LOINC Tutorial Panels, Forms, and Patient Assessments

Daniel J. Vreeman, PT, DPT, MSc Assistant Research Professor, Indiana University School of Medicine

Research Scientist, Regenstrief Institute, Inc

Clinical LOINC Meeting

2013 02 13 © 2013 dvreeman@regenstrief.org

Overview

photo via Vernio77

1.  Background

2.  Standard panels in LOINC

3.  Patient assessment model

4.  Current projects

5.  Lessons learned

Assessments are widely used…

…and not unlike other clinical observations

Purpose

LOINC could be a

master question file and

uniform representation

Standardized Assessments in LOINC

Vreeman DJ, McDonald CJ, Huff SM. Representing patient assessments in LOINC®. AMIA Annu Symp Proc. 2010;832-836. PMID: 21347095.

Vreeman DJ, McDonald CJ, Huff SM. LOINC® - a universal catalog of individual clinical observations and uniform representation of enumerated collections. Int J Funct Inform Personal Med. 2010;3(4):273-291.

Iterative Refinement Started almost 10 years ago

Gradually expanded the base panel model

Informing ideas: Survey instruments have psychometric properties

Question meaning tightly coupled with answers

Many collaborators esp Tom White, Susan Bakken

CHI Functioning and Disability workgroup

ASPE, AHIMA, CMS, RTI, HL7, HITSP

photo via Rainbirder

Consolidated Health Informatics

Standards  ^

LOINC Model for Collections Panels, forms, surveys, and other patient assessments

photo via LuzA

Hierarchy of a Panel in LOINC

Assessment Items Question Text

Question Source

External Copyright

Terms of Use

Description/Definition

Units of Measure (UCUM)

HL7 Data Types (v2, v3)

Structured Answer Lists Answer List Attributes

OID

External Link

Answer Item Attributes ID (contains “LA” prefix)

String

Sequence

Local code

Score

Attributes of Items in a Panel Instance

Display name override

Coding instructions

Cardinality

Local code on that form

Skip logic

Data type in form

Answer sequence override

Consistency/validation checks

Relevance equation

Panels/Forms Available as Separate Download

Assessments Currently in LOINC US Government Forms

CARE, MDSv2, MDSv3, OASIS B1, OASIS C, RFC

US Surgeon General’s Family Health Portrait

Brief Interview for Mental Status (BIMS)

Confusion Assessment Method (CAM)

Geriatric Depression Scale (GDS)

HIV Signs and Symptoms Checklist

Home Health Care Classification

howRU

Living with HIV (LIV-HIV)

Morse Fall Scale

OMAHA

PHQ (9 and 2)

Quality Audit Marker (QAM)

Translational Research Variables

15,000+  variables  Oh  snap!  

Recently Added Neuro-QOL OPTIMAL CARE long term care hospital (LTCH)

Core behavioral health terms (SAMHSA) FACIT VR 12 and 36 Edinburgh Postnatal Depression Scale My Mood Monitor NIH Stroke Scale Borderline Symptom List - 23 Item

Recently Added total scores only

Ages and Stages Questionnaire Blessed Orientation-Memory-Concentration Test Montreal Cognitive Assessment Alcohol Use Disorder Identification Test Knee injury and Osteoarthritis Outcome Score (KOOS) survey Hip Dysfunction and Osteoarthritis Outcome Score (HOOS)

Our Assessment Rockstar

Jaci Phillips, MS, RN

Find them in RELMA

Hit  this!  

Government Forms

Laboratory Panels

Double-­click  panel  name  to  see  components  

Expanded Panel Detail

Newborn Screening (loinc.org/newborn-screening)

Clinical Panels

3141-9

Find  where  a  term  has  been  used  

LOINC Term Panel Usage

DEEDS

NAACCR

NEMSIS

Other Survey Instruments

Not all Use Cases Need Everything

Quality measures sometimes just need:

1.  Name of some specific instrument used

2.  Total score from a particular instrument

Evolve gracefully. photo via Dawn Huczek

Graceful Evolution

1.  Create "panel" codes that represent the named instrument

2.  Create a total score term (as a child) for the instruments where score is needed

3.  When they are needed, fully model the instrument as a complete set of questions (with answers where appropriate)

Could  be  used  as  the  “answer”  to  the  question  of  which  instrument  was  used  

More Cooking… CDC

NIH Toolkit

NIH CDE efforts sprouting up everywhere

Many more…

photo via liber

Lessons

and

Recommendations

LOINC

TIMP

GDS PHQ

Advantages of the Master Catalog

Advantages of the Master Catalog

Lesson 1 Variation Abounds

Variation Abounds

Despite item similarity, much variation…

…many differences might have been avoided

photo via poolie

Original PHQ-9

CARE

MDSv3

MDSv3

MDSv2

OASIS

CARE

• Frequency with which resident complains or shows evidence of pain (in last 7 days)?

• No pain, Pain less than daily, Pain daily MDSv2

• How much of the time have you experienced pain or hurting over the last 5 days?

• Almost constantly, Frequently, Occasionally, Rarely, Unable to answer MDSv3

• Have you had pain or hurting at any time during the last 2 days? • Yes, no, unable to respond CARE

• Frequency of Pain Interfering with patient's activity or movement • Patient has no pain or pain does not interfere with activity or

movement, Less often than daily, Daily but not constantly, All of the time

OASIS-B1

• Frequency of Pain Interfering with patient's activity or movement • Patient has no pain, Patient has pain that does not interfere with

activity or movement, Less often than daily, Daily but not constantly, All of the time

OASIS-C

Weigh the cost of losing comparability before inventing something new

photo via neurmadic aesthetic

Lesson 2 Starting from a uniform data model may bring clarity

photo via pasukaru76

We usually started from paper forms…

…but some had custom programs and databases

!

Discrepancies and Incongruences

How do you store “Other specified ____________”

Which text is the question and which is help

Storing “unknown” or “unable to determine” as answers versus flavors of null

Every “check all that apply” stored as a separate yes/no binary value item

Many Yes/No Diseases

Starting with the LOINC model may help elucidate hidden challenges

Lesson 3 IP issues present large challenges

Funders should require developers to avoid restrictive licenses

Conclusion LOINC has a uniform model with a (rapidly) growing “master question file” that enables interoperable exchange of assessment data

Acknowledgements Clinical LOINC Committee

Kathy Mercer, Jo Anna Hernandez, Jami Deckard, Jaci Phillips

Regenstrief Software Engineers

Michelle Dougherty, Barbara Gage, Jennie Harvell, Tom White, Carol Hamilton

Funding Support NLM: HHSN2762008000006C

AHIMA Foundation: FORE-ASPE-2007-5

RTI International: 0-312-0209853

NCRR: 3UL1RR025761-02S6

photo via milos milosevic