20 Jahre LOINC

Hat es eine Zukunft als semantisches

Codiersystem von Laboranalysen?

Auch in der Schweiz?

W.Fierz

Das semiotische Dreieck

Ding, Begriff und Symbol sollen eindeutig zusammengehören 20. Sept. 2011 3

Das semiotische Dreieck im Labor

Ding, Begriff und Symbol sollen eindeutig zusammengehören

eindeutiger

LOINC Code

Antikörper

gegen TPO

Methode

Material

Einheiten

Konzentration

Labor-spezifische

Auslegung

(Messung)

Medizinische Ontologien,

Terminologien, Vokabulare

• UMLS: Unified Medical Language System (NLM)

• MeSH Thesaurus: Medical Subject Headings (NLM)

• Galen: Generalized Architecture for Languages, Encyclopaedias and Nomenclatures in Medicine

• LOINC: Logical Observation Identifiers Names and Codes

• SNOMED CT: Systematized Nomenclature of Medicine Clinical Terms

• DRG, ICD-10, READ: Klassifizierungssysteme

20. Sept. 2011 W. Fierz, lmz Dr Risch 5

www.loinc.org

Labor-Codes: 6 Dimensionen

1. Komponente (Analyt)

2. Eigenschaft / Einheiten (Masse, Aktivität, etc.)

3. Zeit (Zeitpunkt, Intervall)

4. System (Probenmaterial)

5. Skala (quantitativ, qualitativ, etc.)

6. Methode

• Synonyme (Abkürzungen, etc.)

Logical Observation Identifiers Names and Codes (LOINC®)

HL7 LOINC Dokumenten-Typen zB: 11502-2 LABORATORY REPORT.TOTAL

Sept. 2015 W. Fierz, lmz Dr Risch 6

LOINC-Codes für TPO-Antikörper

LOINC

# Component Property

Time

Aspect System Scale Method Ex. Units Long Common Name

14296-8 Thyroperoxidase

Ab SCnc Pt Ser/Plas Qn Thyroperoxidase Ab [Moles/volume] in Serum or Plasma

17706-3 Thyroperoxidase

Ab Titr Pt CSF Qn LA titer

Thyroperoxidase Ab [Titer] in Cerebral spinal fluid by Latex

agglutination

17707-1 Thyroperoxidase

Ab.IgM ACnc Pt Ser/Plas Qn

Thyroperoxidase IgM Ab [Units/volume] in Serum or

Plasma

18332-7 Thyroperoxidase

Ab.IgG ACnc Pt Ser/Plas Qn

Thyroperoxidase IgG Ab [Units/volume] in Serum or

Plasma

32042-4 Thyroperoxidase

Ab ACnc Pt Ser/Plas Ord Thyroperoxidase Ab [Presence] in Serum or Plasma

32786-6 Thyroperoxidase

Ab Titr Pt Ser/Plas Qn titer Thyroperoxidase Ab [Titer] in Serum or Plasma

5382-7 Thyroperoxidase

Ab ACnc Pt Ser/Plas Qn RIA

Thyroperoxidase Ab [Units/volume] in Serum or Plasma by

Radioimmunoassay (RIA)

5383-5 Thyroperoxidase

Ab Titr Pt Ser/Plas Qn LA titer

Thyroperoxidase Ab [Titer] in Serum or Plasma by Latex

agglutination

56477-3 Thyroperoxidase

Ab ACnc Pt Ser/Plas Qn EIA index

Thyroperoxidase Ab [Units/volume] in Serum or Plasma by

Immunoassay

8099-4 Thyroperoxidase

Ab ACnc Pt Ser/Plas Qn

IU/mL;unit

s/mL Thyroperoxidase Ab [Units/volume] in Serum or Plasma

Sept. 2015 W. Fierz, lmz Dr Risch 7

LOINC-Codes für TPO-Antikörper

Sept. 2015 W. Fierz, lmz Dr Risch 8

LOINC Codes

20. Sept. 2011 W. Fierz, lmz Dr Risch 9

Laboratory Technical Framework

Vol. 4: LOINC Test Codes Subset

Quelle: www.ihe.net/Technical_Framework/upload/ihe_lab_tf_rel2-4.pdf

Sept. 2015 W. Fierz, lmz Dr Risch 10

Probleme?: Beispiel Vitamin D3

Code Component Vitamin Property Time System Scale Method Units

35365-6 Vitamin D+Metabolites D3+D2 MCnc Pt Ser/Plas Qn ng/mL

49543-2 Calcidiol+Calciferol D3+D2 MCnc Pt Ser/Plas Qn ng/mL

1989-3 Calcidiol D3 MCnc Pt Ser/Plas Qn ng/mL

1990-1 Cholecalciferol D3 MCnc Pt Ser/Plas Qn

49054-0 25-Hydroxycalciferol D3 MCnc Pt Ser/Plas Qn ng/mL

47094-8 Calciferol D2 SCnc Pt Ser/Plas Qn pmol/L

Sept. 2015 W. Fierz, lmz Dr Risch 11

Redundanzen

Common Lab Orders LOINC Value Set

Version 1.1 (April 7, 2010)

1) The Indiana Health Information Exchange (INPC), who reported ordering

statistics from a sample of 10 million orders from more than 15 hospitals

and clinics.

2) Health Care (UHC) who derived their statistics from a sample of 30 million

referral laboratory test results from their nationwide database.

3) Five Northeast US hospitals that derived their statistics from a sample of 1.5

million orders.

4) One Southeast US hospital that derived its statistics from 200,000 test

orders.

5) A list of about 200 tests gathered by survey from an internal medicine

project run by Stasia Kahn, MD (Chicago).

