LOINC on OWL James R Campbell MD Nebraska

LOINC on OWL James R. Campbell MD Nebraska Medicine University of Nebraska Medical Center Omaha, NE

LHS and Interoperation Ø Learning Healthcare System requires interoperation of data from EHR and ancillary sources Ø LOINC as ONC standard deployed to varying degrees in all US EHRs Ø Identified as reference terminology standard for laboratory and clinical results, orders, document types

Interoperation research use cases for LOINC Ø Organize metadata for LOINC terms by clinical intent and utility to allow navigation and creation of valuesets by researcher Ø Construct valuesets of LOINC terms for research dataset retrieval across PCORI network datamarts Ø Employ LOINC terms in decision rules for computable phenotypes

I 2 b 2 metadata browser

PCORI Network Data Summary

LOINC codes are not enough for interoperation Ø Multidomain hierarchy supports domain visualization but has limited value for query or valueset specification Ø LOINC term model is not widely understood by clinical, research and public health communities and was designed initially for laboratory test results Ø LOINC term mapping is subject to high intra-observer variance; Legacy code mapping with RELMA is confounded by magnitude of LOINC scope Ø LOINC is large but the applicable domain of use in US for lab&clinical results is small (4 K/78 K) Ø Valueset development with RELMA is error prone and cumbersome depending upon use case

Collaborative concept model for Observables/Observation results Ø 2013 agreement executed between Regenstrief and IHTSDO for cooperative work to link terminologies Ø Observables project cooperatively developed concept model for ontologic definition of Quality/Process/Function observable entities Ø 2015 Technology preview of SNOMED CT post-coordinated expressions defining common lab orders

What Nebraska Medicine has done with LOINC and OWL Ø Compile statistical analysis of observation results across GPC network Ø Developed OWL class axioms using harmonized concept model of lab and clinical observation results recorded in EHRs of our research network (many from LOINC technology preview) Ø Classified with SNOMED 3773 -9 Methadone [presence] in Urine CT to support full ontological definition across defining SNOMED 'Toxicology laboratory observable (observable entity)' domains and ('Role group (attribute)' some ('Component (attribute)' some 'Methadone (substance)')) Ø('Role Extracting LOINC Observables hierarchical subset ')) as and group (attribute)' some ('Property (attribute)' some 'Presence (property) setgroup of OWL axioms and ('Role (attribute)' some ('Scale type (attribute)' some 'Ordinal value')) and group (attribute)' some ('Time aspect (attribute)' to some 'Single point in time)')) Ø('Role Support US LOINC OWL ontology provide and ('Role group (attribute)' some ('Inheres in (attribute)'valueset some 'Urinedefinitions (substance)')) metadata browsing, extensional and ('Role group (attribute)' some ('Direct site (attribute)' some 'Urine specimen (specimen)')) and query support for rseaecrh and clinical decision making

UNMC: Project for structured encoding of AP/MP cancer reports Ø Objective: Detailed structured and coded reporting of all anatomic and molecular pathology observations for all CAP synoptic cancer worksheets (82 types of malignancies including genomic findings) Ø Project plan: Analyze, develop terminology and encode details of CAP cancer worksheets Ø Vet all synoptic concepts for LOINC coding for US consumption Ø Tooling: Nebraska Lexicon© SNOMED CT extension namespace; SNOWOWL authoring platform; Ø SNOMED International committed to project work plan for 2017 -8

Demonstration

Proposal Ø Compile pragmatic statistical analysis of LOINC classtype 1&2 terms conceptually deployed in US EHRs Ø Complete concept definition of this LOINC terms subset employing harmonized OE concept model Ø Model and deploy this concept subset supplemented by OWL grouper concepts which classify into useful clinical and laboratory results ontology Ø Publish six monthly on LOINC site Ø Work with LOINC and NLM valueset authority to publish extensional valuesets of LOINC concepts for recurring ONC use cases

Questions? James R. Campbell campbell@unmc. edu W. Scott Campbell wcampbel@unmc. edu