LOINC Codes & Their Use in Orchard s Systems

Transcription

1 LOINC Codes & Their Use in Orchard s Systems Jacob Eickhoff, HL7 Interface Specialist & Unwilling LOINC Coder Orchard Software Corporation June 22-23, 2016

2 Learning Objectives Recognize the importance of LOINC codes in Meaningful Use (MU) requirements Explain how the LOINC codes affect reference lab interfaces Decipher the imported columns Investigate the LOINC codes search tips and tricks Discover the LOINC codes in Harvest LIS and Copia Submit LOINC codes in HL7-2.3 and HL interfaces

3 What is LOINC? LOINC stands for Logical Observation Identifiers, Names, and Codes. Developed in 1994 by the Regenstrief Institute in Indianapolis. It is a globally recognized set of identifiers for orderable and resultable items. Used in Harvest LIS and Copia, either alongside your local codes or as a replacement for local codes.

4 What is LOINC? More specifically: A LOINC code on an orderable item will tell other systems what was ordered, and in some cases what result components to expect for that orderable item. A LOINC on a resultable item will tell the receiving system exactly how the test was performed, what the sample type should be, and what type of results to expect for that analyte.

5 Why are you hearing so much more about it now? The various Meaningful Use (MU) requirements have LOINC as a key component of their interoperability standards, requiring all or some of your orderable and resultable items to have a LOINC code if it s available. The LRI and ELR guides are the ones that we have seen clients utilizing that require LOINC codes. Many other MU requirements utilize LOINC, but up to this point, those are the ones that have affected Harvest LIS and Copia and their use of LOINC codes.

6 What to Do If LOINC Isn't Required LOINC isn t required for me currently. Do I need to do anything? No, BUT If you look at the bigger picture and the direction things are going, eventually this will impact your organization. Implementing LOINC correctly is a time consuming task, and is taking clients on average several months to complete when it is required. That being said, a wise system admin or lab manager would get started early.

7 Getting Started Adding LOINCs Download the LOINC Code Dictionary file from LOINC.org You need to do this yourself since it requires you to accept the terms of service agreement. Once you have downloaded the file, you can either call Orchard support and request that they import them for you, or go to one of the following links on the ORC for instructions. Harvest LIS: geid= Copia: mport+loinc+codes

8 Getting Started Adding LOINCs If you have added LOINC codes prior to importing them into your system, that is OK. After the LOINC Code Dictionary file is imported, make sure you check to see that your codes are valid. What does valid code look like? Good LOINC in Harvest LIS Bad LOINC in Harvest LIS

9 LOINC Codes for Send Out Test If configured correctly, when a result is received from your reference lab, Harvest LIS and Copia will add the received LOINC code to the lab test if one does not exist. If a LOINC code is received and a different LOINC code already has been assigned to that assay, the default action is to create a new assay. In Harvest LIS, if desired, the interface can also update it to the new LOINC code.

10 LOINC Codes for Send Out Test Currently with reference lab interfaces, LOINC codes for orderable items do not cross the interfaces and have to be manually entered. Some reference labs have been able to produce a list of LOINC codes for orderable items. Contact your reference lab and ask if they can provide a list and start sending you LOINC codes in the results messages. Many national reference labs have the ability, and can send them in the correct format. But, it requires some ACOs or configuration changes in Harvest LIS/Copia. After identifying your reference lab LOINC capabilities, notify your Orchard Account Manager.

11 LOINC Codes for In-house Test Perhaps the most difficult part of finding the right LOINC code is deciphering what is in all of the columns. When you download the LOINC file, one of the files in the folder is LOINCManual.pdf. This file contains extremely detailed explanations as to what's contained in each column, starting in section 2. It s highly recommended that you spend a little time looking at this if you get stuck on choosing codes for your in-house tests.

12 LOINC Codes for In-house Test Since you all have lives, here are some quick descriptions for each column that we import: LOINC The LOINC code itself. Long Name The long description of code and methodology. Component A shorter description of code and more. Property Quantities related to the LOINC code. Timing Whether the result is for a point in time or a range. System Sample type Scale What type of results are allowed for this LOINC.

13 LOINC Codes for In-house Test Method Method used to perform the test UCUM Units UCUM code used for the test CLASS General category assigned by LOINC team Status Active or inactive Related Names Brand or trade names for the analyte Order/Observation Identifies if it is an Order LOINC, an Observations LOINC, or both Version The version number of the LOINC data files

14 LOINC Codes for In-house Test Why do all those columns matter? In short, for a HL7 v2.3 interface, we only look at the LOINC code and make sure it is present. For HL7 v2.5.1 interfaces, we look at the other columns as required by the ELR and LRI guidelines. The Property column is used in conjunction with the Scale column in cases where the results are a date stamp or ratio to ensure the result is correctly formatted. Note that the Scale column can provide the most problems for clients.

15 LOINC Codes for In-house Test

16 Gathering Information For in-house testing, start looking at your instrument manufacturer s website or reagent packaging inserts. Most likely, you will find the LOINC code information available on the website or in the packaging. If not, you will have the information you need to get the LOINC code.

