilot project, Adding Clinical Data to Administrative Data, the standardization of lab terminology allows records from different hospital systems to be grouped into datasets that span hospitals. ¢ Standardization of lab codes allows for more comprehensive analyses of the data. NAHDO 23 rd Annual Conference - October 26 & 27, 2008

Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Christopher B. Sullivan, Ph. D. Bahia N. Diefenbach, Ph. D. Agency for Health Care Administration Florida Center for Health Information and Policy Analysis 2727 Mahan Drive Tallahassee, FL 32308 sullivac@ahca. myflorida. com diefenbb@ahca. myflorida. com NAHDO 23 rd Annual Conference - October 26 & 27, 2008