Indian Health Service Indian Health Service Laboratory ModernizationLaboratory ModernizationLOINC/UCUM Proposed LOINC/UCUM Proposed

Strategy Strategy

Clarence SmileyClarence Smiley

David GiffordDavid Gifford

BackgroundBackground

IHS utilizes the VA’s infrastructureIHS utilizes the VA’s infrastructure

Last major update was in 2005Last major update was in 2005

Meaningful Use and other incentives Meaningful Use and other incentives make the implementation of LOINC make the implementation of LOINC and UCUM imperativeand UCUM imperative

Background Background

IHS “Patch 15”IHS “Patch 15”• Developed a methodology that assisted in Developed a methodology that assisted in

automating mapping to LOINCautomating mapping to LOINC• Developed in conjunction with the CDCDeveloped in conjunction with the CDC• Detailed in a AMIA paper:Detailed in a AMIA paper:

Standardizing Laboratory Data by Mapping to Standardizing Laboratory Data by Mapping to LOINCLOINC

Agha N. Khan, MD, MPH, Stanley P. Griffith, MD, Agha N. Khan, MD, MPH, Stanley P. Griffith, MD, Catherine Moore, Dorothy Russell, Arnulfo C. Rosario, Catherine Moore, Dorothy Russell, Arnulfo C. Rosario, Jr., MD, MPH, and Jeanne Bertolli, PhD, Jr., MD, MPH, and Jeanne Bertolli, PhD, J Am Med J Am Med Inform Assoc. Inform Assoc. 2006 May–Jun; 13(3): 353–355. 2006 May–Jun; 13(3): 353–355.

doi: 10.1197/jamia.M1935.doi: 10.1197/jamia.M1935.

BackgroundBackground Pilot project to standardize local laboratory data Pilot project to standardize local laboratory data

at five Indian Health Service (IHS) medical at five Indian Health Service (IHS) medical facilities by mapping laboratory test names to facilities by mapping laboratory test names to Logical Observation Identifier Names and Codes Logical Observation Identifier Names and Codes (LOINC). (LOINC).

An automated mapping tool was developed to An automated mapping tool was developed to assign LOINC codes. At these sites, they were assign LOINC codes. At these sites, they were able to map from 63% to 76% of the local active able to map from 63% to 76% of the local active laboratory tests to LOINC laboratory tests to LOINC

Eleven percent to 27% of the tests were mapped Eleven percent to 27% of the tests were mapped manually. They could not assign LOINC codes to manually. They could not assign LOINC codes to 6% to 19% of the laboratory tests due to 6% to 19% of the laboratory tests due to incomplete or incorrect information about these incomplete or incorrect information about these tests. tests.

Background Background

Rural hospitalsRural hospitals

Rural ClinicsRural Clinics

No laboratorian present No laboratorian present

Limited knowledge of terminologiesLimited knowledge of terminologies

Proposed Updated Methodology Proposed Updated Methodology

Using VA’s Laboratory Electronic Data Interchange Using VA’s Laboratory Electronic Data Interchange specimen codes associate local codes to specimen.specimen codes associate local codes to specimen.

Produce candidate matches of local unit codes to Produce candidate matches of local unit codes to UCUM. UCUM.

Finally, using a IHS master LOINC file, auto-map local Finally, using a IHS master LOINC file, auto-map local codes to the Common Lab Orders LOINC Value Set codes to the Common Lab Orders LOINC Value Set Version 1.1. Version 1.1.

Those codes that are not automatically mapped, will be Those codes that are not automatically mapped, will be put into a file and submitted to OIT for further put into a file and submitted to OIT for further investigation and possible matching through the investigation and possible matching through the Regenstrief’s RELMA tool.Regenstrief’s RELMA tool.

Proposed Methodology IssuesProposed Methodology Issues LEDI Specimen codes – are based upon a LEDI Specimen codes – are based upon a

deprecated table from HL7 V2.x.deprecated table from HL7 V2.x.

IHS Patch 15 LOINC is out of date; need to IHS Patch 15 LOINC is out of date; need to update IHS master list…..In processupdate IHS master list…..In process

Local panels may not match LOINC definitions: Local panels may not match LOINC definitions: new code submission?new code submission?• This is an interesting point of discussionThis is an interesting point of discussion

Need to centralize process as much as Need to centralize process as much as possible due to local resource issues. possible due to local resource issues. • Need for LOINC but no laboratorians at some clinics.Need for LOINC but no laboratorians at some clinics.

Some next stepsSome next steps

LOINC code look up – link to RELMA LOINC code look up – link to RELMA from IHS Lab home page.from IHS Lab home page.

Support desk specialist will be Support desk specialist will be trained and be able to provide trained and be able to provide guidance. guidance.

Deployment will include training on Deployment will include training on LOINC for all levels of end users. LOINC for all levels of end users.

““Meaningful Use Report” for the Meaningful Use Report” for the clinics.clinics.

Continuous improvementContinuous improvement

As we deploy, the master list gets As we deploy, the master list gets better. The process is refined until it better. The process is refined until it will be highly accurate. This will allow will be highly accurate. This will allow us to have a “Gold” standard for us to have a “Gold” standard for future deployments.future deployments.

Continuous improvementContinuous improvement

Additional outcome is a study of the Additional outcome is a study of the C80 top % compared to the Indian C80 top % compared to the Indian Health Population.Health Population.

Currently working on the design of Currently working on the design of experimentexperiment

Will they be the same?Will they be the same?

Will our top 99% be the same as Will our top 99% be the same as the general population?the general population?

Seeking Feedback Seeking Feedback

IHS is soliciting comments from the IHS is soliciting comments from the Lab LOINC community on all aspects Lab LOINC community on all aspects of the methodologyof the methodology

• David Gifford, David Gifford, david.gifford@ihs.gov • Michael Walker,developer,Michael Walker,developer,michael.walker@ihs.gov