Sept. 2015 W. Fierz, lmz Dr Risch 12

Common Lab Orders LOINC Value Set

Version 1.1 (April 7, 2010)

• Value set of universal laboratory order codes from LOINC includes 292

laboratory test and test panel codes

• The purpose of this value set is to define a set of universal laboratory order

codes that would be recommended and adopted by developers of order

entry systems for delivery in HL7 messages to laboratories, where they

could be understood and fulfilled.

• This value set is designed to cover greater than 95% of the test ordering

volume in the US, and was developed with both empirical and consensus-

driven approaches.

• This list … "should be considered a minimum 'starter' set" and "does not

attempt to include all possible LOINC codes" or all possible lab orders.

Quelle: loinc.org/usage

Sept. 2015 W. Fierz, lmz Dr Risch 13

Erfahrungen aus den USA

Methods Inf Med 2011; 50: 105–114 Sept. 2015 14

medical informatics project

initiated in 1997 in Geneva

Einführung in der Schweiz ? Einführung

in Einführung in der Schweiz ?

Einführung in der Schweiz ?

• Empfehlung durch die Expertengruppe Semantik von

eHealth Suisse ? -> Anwendungsfälle www.e-health-suisse.ch/umsetzung/00146/00148/00244/index.html

• Über die eidg. Analysenliste:

– in Arbeit seit August 2015, unterstützt durch

eHealthSuisse

– erste 200 Positionen sind codiert.

• Durch die Industrie: Kennzeichnung der Analysen-Kits ? ivdconnectivity.org/

Semantik im Laborumfeld /

LOINC-Anwendungsfälle

eHealth Suisse

„Semantik und Metadaten“

IHE/HL7/LSI/SULM

Projektgruppe Labor

HL7 CH IHE Suisse FAMH SULM

BAG

Strategie

Umsetzung

Use cases Value Set für

Meldungen von

Erregernachweisen

CDA-CH-LRPH

Sektion

Meldesysteme

Sektion

Transplantation und

Fortpflanzunungsmedizin

Value Set für

Laborbefunde im

Transplantationsprozess

CDA-CH-LRTP

User

QUALAB

Q-Control

Centers

Value Set für

Laborbefunde

Ringversuchen

CDA-CH-LRQC

18

IVD Industry Connectivity Consortium (IICC)

ivdconnectivity.org

IICC

Board of Directors

Executive Committee

Jay Jones, PhD, Director of Chemistry and Regional Labs Geisinger Health Systems

X

Provider Review Committee Chair

Mojgan Lefebvre, Corporate Vice President & CIO bioMérieux

X

President

Jean-Claude Lugeon, Head of Methods and IT Architecture Roche Diagnostics

X

Carl Murray, Principal Staff Software Development Engineer Beckman Coulter

X

Eric Olson, Vice President of Informatics and eBusiness Siemens Healthcare Diagnostics

X

Chief Technology Officer

Scott Goss, Global Marketing Director Informatics & New Instrument System Development Abbott Diagnostics

Treasurer & Secretary

Sept. 2015 W. Fierz, lmz Dr Risch 19

IICC and LOINC Rob Bush, Orchard Software

LOINC Planning Memo 7 June 2011

INTRODUCTION TO PROJECT

Dr. Fierz, a lab director in Switzerland, has made a very practical suggestion in a letter to

Eric Olsen. He asked that the IICC promote the inclusion of LOINC code information

on test kit labels or in the package inserts for assays.

…

While Eric points out that labeling is outside the scope of our interface standards group

(IICC), it is within our scope to consider the problem of test identification within our

interfaces, and subsequently within our databases. ...

…

I believe there is a very valuable side task that our IICC could accomplish on his behalf.

…

Sept. 2015 W. Fierz, lmz Dr Risch 20

IICC and LOINC

Key to our success will be identifying people from each of our member companies who

will commit to accomplishing this task within our chosen time frame (which I

recommend is by Aug 2011).

…

To help with this task, I propose that Orchard write a small database tool that will help us

consolidate information and compare our work. …

…

As a way to disseminate this information, I propose that we post the results on the IICC

site (IVDconnectivity.org) and on the Regenstrief site (regenstrief.org).

…

Unquestionably, each company will want to be able to provide this information to their

own clients. As we complete the project we can further discuss how we can facilitate

this goal.

Rob Bush

Orchard Software

Sept. 2015 W. Fierz, lmz Dr Risch 21

Beckman Coulter

IICC Conducts Live Plug and Play Instrument

Connectivity Demonstrations at AACC 2015

• At its booth at AACC 2015, the IVD Industry Connectivity

Consortium (IICC) successfully conducted live plug and play

instrument connectivity demonstrations of the IICC/IHE LAW Profile.

• It involved one analyzer (Abbott) and one analyzer manager

(Orchard Software) in the booth, as well as one remote analyzer

(Beckman) connecting over the Internet to the cloud-based IHE

Gazelle Order Manager simulator.

• In addition to establishing a plug and play connection and

exchanging work orders and test results using the LOINC

vocabulary, the participants also demonstrated several features

defined in the LAW Profile,

LOINC und andere

Nomenklaturen

Nomenclature Properties and Units

(C-NPU)

SNOMED CT

IUPAC/IFCC Commission on

Nomenclature Properties and Units (C-NPU)

International Union of Pure and Applied Chemistry

LOINC, C-NPU & SNOMED CT

LOINC, C-NPU & SNOMED CT

SNOMED CT and LOINC

http://www.ihtsdo.org/loinc/press_release.pdf www.ihtsdo.org/loinc/agreement.pdf

SNOMED CT and LOINC

https://loinc.org/downloads/files/loinc-snomed-ct-expression-associations-technology-preview

2014-10-27

Danke für das Interesse

LOINC !