17 Searching for LOINC Codes In Harvest LIS, the search feature in the LOINC table allows you to select one column to search in at a time. However, searching for LOINC codes from the Order Choice or Lab Test windows functions differently than searching from the LOINC table.

18 Searching for LOINC Codes When searching from File Table Setup LOINC: Harvest LIS will search the column specified for the information you have entered and show you the first match based on your criteria. Searching again for that same criteria will give you the next match. Searching for a LOINC code directly from the LOINC table would be difficult, unless you knew the LOINC code ahead of time and were checking to make sure it was in the system.

19 Searching for LOINC Codes Searching from the Order Choice and Lab Test tables works much better. When searching from these tables, it uses more of a drill down method that can be quite handy. Once you have completed your initial search, all the subsequent searches only search the results from the previous search. E.g., you start by searching for your analyte or test name, then you search those results for LOINC codes that have the correct scale type.

20 Searching for LOINC Codes

21 Searching for LOINC Codes You will need to go to Administration Order Choice Setup LOINC Codes. When searching the LOINC table, items entered into the search box are only scanning the LOINC number and Long Description fields. Searching inside of Copia works best if you know the LOINC code needed in the first place, or if your search only returns a few items. In Copia, you have to click on the individual LOINC codes to view more columns.

22 Searching for LOINC Codes

23 Searching for LOINC Codes Searching for a unknown LOINC code in Harvest LIS and Copia can be difficult, so we recommend using the following website: This site is published and maintained by the Regenstrief Institute, the creators of LOINC.

24 Searching for LOINC Codes

25 Searching for LOINC Codes The search feature on this website searches all the LOINC columns for the information you provided in the search box. It s always searching the most up-to-date version of the LOINC table. The process used for searching is: 1. Do a query for the general test name. 2. Scan through the results for ones that contain the correct method of performing the test. 3. Check the filtered list for ones that have the correct sample type in the System column. 4. Verify the Scale column value supports the type of results I am entering in all cases.

26 Searching for LOINC Codes Other important columns to consider: The UCUM and Units columns to make sure those are correct. The OrderObs column to see if it s an order choice or result LOINC code. Some are both. Class can also be useful for some testing that can fall under multiple disciplines.

27 Searching for LOINC Codes Additionally, in some cases if you can find the order LOINC for a given test, double-clicking that LOINC code will open up a new window with detailed information on that LOINC code. That information can include the LOINC codes for the components they would expect as well.

28 Searching for LOINC Codes

29 Assigning a LOINC in Harvest LIS The Order Choices and Lab Tests windows are where you can correctly put your Orderable and assay-level LOINC codes. On the Order Choices window, you can type the LOINC code into the LOINC field. If it shows up in red, the LOINC code you entered does not exist in the LOINC table. If it shows up in blue, a corresponding LOINC code was found. There is also the (Ellipsis) button. Clicking that will open the LOINC search window and allow you to search for and assign the desired LOINC code.

30 Assigning a LOINC in Harvest LIS

31 Assigning a LOINC in Harvest LIS Similar to the Order Choices window, on the Lab Tests window, you can directly type in the LOINC code you desire to use and it will display in blue if it was able to find the code, or red if not. You can also click the LOINC button and to open the search LOINC window, where you can search for and choose the desired LOINC code.

32 Assigning a LOINC in Harvest LIS

33 Assigning a LOINC in Copia LOINC codes in Copia work slightly different. Administration Order Choice Setup Order Choices find the Order Choice you want to add a LOINC code to. LOINC codes are assigned per host and are put in the same table as the host codes all the way to the right. Its important to note that if you want Copia to use only the LOINC code as a matching criteria for inbound orders/results in a interface, you will need to check Use only LOINC for HL order choice matching. If you want to assign the same LOINC codes for all of your host on a given orderable item, you can select the Fill option. In the resulting box, put in the LOINC code you want to use and it will assign it to all host.

34 Assigning a LOINC in Copia

35 Assigning a LOINC in Copia Test-level LOINCs in Copia: Administration Order Choice Setup Test find the test you want to add a LOINC code to. Once you have located the test, you can type in the LOINC code in the LOINC field.

36 Assigning a LOINC in Copia

37 Assigning a LOINC in Copia Copia will automatically assign the LOINC code to an order choice or lab test when received from a host. It will NOT add a LOINC code to the LOINC table if the received code does not exist in the table.

38 LOINCs in a HL7 2.3 Interface The use of LOINC codes in an Orchard HL7 v2.3 (classic) interface message is drastically different than in a HL7 v2.5.1 message. If the LOINC codes are present and the related ACOs are in place, we have the ability to send both the orderablelevel LOINC codes and the result-level LOINC codes out of Harvest LIS.

