A Deep Dive in the Use of LOINC Codes. C-CDA and LOINC

Transcription

1 A Deep Dive in the Use of LOINC Codes C-CDA and LOINC Rick Geimer Lantana Consulting Group 2018 Summer Forum Tuesday, July 31

2 Disclaimer Conference presentations are intended for educational purposes only and do not replace independent professional judgment. Statements of fact and opinions expressed are those of the participants individually and, unless expressly stated to the contrary, are not the opinion or position of the Workgroup for Electronic Data Interchange, its cosponsors, or its committees. The Workgroup for Electronic Data Interchange does not endorse or approve, and assumes no responsibility for, the content, accuracy or completeness of the information presented.

3 Agenda LOINC in CDA/C-CDA Documents HL7 Attachments Implementation Guide C-CDA/RELMA Discrepancies Questions

4 LOINC in CDA/C-CDA Documents CDA uses LOINC for Document type codes Section codes Various observations (lab results, vital signs, etc.) Document type codes are most relevant for attachments The document type code in CDA specifies the particular kind of document (e.g. History and Physical, Discharge Summary, Progress Note)

5 LOINC in Consolidated CDA (C-CDA) The C-CDA US Realm Header is required for all valid attachments Requires the use of LOINC codes where SCALE = DOC Structured documents Require specific LOINC codes or value sets cited in the C-CDA spec. Found in the Documents with Implementation Guide tab in RELMA. Unstructured Documents Found in the Documents without Implementation Guide tab in RELMA

6 Attachments Implementation Guide (IG) HL7 CDA Attachment Implementation Guide (IG): Exchange of C-CDA Based Documents, Release 1 Standard for Trial Use (STU) Released August 2017 The IG Documents: Approach Background - Structured/unstructured - ISO Object Identifiers (OIDs) - Base64 Encoding - Document Succession Classification using LOINC Business requirements Rules (conformance requirements)

7 HL7 Attachments IG Classification using LOINC Overview of LOINC Use of LOINC in Identifying Documents LOINC Attachment Code Sets Use of LOINC in CDA Documents Requesting an Attachment Submitting an Attachment Navigating LOINC to Identify Valid Attachment Types Updating LOINC and the Attachment Document Type Codes

8 CDA/RELMA Discrepancies Sometimes LOINC codes are deprecated after they are cited in C-CDA Deprecated LOINC codes do not appear in the HIPAA tab in RELMA Better coordination between Regenstrief and HL7 needed to address this issue not shown in RELMA

9 Finding the Right LOINCs for Claims Attachment Requests and Responses Swapna Abhyankar, MD Associate Director for Content Development LOINC and Health Data Standards July 31, 2018

10 OUTLINE Three ways to access LOINC Key concepts Using the RELMA HIPAA Attachments tab Finding valid attachment requests and responses Using RELMA or online search Using LOINC table Search tips, examples

11 THREE WAYS TO ACCESS LOINC 1. Regenstrief LOINC Mapping Assistant (RELMA ) LOINC table in a variety of formats Primary LOINC content is exactly the same no matter which format you use as long as you get the updates twice a year, with each new LOINC release (usually June and December)

12 Tool #1: RELMA REgenstrief LOINC Mapping Assistant (RELMA ) Free Windows-based mapping utility developed by the LOINC software team Use to search the LOINC database and help map local codes to LOINC Have to update twice a year with the LOINC release in order to get new LOINC content Need admin rights to install Available from:

13 Tool #1: RELMA (cont.) Two ways to find attachment request and response codes in RELMA HIPAA Attachment tab Created specifically for LOINC Attachments content Includes all of the LOINC terms and associated information (e.g., C-CDA document and section terms) relevant to Attachments Search screen

14 Tool #2: Free online search tool Great for looking up a few codes at a time Fast, easy to use Content updated twice a year with each LOINC release Requires a free LOINC account

15 Tool #3: LOINC download file LOINC table available in.csv and.mdb formats Updated twice a year Convenient if working offline Available from:

16 LOINC TOOLS SUMMARY Free Can use offline Requires user action to get the latest content twice a year* Automatically includes new content twice a year* Contains all of the information necessary to find valid attachment request/response codes *If you do not download the latest release of RELMA or the LOINC table after each release, the content you see will be different from what you can find online (i.e., Some new codes are missing from RELMA )

17 DEFAULT SETTINGS In both RELMA and the online search, the default setting is to NOT include terms with a status of DEPRECATED If you want to include DEPRECATED codes in your search results, you will have to change you settings If you are getting inconsistent results between the online search, RELMA, and/or the download file, make sure #1, you have the latest release of RELMA and/or the download file #2, the search settings match

18 INCLUDING DEPRECATED CODES IN RELMA SEARCH Go to Hierarchy & Search limits tab Make sure the DEPRECATED box is checked

19 INCLUDING DEPRECATED CODES IN ONLINE SEARCH Go to Options -> Search Constraints Make sure the DEPRECATED box is checked

20 KEY CONCEPTS #1 Documents with implementation guides ( with HL7 IG ) = documents that have a clinically-relevant HL7 CDA implementation guide (IG) that uses the U.S. Realm header Documents without implementation guides ( without HL7 IG ) = documents that don t (yet) have a clinically-relevant HL7 CDA IG that uses the U.S. Realm header Selected by the HL7 Attachments Working Group

21 KEY CONCEPTS #2 Valid HL7 Attachment Request = LOINC terms that payers can use to request claims attachments Two types The "top level" (i.e., most generic) document codes with HL7 IG Document codes without HL7 IGs that have been approved by the HL7 Attachments Working Group Valid HL7 Attachment Responses = LOINC terms that providers may use to send information in response to a payer request Also two types All of the valid request terms above More specific document codes with HL7 IGs

