A Helpful Four Part Series on LOINC – Part IV


This is the final part of the series on LOINC®. Please refer to the LOINC category on the right for all posts related to this topic.

Part IV – Populating Your LIS with LOINC

Now that you know all about LOINC ®, the million dollar question becomes: “How do I get this information in my LIS?”  It would be great if your LIS vendor could do this for you, but they can’t. It’s not that the vendors don’t want to help. The reality is that there are far too many variables in each of your test menu dictionaries.

Consider a simple glucose test. A glucose is a glucose is a glucose, right? Not quite. Is it fasting, is it timed, is it following an oral challenge, and if so, how many hours? While the glucose test is the same on the analyzer, how many variations of glucose do you use at your facility? Is it serum, urine, CSF, or another fluid? Which method is used on your analyzer? Do you use reagents manufactured by the instrument vendor, or are you using another vendor’s reagents? The method may vary between the instrument vendor’s and the third party’s reagents. I think you get the picture. Multiply that by the number of clients for each LIS vendor, and it becomes an impossible task to simply import the codes. A search of the LOINC database for glucose brings up 851 different codes. How would your LIS vendor possibly know which one to map to yours? The appropriate code depends on the combination of the instrument and reagent vendors.

Don’t despair, though. There are ways to minimize the scope of entering the codes in your LIS. Your instrument vendor knows the methodology better than anyone, so call them and/or reagent vendor(s) and ask them what LOINC is appropriate for the method used on your analyzer, as the method on one analyzer in a series may differ from the next generation of that analyzer from the same manufacturer. Remember, too, that your LIS vendor is not a client of your instrument manufacturer, so they will not have access to the instrument or reagent vendor technical support groups, but you may access these groups through your instrument and reagent vendors for further assistance. Fortunately, some vendors are beginning to include the LOINC codes in their package inserts to make things easier.

Once the codes are populated into the correct field of the LIS, it will include them in interface transmissions to the EMR, and you’ll be ready to go!

We hope you have found this series helpful. As always, we welcome suggestions or tips that you would like to share.

Ginger Wooster, MBA, MT (ASCP)
Director of Regulatory Affairs & Applications Specialist
Orchard Software Corporation

Comments (0) Apr 14 2011

A Helpful Four Part Series on LOINC – Part III


This is the third of a four-part series on LOINC. Stay tuned to colLABoration for the rest of the four-part series.

Part 3: Understanding and using the LOINC database

The overall organization of the database is divided first into four categories: “lab,” “clinical,” “attachments,” and “surveys” (this split is recorded in CLASSTYPE). The laboratory portion is further divided into the usual categories of chemistry, hematology, serology, microbiology (which includes parasitology and virology), and toxicology. Antibiotic susceptibilities have their own category.

Each LOINC record (fully specified name) corresponds to a single test result by method or panel. While each LOINC is unique, the codes were not designed, nor intended, to be unique by testing location. For example, your lab may use the same methodology as your reference lab. If so, both results would use the same LOINC. A formal, distinct, and unique six-part name is given to each term for test or observation identity. The database currently has over 58,000 observation terms that can be accessed and understood universally. Each database record includes six fields for the unique specification of each identified single test, observation, or measurement:

  • Component (analyte): What is measured, e.g., potassium or hemoglobin.
  • Property Measured: How it is measured, e.g., a mass concentration or enzyme activity (catalytic rate).
  • Timing: Whether the measurement is an observation at a moment of time, or an observation integrated over an extended duration of time, e.g., 24-hour urine.
  • Sample Type: The type of sample, e.g., urine or blood.
  • Scale Type: The type of scale, e.g., whether the measurement is quantitative (a true measurement), ordinal (a ranked set of options), nominal (e.g., E. coli, Staphylococcus aureus), or narrative (e.g., dictation results from x-rays).
  • Method: The method used to produce the result or other observation, where relevant.

Example :

Sodium:SCnc:Pt:Ser/Plas:Qn

The analyte is sodium, measured by substance concentration, done at one point in time, on either serum or plasma, and the result is quantitative. In this case, the method used is not included.

Certain parameters and descriptions pertaining to test performance are specifically excluded from the database. These parameters will typically be reported in separate fields (attributes) of a test/observation report message, not as part of the observation name. Attributes that are explicitly excluded from the fully specified name are:

  • The instrument used in testing.
  • Fine details about the sample or the site of collection, e.g., “right antecubital fossa.”
  • The priority of the testing, e.g., whether STAT or routine.
  • Who verified the result.
  • The size of the sample collected.
  • The place of testing, e.g., home, bedside, clinical lab.

Also, become familiar with the online search tool, RELMA®. To use it, go to www.search.loinc.org, and agree to the disclaimer. Enter your test name into the search field. Knowing the database structure will aid your search. In the example above, searching on “glucose” brings 851 hits, but searching on glucose and fasting reduced the number to 19. You can sort on any of the columns. Scroll to the right to the “Long Name” column and find the one that best fits your lab. To make it easier, we have posted a list of the long common names on our website at www.orchardsoft.com. For more information on LOINC®, the LOINC Manual is also available on our website.

Late in 2009, a new set of codes at the order level was introduced. Still in the experimental stage, approximately 300 have been published. The intent of the order-level codes is to simplify communication between disparate systems at the order level to complement the existing database, which focuses on the result level. We will be hearing more on this.

*Stay tuned to colLABoration for the rest of the series—Part IV.

Ginger Wooster, MBA, MT (ASCP)
Director of Regulatory Affairs & Applications Specialist
Orchard Software Corporation

Comments (0) Apr 08 2011

CMS Physician Signature Requirement Withdrawal Hits a Snag; However, the Requirement is Not Being Enforced.


We interrupt our four-part blog series on LOINC with this important update. Many are closely following the signature rule and waiting for CMS to officially announce they have rescinded the signature rule. The agency had sent an interim final rule to rescind the signature requirement to the White House Office of Management and Budget for review on March 21. However, administration lawyers said the interim rule could not go forward as presented, because CMS must go through the proper federal rulemaking process. That is, issue a notice or rule with a comment period. The result is that the process of rescinding the rule may not conclude until the end of 2011.

The official rescission of the requirement most likely will appear in the proposed Medicare physician fee schedule expected this summer, according to a report issued by American Medical News. Meanwhile, a bipartisan group of House and Senate legislators have been urging CMS Administrator Don Berwick, MD, to at least delay enforcing the requirement until 2012, and per the Dark Daily e-newsletter published April 5, 2011, the CMS has instructed its Medicare contractors to not enforce the physician signature requirement. More to come.

Ginger Wooster, MBA, MT (ASCP)
Director of Regulatory Affairs & Applications Specialist
Orchard Software Corporation

Comments (0) Apr 06 2011