39 LOINCs in a HL7 2.3 Interface When the proper configuration is in place the message structure will look something like this. OBR-4.1 Local order code OBR-4.2 Local orderable description OBR-4.3 Blank OBR-4.4 LOINC code OBR-4.5 Local orderable description again OBR-4.6 LN (identifier for LOINC) OBR ORC123^PSA^^ ^PSA^LN

40 LOINCs in a HL7 2.3 Interface OBX-3.1 Local analyte code OBX-3.2 Local analyte description OBX-3.3 Blank OBX-3.4 Analyte LOINC code OBX-3.5 Local analyte description again OBX-3.6 LN (identifier for LOINC) OBX 1 ST TST987^TOTAL PSA^^ ^TOTAL PSA^LN

41 LOINCs in a HL7 2.3 Interface WARNING!! The following information will tell you how to turn on sending LOINC codes in your Orchard HL7 v2.3 interfaces. This should be used with extreme caution as it may cause your interfaces to stop functioning. Any and all changes should be made with the assistance of an Orchard Software Employee, and done first in a test system to verify that there will be no adverse affects prior to implementation in a live system. Don t say I didn t warn you.

42 LOINCs in a HL7 2.3 Interface For a classic interface to include LOINCs in Harvest LIS, it requires ACOs to be added to your system. [HL7 Outgoing Port #] SendLOINCInOBR=true SendLOINCInOBX=true Note that if you are going to put these into your system, you should do it in your test system first, since not all EHRs can take them, and may not accept them in these fields.

43 LOINCs in a HL7 2.3 Interface For Copia to send LOINC codes in a 2.3 interface, the only requirement is that they are in the system correctly. The difference between Harvest LIS and Copia is that Copia will send the LOINC codes description from the LOINC table by default. If you wish to send your description in OBX-3.5, you can change that in outbound host configuration, enabling the setting labeled Populate OBX-3.5 with the received LOINC description.

44 LOINCs in a HL Interface As mentioned several times before, the use of LOINC codes in a HL7 v2.5.1 interface functions drastically different than in the classic 2.3 interface. In the interfaces, LOINC codes become your primary identifier for all of your order choices and lab tests. They can also be used in other places, e.g., your clinical information questions. Use of LOINCs in the interfaces is a default action. Depending on the type of implementation you re doing, they may be required for all or some of your testing.

45 LOINCs in a HL Interface In a interface, Harvest LIS and Copia check to make sure that the results entered meet all of the LOINC codes attributes. If a result does not meet the LOINC codes defined properties, we may not send the result. We will send a placeholder OBX in the result message that indicates the result was not sent. Optionally, we could send the result in an alternate format that does not adhere strictly to the ELR and LRI guidelines, and may fail in the downstream system.

46 LOINCs in a HL Interface What does a LOINC code look like in a interface? OBR ^Lipid 1996 panel:-:pt:ser/plas:qn:^ln^7600^lipid Panel^L^2.46^ ^Lipid Panel OBX ^Cholesterol:MCnc:Pt:Ser/Plas:Qn:^LN^^^^2.46^^Cholesterol If you need a detailed explanation of the contents of these fields, you can refer to our ELR, LRI, or orders interface specifications, available from your account manager or HL7 interface specialist.

47 Learning Objectives Review Recognized the importance of LOINC codes in Meaningful Use (MU) requirements Explained how the LOINC codes affect reference lab interfaces Deciphered the imported columns Investigated the LOINC codes search tips and tricks Discovered the LOINC codes in Harvest LIS and Copia Submitted LOINC codes in HL7-2.3 and HL interfaces

48 Questions?

49 2016 Upcoming Training Courses Orchard Harvest LIS System Administrator July August 9-11 September October November December Orchard Harvest LIS Advanced User July August October 4-6 Nov./Dec Orchard Pathology Administrator June August October December 6-8 Orchard Harvest LIS Microbiology Module June August October December 6-8 To schedule, contact your Account Manager or call Orchard Copia Administrator & Integration Training Courses June August September October October December 6-8

50 Orchard Resources White papers: orchardsoft.com/whitepapers collaboration blog: blog.orchardsoft.com Newsletter online: orchardsoft.com/newsletters enewsletter sign up: orchardsoft.com/newsletters Orchard Resource Center (ORC): orc.orchardsoft.com Questions user forum: orc.orchardsoft.com/questions

51 P.A.C.E. Credit & Feedback Visit the P.A.C.E. table to complete the sign in form, once per day, to receive full credit Be sure to enter your address; a P.A.C.E. certificate will be ed to each user after the symposium Complete the feedback form for the event and for P.A.C.E. feedback

52 Day 2 P.A.C.E. Program Information P.A.C.E. Provider Number: 526 Program Number: Program Title: Day 2 Orchard Symposium 2016 Speakers: Jon Payne, Sheri Boes, Clair Smith, Yuri Dozier, Jacob Eickhoff, David Bracewell, Shaun Mohle, Natalie Dorsch, Greg Lyons, Nancy Stoker, Gwenn Brode, Wendy Forgey, Nathan Sweany, Brad Brimhall, MD, MPH; Thomas Novicki, PhD, DABMM; Matt Pollock, Derick Wilson, Debbie Schilling, John Kramer, Steve Brady, Chris Lamb, Beth Eder, John Miller, Seth Bosworth, Leigh Boje Contact Hours: 5

53 Thank you!