22 Using the RELMA HIPAA Attachments tab

23 CLAIMS ATTACHMENT REQUESTS Includes all LOINC terms that can be used by payers to request claims attachments Divided into those that have HL7 IGs and those that don t

24 CLAIMS ATTACHMENT REQUEST MODIFIERS Modifier codes to send with the attachment request To constrain responses By time By CDA template

25 CLAIMS ATTACHMENT RESPONSES WITHOUT IG Document codes that do not have associated HL7 CDA IGs but are approved as attachment response codes Exactly the same list as the Documents without implementation guide set on the Valid attachment requests tab NOTE: This list contains a small subset of LOINC document codes without associated CDA IGs i.e., not all LOINC document codes are valid attachment responses

26 CLAIMS ATTACHMENT RESPONSES WITH IG: OVERVIEW OF DOCUMENTS WITH IMPLEMENTATION GUIDE TAB #1: Dropdown menu of HL7 CDA implementation guides with the U.S. Realm header #2: Expandable list of document types associated with the IG selected in #1 #3: List of recommended Section and Entry codes associated with the IG (#1) and document type (#2) #1 #2 #3

27 CLAIMS ATTACHMENT RESPONSES WITH IG, STEP 1 Choose the appropriate HL7 IG using the dropdown (C-CDA R2.1 is the default) The list of document types will change depending on the selection

28 CLAIMS ATTACHMENT RESPONSES WITH IG, STEP 2 Click on the + next to the appropriate document type to see all of the LOINC codes for that type of document All of the codes that are shown are valid response codes The top-level code, indicated by a, is a valid attachment request code All of the starred codes together comprise the Documents with implementation guide list on the Valid attachment requests tab

29 CLAIMS ATTACHMENT RESPONSES WITH IG, STEP 3 Use the right pane to see the Section and Entry codes that are contained in the selected IG (#1) and document type (#2)

30 FINDING REQUEST/RESPONSE CODES WITHOUT USING RELMA HIPAA ATTACHMENT TAB If you are not using the HIPAA Attachments tab in RELMA, you can get all of the same information using the RELMA search, online search, or LOINC table Very easy to find valid request and response codes using all of the alternate methods Pretty easy to get specific CDA IG, Section, and Entry information using RELMA search and online search If you want to get specific CDA IG, Section, and Entry information using the LOINC table, please see me Key fields: ValidHL7AttachmentRequest: Use this field to identify valid request terms HL7AttachmentStructure: Use this field to differentiate between terms for which an HL7 IG exists and those for which no HL7 IG exists

31 SEARCHING FOR REQUEST CODES ValidHL7AttachmentRequest:TRUE Combine with HL7AttachmentStructure field to find valid request terms that do or do not have HL7 CDA IGs HL7AttachmentStructure:IGexists HL7AttachmentStructure:NoIGexists

32 SEARCHING FOR RESPONSE CODES HL7AttachmentStructure:IGexists All LOINC codes that are valid response codes and have HL7 CDA IGs HL7AttachmentStructure:NoIGexists All LOINC codes that are valid response codes and do not have HL7 CDA IGs (remember, the list of request and response codes that do not have associated IGs is exactly the same) BONUS: HL7AttachmentStructure:TRUE Identifies all LOINC codes that are valid response codes

33 CDA IG, SECTION, AND ENTRY INFORMATION USING RELMA OR ONLINE SEARCH The details page for each term includes a variety of information, including associated HL7 CDA IGs and Section/Entry codes Open the details page by Double-clicking on the row in the RELMA search screen Clicking on the LOINC code in the online search

34 USING THE LOINC TABLE TO FIND REQUEST AND RESPONSE CODES Use the same two fields as for searching ValidHL7AttachmentRequest HL7AttachmentStructure column header is HL7_Attachment_Structure Filter on the relevant column to find all of the LOINC terms

35 REQUEST CODES: VALIDHL7ATTACHMENTREQUEST = Y

36 RESPONSE CODES WITH IG: HL7_ATTACHMENT_STRUCTURE = IG exists

37 RESPONSE CODES WITHOUT IG: HL7_ATTACHMENT_STRUCTURE = No IG exists

38 SEARCH TIP #1: INCLUDE RELEVANT DETAILS If you need a LOINC term for an Oncology Discharge summary Discharge = 384 terms Discharge summary = 108 terms Oncology discharge summary = 3 terms If you need a term for Influenza RNA in CSF flu = 4537 terms Influenza RNA = 101 terms Influenza RNA CSF = 2 terms

39 SEARCH TIP #2: USE THE - OPERATOR If you are not sure about the exact concept, it s okay to start broad and then narrow down based on what you want to exclude Example #1 need a code related to Cardiology Cardiology = 1155 terms Cardiology -Scale:Qn = 239 terms Cardiology -Scale:Qn -Outpatient = 233 terms Cardiology -Scale:Qn -Outpatient Pediatric = 10 terms Example #2 need a code related to Speech Speech = 182 terms Speech Scale:Doc = 30 terms Speech Scale:Doc -Counseling -Discharge Hospital = 24 terms

40 SEARCH TIP #3: USE ANCILLARY SEARCH FIELDS Every LOINC terms has lots of attributes outside of the primary Parts A few that I find useful are: Class VersionLastChanged Chngtype And of course HL7AttachmentStructure and ValidHL7AttachmentRequest Example #1 new Microbiology codes added in last release Class:micro versionlastchanged:2.64 chngtype:add If you leave off Class, this query will find all new terms in the Microbiology class as well as with Microscopy as the Method and Micro in the Component Example #2 attachment response codes DEPRECATED in last release HL7attachmentstructure:TRUE versionlastchanged:2.64 chngtype:del = 31 terms

41 Any questions? 41